How Does Celiac Disease Affect Fertility and Pregnancy?

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Celiac disease is often misunderstood, poorly treated, and rarely tested for in a general population. In fact, about 1 in 100 people have celiac disease, but 2.5 million Americans are undiagnosed, according to the Celiac Disease Foundation. One aspect of your health celiac disease can negatively impact is your reproductive life. Read on to learn how —and what you can do about it.


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Changes to your menstrual cycle might be related to celiac disease

Women with celiac disease can have a host of issues related to their fertility. This can include not having periods (amenorrhea), having strange periods, and other unexplained issues. Many women aren’t diagnosed as having celiac disease until they reach midlife, well after the most common baby-making years, meaning that undiagnosed celiac disease could have led to fertility problems without women realizing the cause.


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Does your first period come later if you have celiac disease?

This is a highly debated topic. Some studies show that regardless of celiac disease diagnosis status, the age a mother started her period is the biggest predictor of when her daughter will get her first period. Other studies show that it’s not the diagnosis, but whether a person is being treated with a gluten-free diet that helps ensure the start of menstrual cycles isn’t delayed.


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Unexplained infertility might be related to celiac disease

Some women who are diagnosed with infertility aren’t given a specific cause for that infertility. Research says a good portion of these unexplained cases may be related to celiac disease. In a 2016 meta-analysis published in the Journal of Clinical Gastroenterology, researchers found women who were diagnosed with infertility were 3.5 times more likely to have celiac disease, and that number was six times greater if the infertility was determined to be “unexplained” infertility.


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People with celiac disease have a shorter fertile window

In addition to potential fertility problems, you may have a shorter period of fertility during your lifetime if you’re a woman with celiac disease. This means you may have fewer fertile cycles in your life, potentially due to a later age at the start of your first period or due to earlier menopause. It can also be the result of undiagnosed celiac disease.


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Women with celiac may have pregnancy complications

A large 2012 meta-analysis in the American Journal of Obstetrics and Gynecology showed that complications within pregnancy were increased in people with both treated and untreated celiac disease. Pregnancy complications included low-birth weight, preterm labor, and small-for-gestational-age babies. Birth defects also may be increased when parents with celiac are untreated. The good news is that keeping a strict gluten-free diet and other changes can drastically improve the pregnancy outcomes.


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Why does celiac disease potentially harm a pregnancy?

There’s not yet a clear answer as to how or why celiac disease increases risks in pregnancy. However, data does show that gluten damages the placenta, perhaps in multiple ways, when a pregnant woman has celiac disease. Some say this only happens when the celiac is untreated; others are not so sure. Testing for celiac in early pregnancy and offering a gluten-free diet to anti-tTG antibody-positive women may be the best option.


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Should you act like you have celiac if you have a problem pregnancy?

Just as a gluten-free diet may be suggested for people with a history of unexplained infertility, it may be helpful in reducing pregnancy complications as well. In the absence of another diagnosis, if you are struggling with fertility issues, miscarriages, stillbirth, or other problems, ask your doctor if you should consider a gluten-free diet, and whether it may be beneficial even without the diagnosis of celiac disease.


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Diagnosis is the key

A 2018 study found that once you have a diagnosis, the risks that can be associated with undiagnosed celiac disease in terms of pregnancy rates, miscarriage, stillbirth, or other pregnancy complications return to the baseline level. This means that getting a celiac diagnosis and receiving treatment are the keys to getting on the pathway to a healthy pregnancy. Beyond pregnancy, getting a diagnosis is also helpful in reducing issues later in life like problems with bone density.


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Test first, ask questions later?

Because many people with celiac disease remain undiagnosed, it’s something to consider if there is a history of issues with your reproductive life, including pregnancy loss, issues with fertility, and possibly even a delayed start to a normal period. When in doubt, ask for the test!


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The bottom line on celiac and fertility

It’s also important to keep in mind that there’s much room for improvement in the medical literature on celiac disease and reproductive health. Many of the studies that have been done are small. There is also some argument over what the best research is, meaning we are still operating in a gray area at times. Nonetheless, it’s important to consider testing for celiac if you experience any of these reproductive issues — especially if you’ve also been having digestive symptoms of celiac disease.