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"Women having unexplained infertility, recurrent abortions, stillbirths or intrauterine growth retardation could have subclinical celiac disease, which can be detected by serological screening tests," Dr. Ashok Kumar told Reuters Health by email.
Improved diagnostic tools, and greater access to screening have led to greater meant more latent or subclinical celiac disease, says Dr. Kumar, of Maulana Azad Medical College & Lok Nayak Hospital in New Delhi.
Doctors know that women with full, biopsy-proven, untreated celiac disease have more reproductive problems if they don't follow a gluten-free diet.
Until now, there have been "very few studies regarding the effect of latent celiac disease on reproductive performance; the association has never before been investigated in India," say the authors.
To study the effect of latent celiac disease on reproductive performance, the researchers examined 893 women.
They found that a total of 104 women had undergone idiopathic recurrent abortion, 104 had unexplained stillbirth, 230 had unexplained infertility, and 150 were pregnant, but showed idiopathic intrauterine growth restriction. The remaining 305 women, with normal obstetric histories, and served as control subjects.
Based on IgA tTG antibody titers, latent celiac disease was 5.43 times more common in the group with recurrent spontaneous abortion than in the control group.
Rates of latent celiac disease for the group with stillbirth were 4.61 times greater than the control group.
Rates for the group with intrauterine growth restriction were 7.75 times greater than control subjects, while rates for those with unexplained infertility were 4.51 higher.
The researchers also found that women with positive blood screens showed higher rates of previous early births, low-weight births, and cesarean sections than did seronegative subjects.
Not every study shows a clear reduction in fertility, the researchers admit, but a number do show a higher risk of adverse pregnancy outcomes for women with latent celiac disease.
Spotting the celiac disease and treating it with a gluten free diet may reduce these associated risks.
Moreover, the researchers note that "the classic presentation of diarrhea and malabsorption is now less common, and atypical and silent presentations are increasing."
As a result of their findings, Dr. Kumar and his colleagues are recommending celiac disease blood screens for women with idiopathic cases of poor reproductive performance.