A risk factor for female fertility and pregnancy: Celiac disease

Laboratory of Comparative Toxicology and Ecotoxicology, Istituto Superiore di Sanità, Rome, Italy.
Gynecological Endocrinology (Impact Factor: 1.14). 01/2001; 14(6):454-63. DOI: 10.3109/09513590009167719
Source: PubMed

ABSTRACT Celiac disease is a genetically-based intolerance to gluten. In the past, celiac disease has been considered a rare disease of infancy characterized by chronic diarrhea and delayed growth. Besides the overt enteropathy, there are many other forms which appear later in life; target organs are not limited to the gut, but include liver, thyroid, skin and reproductive tract. It is now recognized that celiac disease is a relatively frequent disorder; the overall prevalence is at least 1:300 in Western Europe. Celiac disease may impair the reproductive life of affected women, eliciting delayed puberty, infertility, amenorrhea and precocious menopause. Clinical and epidemiological studies show that female patients with celiac disease are at higher risk of spontaneous abortions, low birth weight of the newborn and reduced duration of lactation. No adequate studies are available on the rate of birth defects in the progeny of affected women; however, celiac disease induces malabsorption and deficiency of factors essential for organogenesis, e.g. iron, folic acid and vitamin K. The overall evidence suggests that celiac disease patients can be a group particularly susceptible to reproductive toxicants; however, the pathogenesis of celiac disease-related reproductive disorders still awaits clarification. At present, like the other pathologies associated with celiac disease, the possible prevention or treatment of reproductive effects can only be achieved through a life-long maintenance of a gluten-free diet.

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    • "People suffering from coeliac disease react with inflammation of the small intestine, leading to malabsorption of several important nutrients including iron, folate, calcium and fat soluble vitamins (Feighery, 1999; Murray, 1999). Clinical and epidemiological studies have showed coeliac disease to be a risk factor for cancer (Silano et al., 2007), osteoporosis (Sategna-Guidetti et al., 2000), thyroid disease (Sategna-Guidetti et al., 1998), female infertility (Stazi & Mantovani, 2000), neurological and psychiatric disorders (Ludvigsson, Osby, Ekbom, & Montgomery, 2007; Tengah, Wills, & Holmes, 2002). Therefore a strict gluten-free diet – without cereals containing gluten proteins (wheat, barley, rye, triticale, dinkel and kamut) is essential (Gallagher, Gormley, & Arendt, 2004). "
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    ABSTRACT: Folate content in some gluten-free cereal products and their main ingredients was determined using a validated method based on reversed-phase high performance liquid chromatography (HPLC) with fluorescence and diode array detection. The main folate forms found in gluten-free products were 5-methyl-tetrahydrofolate and tetrahydrofolate. Starches and low protein flours commonly used as main components in gluten-free products appeared to be poor folate sources with folate content ⩽6 μg/100 g fresh weight. Folate content in gluten-free breads was higher (15.1–35.9 μg folate/100 g fresh weight) due to use of bakery yeast which is a rich folate source. Overall, folate content in gluten-free products was lower than in their gluten-containing counterparts. Therefore, fortification of gluten-free products with folic acid or enrichment of these products with nutrient-dense fractions of cereals naturally free from gluten (such as buckwheat, quinoa, amaranth or millet) can be of interest.
    Food Chemistry 11/2008; 111(1-111):236-242. DOI:10.1016/j.foodchem.2008.03.055 · 3.26 Impact Factor
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    • "Untreated CD is associated with an increased risk of developing other diseases, such as osteoporosis (Meyer et al., 2001; Corazza et al., 2005), reproductive problems in both women and men (Nørgård et al., 1999; Gasbarrini et al., 2000; Stazi & Mantovani, 2000; Ludvigsson & Ludvigsson, 2001), neurological illness (Collin et al., 1991; Hadjivassiliou et al., 1996), cancer (Holmes et al., 1989; Green et al., 2001; Smedby et al., 2005) and possibly the development of other autoimmune diseases (Ventura et al., 1999; Hakanen et al., 2001; Sategna Guidetti et al., 2001). Early diagnosis and treatment usually result in mucosal recovery and a reduced risk of developing associated conditions (Holmes et al., 1989; Nørgård et al., 1999; Martinelli et al., 2000; Corazza et al., 2005). "
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    ABSTRACT: OBJECTIVE We sought to evaluate the impact of the gluten-free diet on the 5,240 members of the Canadian Celiac Association (CCA). Data are presented on 2,681 adults (>or=16 years) with biopsy-proven celiac disease (CD). A mail-out survey was used. Quality of life was evaluated using the 'SF12', and celiac-specific questions. Mean age was 56 years, mean age at diagnosis was 45 years, and 75% were female. The 'SF12' summary scores were similar to normative Canadian data, but were significantly lower for females and newly diagnosed patients. Respondents reported: following a gluten-free (GF) diet (90%), improvement on the diet (83%), and difficulties following the diet (44%), which included: determining if foods were GF (85%), finding GF foods in stores (83%), avoiding restaurants (79%), and avoiding travel (38%). Most common reactions to consumed gluten (among 73%) included pain, diarrhea, bloating, fatigue, nausea, and headache. Excellent information on CD and its treatment was provided by the CCA (64%), gastroenterologists (28%), dietitians (26%) and family doctor (12%). Quality of life in those with CD could be increased with early diagnosis, increased availability of gluten-free foods, improved food labelling, and better dietary instruction. Education of physicians and dietitians about CD and its treatment is essential.
    Journal of Human Nutrition and Dietetics 02/2006; 19(1):41-9. DOI:10.1111/j.1365-277X.2006.00659.x · 2.07 Impact Factor
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    • "Indeed, affected women have poor reproductive health with a high risk of early miscarriage, which can be partially prevented or treated by the continuous maintenance of a gluten-free diet. However, no adequate data exist concerning birth defects in their offspring (Stazi and Mantovani, 2000). Overall, the Workshop recognized the growing amount of data on environmental factors interacting with folates. "
    Birth Defects Research Part A Clinical and Molecular Teratology 06/2003; 67(6):457-9. DOI:10.1002/bdra.10056 · 2.21 Impact Factor
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