The influence of Celiac disease on fertility and pregnancy: an Italian survey

Abstract

Abstract Background Celiac disease (CD) is a permanent inflammatory enteropathy that has been associated to obstetric and gynecological disorders, like reduction of fertile period, increased risk of miscarriage and infertility, increased risk of gestational anemia, premature labor and delivery, low birth weight, small for gestational age and intrauterine fetal growth retardation. Despite the impact of celiac disease on women’s reproduction, this condition is still not adequately tested by gynecologists, mainly because it is, often, wrongly considered as an exclusively gastrointestinal disease. Limited knowledge and underestimation of the disease require the development of targeted awareness-raising interventions. Our study aimed to evaluate the association between celiac disease and obstetric and gynecological complications; to highlight the importance of informing patients about the manifestations of CD; assess the patient satisfaction with the information provided by healthcare professionals on the reproductive implications of CD.Methods administration of a digital survey to celiac women. The link to access the questionnaire has been uploaded on the website of the Italian Celiac Association.Results we analyzed 493 questionaries. The obstetric and gynecological disorders led to the diagnosis of CD in 58 out of 493 interviewees (11.7%). From the analysis of questionaries, it emerged that patients suffering from untreated CD are more predisposed to: miscarriages (in our survey, 41.8% vs 34% respectively before and after CD diagnosis, p = 0.1122), anemia in pregnancy (71.4% vs 41.7% respectively before and after CD diagnosis, p = 0000) and the risk of giving birth to a newborn with low birth weight (newborns weighing < 1500 grams were 4.0% before and 1.1% after the establishment of gluten-free dietary treatment, p = 0.028). Women with CD, both before and after gluten-free diet, were more infertile (about 19%) than the general population. The majority of patients interviewed (73%) were dissatisfied with the level of information they received from health professionals about the reproductive implications of CD.Conclusion Our research contributes to a deeper understanding of the intersection between CD and reproductive outcomes, highlighting the main obstetric and gynecological problems related to it, and also emphasizing the importance of patient's perspective and the need of more awareness about Celiac disease from healthcare workers.