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Celiac.com 12/03/2014 - It is important for pregnant women seeking medical consultation to get good, evidence-based information. This is especially true for pregnant women with celiac disease, who might wonder whether they face an increased risk of adverse birth outcomes and pregnancy complications as a result of their disease. So, does celiac disease increase a woman’s risk for pregnancy complications and adverse birth outcomes? Until now, there hasn’t been much good, solid data to give women a clear answer. With that in mind, a research team in England recently conducted a population-based study on pregnancy outcomes and adverse birth conditions in women with celiac disease. The research team included Alyshah Abdul Sultan PhD, Laila J Tata PhD, Kate M. Fleming PhD, Colin J. Crooks PhD, Jonas F. Ludvigsson PhD, Nafeesa N. Dhalwani PhD, Lu Ban PhD, and Joe West PhD. They are variously affiliated with the Division of Epidemiology and Public Health, City Hospital Campus at the University of Nottingham, Nottingham, UK; the Department of Medical Epidemiology and Biostatistics at the Karolinska Institute in Stockholm, Sweden; and with the Department of Paediatrics at Örebro University Hospital in Örebro, Sweden. The team used linked primary care data from the Clinical Practice Research Datalink and secondary care Hospital Episode Statistics data to assess all singleton pregnancies between 1997 and 2012. They used logistic/multinomial regression to compare pregnancies of women with and without celiac disease for risks of pregnancy complications (antepartum and postpartum hemorrhage, pre-eclampsia, and mode of delivery), and for adverse birth outcomes (preterm birth, stillbirth, and low birth weight). They stratified risk levels based on whether women were diagnosed or undiagnosed before delivery. They found 363,930 pregnancies resulting in a live birth or stillbirth, 892 (0.25%) of which were among women with celiac disease. Women with diagnosed celiac disease showed no increased risk of pregnancy complications or adverse birth outcomes compared with women without celiac disease. However, pregnant women with diagnosed celiac disease did show a higher risk of postpartum hemorrhage and assisted delivery, with an adjusted odds ratio (aOR) of 1.34. Importantly, the team found no increased risk of any pregnancy complication among those with undiagnosed celiac disease. In all, they found just a 1% absolute excess risk of preterm birth and low birth weight among mothers with undiagnosed celiac disease, which corresponds to aOR=1.24 (95% confidence interval (CI)=0.82–1.87) and aOR=1.36 (95% CI=0.83–2.24), respectively. Overall, the results of this study offer some good news to pregnant women with celiac disease. Whether diagnosed or undiagnosed during pregnancy, celiac disease is not associated with a significantly higher risk of pregnancy complications and adverse birth outcomes. Source: Am J Gastroenterol. 2014;109:1653-1661.
Jefferson Adams posted an article in Fertility, Pregnancy, Miscarriage and Celiac DiseaseCeliac.com 04/27/2015 - We know that women with infertility have higher rates of celiac disease than women who are not infertile. There's been some evidence to suggest that celiac disease might have impact women's reproductive health. However, the quest for more solid answers continues. A team of researchers recently set out to assess fertility and outcomes of pregnancy among women with celiac disease. The research team included Stephanie M. Moleski, Christina C. Lindenmeyer, J. Jon Veloski, Robin S. Miller, Cynthia L. Miller, David Kastenberg, and Anthony J. DiMarino. The team crafted a retrospective cohort study in which they analyzed information gathered from patients at a tertiary care celiac center, along with information gathered from members of two national celiac disease awareness organizations. A group of women without celiac disease served as control subjects. Both groups answered an anonymous online survey of 43 questions about menstrual history, fertility, and pregnancy outcomes. The group included 329 women with small bowel biopsy-confirmed celiac disease and 641 control subjects. Of the 970 women included in the study, 733 (75.6%) reported that they had been pregnant at some point. In terms of pregnancy, there was no significant difference between women with celiac disease (n=245/329, 74.5%) and controls (488/641, 76.1%; P=0.57). However, fewer women with celiac disease than controls (79.6% vs. 84.8%) reported giving birth following 1 or more pregnancies (P=0.03). Women with celiac disease had higher rates of spontaneous abortion than did control subjects (50.6% vs. 40.6%; P=0.01). Women with celiac disease also had higher rates of premature delivery, at 23.6% compared to 15.9% among controls (P=0.02). The average age at menarche was a bit higher in the celiac disease group, at 12.7 years, than in the control group, which came in at 12.4 years (P=0.01). This retrospective cohort analysis examining reproductive features of women with celiac disease, found that celiac disease was associated with significant increases in spontaneous abortion, premature delivery, and later age of menarche. Source: Ann Gastroenterol 2015; 28 (2): 236-240
Jefferson Adams posted an article in Additional Celiac Disease ConcernsCeliac.com 11/09/2010 - Each year in the United States, millions of people undergo gastrointestinal (GI) endoscopic procedures. Generally, the procedures have been regarded as safe, with a physician-reported complication rate for endoscopies of just 7%. However, most systems, including the gastroenterology department at Beth Israel, maintain a voluntary, paper-based physician reporting system wherein each gastroenterologist submits a monthly log describing any known complications. To get a better idea of actual numbers based on Emergency Room (ER) visits within two weeks of an endoscopy, Daniel A. Leffler, MD, of Beth Israel Deaconess Medical Center in Boston, set out with a research team to conduct a more in-depth review. Their review of electronic medical records (EMR) showed that complications after endoscopy may be more common than previously thought. Dr. Leffler and his colleagues reviewed over 400 emergency department (ED) visits logged in one hospital's EMR system within two weeks of an endoscopic procedure. They found that nearly one-third of those visits were related to the previous endoscopy. Overall, they looked at records for follow-up visits for 6,383 esophagogastroduodenoscopies and 11,632 colonoscopies. The medical center's electronic reporting system showed 419 ED visits within two weeks of these procedures. The review team determined 32%, or 134 of these visits, to be directly related to the endoscopic procedure. Yet only about 7% of these were reported using the standard physician reporting system, the researchers said (P<0.001). The team also found that 29% of 266 subsequent hospitalizations were directly related to the patients' endoscopic procedure. Most of the ER visits were a result of abdominal pain (47%), gastrointestinal tract bleeding (12%), or chest pain (11%). By looking at actual electronic admission data, rather than relying on the more cumbersome physician reporting data, the research team found "a 1% incidence of related hospital visits within 14 days of outpatient endoscopy, 2- to 3-fold higher than recent estimates." This is important not just from a patient wellness perspective, but from a financial one. According to Medicare standardized rates, the average costs of endoscopic-related complications is $1403 per ED visit, and $10123 per hospitalization. Over the full screening and surveillance program, such complications added an extra $48 to each exam. The team's own words reinforce their conclusions: "Although the overall rate of severe complications, including perforation, myocardial infarction, and death remained low, the true range of adverse events is much greater than typically appreciated." Moreover, "standard physician reporting greatly underestimated the burden of medical care related to endoscopic procedures and unexpected hospital utilization," Leffler and colleagues wrote. With so many cases of celiac disease relying on biopsy via endoscopy, these numbers might be especially interesting to people with celiac disease, in addition to anyone else facing endoscopy in the future. Source: Arch Intern Med 2010; 170(19): 1752-1757