Celiac.com 12/27/2023 - Researchers Aljoharah Al Saud and Ziad F. Rayes deliver a case study report on the uncommon but impactful coexistence of celiac disease and antiphospholipid syndrome, two conditions with links to infertility. Respectively, they are associated with the Family Medicine and Polyclinics, Alfaisal University College of Medicine, and Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Centre, in Riyadh, SAU.

The journey began for a 23-year-old woman with seemingly unrelated symptoms—urticaria and vitamin D deficiency. Initially diagnosed with idiopathic urticaria, her health story unfolded over 13 years. Recurrent miscarriages became a recurring theme, casting shadows on her dream of motherhood. The puzzle pieces started to fit together when antiphospholipid syndrome was identified after multiple pregnancy losses.

Symptoms of Osteoporosis

The patient's persistence paid off as she successfully underwent in vitro fertilization, leading to a diamniotic dichorionic pregnancy. However, post-delivery brought an unexpected twist—severe back pain unveiling acute wedge fractures, a sign of osteoporosis.

Diving deeper into investigations, elevated antigliadin and anti-tissue transglutaminase antibodies emerged, revealing the presence of celiac disease. A gluten-free diet became the transformative key, bringing not only relief from symptoms but also notable improvements in bone mass density.

This case serves as a poignant reminder of the intricate links between seemingly unrelated health issues. The intersection of celiac disease and antiphospholipid syndrome highlights the importance of thorough investigations in cases of unexplained infertility and unexpected osteoporosis.

Beyond its diagnostic implications, this case underscores the critical need for early identification of celiac disease. Swift action can mitigate its potentially detrimental effects on fertility and bone health. As healthcare continues to unveil the complex interplay of various conditions, stories like these emphasize the significance of holistic and timely approaches to diagnosis and treatment, ensuring a healthier and more informed future for individuals navigating the intricate landscape of their well-being.

Read more in cureus.com

Celiac.com 10/18/2018 - A team of researchers recently set out to investigate the prevalence of human leukocyte antigens (HLA) DQ2 and DQ8 haplotypes, two common polymorphisms associate with celiac disease, in women who have had previous stillbirth, but who do not have celiac disease.

The research team included Mauro Cozzolino, Caterina Serena, Antonino Salvatore Calabró, Elena Savi Marianna, Pina Rambaldi, Serena Simeone, and Serena Ottanelli, Giorgio Mello, Giovanni Rombolá, Gianmarco Troiano, Nicola Nante, Silvia Vannuccini, Federico Mecacci, and Felice Petraglia. They are variously affiliated with the Division of Obstetrics and Gynecology, and the Department of Experimental and Clinical Biomedical Sciences, Gastroenterology Unit, at Careggi University Hospital, University of Florence in Florence, Italy.

For their study, the team enrolled 56 women with history of unexplained term stillbirth referred to our Center for High‐Risk Pregnancies for a preconception counseling. As a control group, they enrolled 379 women with previous uncomplicated pregnancies. They excluded women with celiac women from the study. 

The team then conducted genetic tests for HLA DQ2/DQ8 on both groups, and compared patients data against controls. They found that 50% of women with history of unexplained term stillbirth tested positive for HLA‐DQ2 or DQ8, compared with just 29.5% for controls. Women with HLA DQ8 genotype showed a substantially higher risk of stillbirth (OR: 2.84 CI: 1.1840‐6.817).

For patients with the DQ2 genotype, the OR for stillbirth was even higher, at 4.46 with a CI of 2.408‐8.270. In the stillbirth group, the team found that SGA neonates in 85.7% those with HLA‐DQ2/DQ8 haplotypes, and in just 42.8% with negative genetic testing.

The team found significantly higher rates of HLA DQ2/DQ8 haplotypes in women with history of unexplained term stillbirth than in women with previous uneventful pregnancies.  Moreover, they found that HLA DQ2/DQ8 positivity was significantly associated with suboptimal fetal growth in intrauterine fetal death cases, as shown by an increased prevalence of SGA babies.

This study will definitely be of interest to women with HLA DQ2/DQ8 haplotypes, and to those who have experienced unexplained stillbirths. Stay tuned for more information on this important topic as news becomes available.

Read more at: American Journal of Reproductive Immunology

Celiac.com 11/05/2012 - Over the last 40 years, studies have shown higher rates of menstrual abnormalities and pregnancy complications among women with celiac disease.

However, the data from these studies have been inconsistent, and inconclusive regarding the actual effects of celiac disease on female fertility. To get a better picture of the relationship between celiac disease and female fertility and pregnancy, researchers recently conducted a more comprehensive study.

The research team was led by Stephanie M. Moleski, MD, of Thomas Jefferson University Hospitals in Philadelphia. Dr. Moleski presented an abstract of the study data at the American College of Gastroenterology Annual Meeting 2012.

In the abstract, she points out that women with biopsy-proven celiac disease had significantly higher rates of fertility and pregnancy complications and gave birth to less children than those without the disease.

Because it is an abstract, the study data and conclusions should be regarded as preliminary until they appear in a peer-reviewed journal, where they can be given a fuller context and be more widely scrutinized.

For their study, Dr. Moleski and her colleagues recruited patients treated for celiac disease at Thomas Jefferson University Hospitals, as well as members of the National Foundation for Celiac Awareness and the Gluten Intolerance Group, to respond in an anonymous Internet-based survey about fertility and pregnancy. Women without celiac disease also completed the survey and served as a control group.

The survey included questions about celiac diagnosis and history, menstrual history, fertility, spontaneous abortions, and pregnancy outcomes.

Approximately 1,000 women who completed the survey. Of those, 473 had physician-diagnosed celiac disease, while 298 women had the been confirmed for celiac via small-bowel biopsy. The researchers used the group with biopsy-proven disease to compare against 560 women without celiac disease.

The data showed that 41.2% of women with celiac disease had increased difficulty conceiving compared with 36.5% of control subjects (P=0.03). Women with celiac disease also had more consultations with fertility specialists and higher rates of spontaneous abortion, preterm delivery, and cesarean section, compared with control subjects.

Additionally, women with celiac disease were shown to have a shorter duration of fertility, to have a later onset of menarche and be younger when they experienced menopause, said Dr. Moleski.

The data also revealed important differences between women with and without celiac disease. In all, 22.4% of women with celiac disease had consulted with fertility specialists, compared with 19% of those without (P=0.04). Also, 43.3% of celiacs had a history of spontaneous abortion, compared with 36.6% of non-celiacs (P=0.02).

Compared with the control group of non-celiacs, women with celiac disease also had higher rates of cesarean delivery, 26.4% versus 23.8% of non-celiac women.

Lastly, rates of preterm delivery were 23.2% for celiac women, and 14% for those without celiac disease (P=0.007), while the group with celiac disease was was also slightly older at the onset of their first period (12.7 versus 12.4 years, P=0.01).

Among women reporting a history of spontaneous abortion, more than 80% of miscarriages occurred prior to diagnosis of celiac disease, said Dr. Moleski.

She concluded that the retrospective analysis done by her team shows a clear relationship between celiac disease, fertility, and pregnancy outcomes, and suggests that the results demonstrate "a need for increased awareness of this association among patients and physicians."

Sources:

• Medpagetoday.com
• American College of Gastroenterology, 2012; Moleski SM, et al "Infertility and pregnancy outcomes in celiac disease" ACG 2012; Abstract 15.

Celiac.com 12/20/2011 - There has been some controversy surrounding the idea that there is a higher prevalence of undiagnosed celiac disease in people with infertility, with some studies finding it but others not. Most of these studies have been performed in Europe; only two to date have taken place in the United States. Peter Green’s group at Columbia recently tried to establish the actual prevalence of undiagnosed celiac disease in the infertile population in the United States, to determine if it would make sense to routinely screen a subgroup of infertile patients for celiac disease. Their results are published in The Journal of Reproductive Medicine.

Study participants were recruited from the population who came to Columbia’s Center for Women’s Reproductive Care to deal with their infertility issues, which they had been coping with for at least a year. One hundred eight-eight women, ages 25-39, volunteered to participate in the study. They underwent serological screening for tissue transglutaminase (tTG IgA) and endomysial antibodies (EMA IgA), and measurement of total IgA and both IgA and IgG antigliadin antibodies was done to control for the potential IgA deficiency in some individuals. Four of the 188 patients enrolled in the study were diagnosed with celiac disease, making the prevalence of celiac disease in this population 2.1%. Yet a subgroup analysis of the prevalence of celiac disease in women with unexplained fertility revealed a prevalence of 5.9%, which achieves statistical significance.

All four women reported suffering from gastrointestinal symptoms before their diagnosis, and they had a significantly increased prevalence of Irritable Bowel Syndrome as well. The authors admit that this is quite a small sample, and because screening was voluntary, it is also a selected population.

But even so, they suggest that physicians should inquire about GI symptoms when patients present with infertility, and that screening for celiac is appropriate in those with unexplained infertility who complain of gastrointestinal distress. They even go so far as to posit that all women with unexplained infertility be screened for celiac, even if they don’t have gastrointestinal trouble.

All four women conceived within ten months after starting on a gluten free diet, two naturally and two with help. And all of them went on to deliver healthy babies.

Source:

• Open Original Shared Link

Celiac.com 12/08/2011 - Researchers have shown that celiac disease and Toxoplasma gondii infection can both cause a strong neutrophil-mediated immune reaction that can have an adverse impact pregnancy outcomes.

In most cases, people with otherwise healthy immune systems who develop toxoplasmosis remain asymptomatic, but Toxoplasma gondii can trigger both chronic infection and abortion in adults, as well as fatal illness in patients with immune deficiencies.

In addition, interleukin-8 (IL8) is known to selectively stimulate the ability of tissue that has been injured or inflamed by neutrophil and T lymphocytes.

To determine a possible connection between celiac disease and Toxoplasma
gondii, the research team recruited 827 pregnant women.

On average, the team took samples 5.5 months into pregnancy, and used enzyme-linked immunosorbent assay to determine Toxoplasma-specific immunoglobulin (Ig) G and IgM (Trinity-Biotech Toxo IgG & IgM, NY).

To assess IL8 levels, they used human IL8/ NAP-1 enzyme-linked immunosorbent assay, Bender MedSystems, Vienna, Austria, in accordance with manufacturer's instructions as well as IgA anti-tissue transglutaminase antibodies for celiac disease as described previously.

After childbirth, those patients satisfied for follow-up who tested positive for anti-tissue transglutaminase submitted to biopsy specimens. The team evaluated biopsies using Marsh-Rostami classification.

In all,  27 subjects (3.3 % confidence interval: 1.2 – 4.3) tested positive for anti-tissue transglutaminase. Those patients averaged 27 years of age, and 4.8 months mean pregnancy. Eight of the 27 celiac disease-serology positive subjects submitted to endoscopy. Six of them showed abnormal histology, including two Marsh I, three Marsh IIIa, and one Marsh IIIc.

Overall, one hundred and fifty-four women (31% ) and 58 (7% ) pregnant women showed positive results for total IgG and IgM for Toxoplasma gondii serology, respectively.

Notably, 16 out of 27 (59%) celiac disease-serology positive subjects were infected by T. gondii compared with 257 out of 800 (32%) non-celiac disease pregnant women (odd ratio = 3.07, 95% confidence interval: 1.4 – 6.7)

This finding highlights an important relationship between incidences of celiac disease-serology and Toxoplasma gondii ( P = 0.04).

Three patients with Marsh I, IIIa, and IIIc also positive IgG showed Toxoplasma gondii infections.

Regardless of their celiac disease status, patients infected with toxoplasma gondii showed elevated levels of IL8, especially IgM positive patients.

Results showed that positive celiac disease or Toxoplasma gondii blood screens were connected to poor pregnancy outcomes.

In all, 9 of 27, or 33.4%, of test subjects with positive celiac disease-serology showed poor medical histories, while more than half of had either previously miscarried (4/9) or produced low birth weight babies (3/9).

Thus, the researchers point out that positive celiac disease-serology correlated with greater risk of low birth weights and miscarriages regardless of T. gondii status.

The results of this study show patients with positive celiac disease-serology had higher overall rates of Toxoplasma gondii infection rates than did those with negative celiac disease serology, but celiac disease did not trigger increase in proinflammatory cytokines, such as IL8.

This suggests that celiac disease may increase the risk of Toxoplasma gondii infection.

From these observations, the research team proposes that celiac disease predisposes individuals to Toxoplasma gondii infection and may promote distribution of the ingested Toxoplasma gondii oocysts beyond small bowel lesions and might increase sensitivity to gluten in some way.

On the other hand, the presence of Toxoplasma gondii may promote the celiac disease in susceptible individuals. This is in keeping with prior studies that suggest that other enteric infections may promote celiac disease among susceptible individuals.

Source:

• Open Original Shared Link
  

Celiac.com 07/11/2011 - Is celiac disease associated with infertility? Although some reports suggest that as much of 8% of women with unexplained infertility have celiac disease, others found no correlation between the two conditions. And there is little hard evidence that celiac disease is an actual cause of infertility. To begin to bring some clarity to this issue, Khoshbaten et al. tried to determine the prevalence of celiac disease among couples with unexplained infertility in Iran. Their results are reported in the Journal of Obstetrics and Gynaecology Research.

Infertile couples were recruited in Tabriz, Iran, between October 2006 and September 2007. After a complete evaluation of their endocrine status, one hundred couples with unexplained infertility were chosen for this study. Two hundred couples with at least one child and no reproductive problems served as controls. Thirteen infertile subjects - 5 men and 8 women - had elevated levels of tissue transglutaminase antibodies, compared to eleven controls - 4 men and 7 women. Fourteen infertile subjects and eleven controls were found to be IgA deficient; of these, three of each had elevated tissue transglutaminase IgG. Based on this serology, the researchers note that the likelihood of celiac disease in infertile patients is 2.39 times higher than in controls; the frequency of celiac disease is 8% in infertile patients, compared to 3.5% in controls.

Only five infertile subjects and four controls with elevated tissue transglutaminase antibodies agreed to have duodenal mucosal biopsies; the remainder had no gastrointestinal complaints or other symptoms, so they opted out of the endoscopy. According to the biopsy, celiac disease was indicated in three cases of unexplained infertility compared to one case in the control group.

Previous studies have demonstrated that men with celiac disease have an increased incidence of hypogonadism, sexual dysfunction, and poor semen quality. Women with celiac disease can have major menstrual problems. Systemic diseases like celiac can exert subtle effects on the reproductive system in both genders. A gluten free diet can alleviate infertility if it is caused by nutritional imbalances due to celiac disease, such as malabsorption of zinc, selenium, iron, and folate.

This Iranian study, like previous studies in Finland, Italy, Israel, and the US, thus seems to come down on the side of celiac disease, as measured by serological markers, being more significantly frequent among couples with unexplained infertility than in controls.

Source:

• Open Original Shared Link

Hyperprolactinaemia is seen in 25% of celiac patients, which causes impotence and loss of libido. This quote was taken from an abstract at the following cite: Dig Dis, 12(3):186-190 1994, May-Jun. The title of the article is Infertility, Obstetric and Gynaecological Problems in Celiac Sprue. Here are some more references:

• Molteni N, Bardella MT, Bianchi PA. Obstetric and gynecological problems in women with untreated celiac sprue. J Clin Gastroenterol 1990; 12: 37-9.
• Sher KS, Mayberry JF. Female fertility, obstetric and gynaecological history in celiac disease. A case control study. Digestion 1994; 55: 243-6.
• Sher KS, Jayanthi V, Probert CS, Stewart CR, Mayberry JF. Infertility, obstetric and gynaecological problems in celiac sprue. Dig Dis 1994; 12:186-90.
• McCann JP, Nicholls DP, Verzin JA. Adult celiac disease presenting with infertility. Ulster Med J 1988; 57: 88-9.
• Ferguson R, Holmes GKT, Cooke WT. Celiac disease, fertility and pregnancy. Scand J Gastroenterol 1982; 17: 65-8.
• The good news is that the overwhelming opinion was that adherence to a strict gluten free diet should and would restore fertility if the infertility was a result of celiac disease.