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February 16, 2011
Sometimes deciding whether to include a new research study in our regular column, “Research Roundup,” or here in our blog, is pretty straightforward. Other times it’s a bit more complicated. A case in point? The recently published study in Fertility and Sterility entitled Latent celiac disease in reproductive performance of women. Here, Living Without's medical writer Christine Boyd describes the study, along with her thought process behind the decision to cover it:
In a nutshell, researchers looked at the prevalence of celiac antibodies in Indian women who had experienced unexplained infertility, recurrent miscarriage, stillbirth or intrauterine growth restriction (IUGR). They tested nearly 900 women for IgA anti-tissue transglutaminase, the widely used blood test to screen for celiac. Approximately 300 of the study participants were women who had normal obstetric histories included for comparison. Researchers found celiac antibodies were nearly 5 times more likely to be present in women with unexplained infertility, recurrent miscarriage and stillbirth compared to women without complications. In women with IUGR, antibodies were nearly 8 times more likely to show up. The team concluded that women experiencing unexplained infertility, recurrent miscarriage, stillbirths or IUGR could have subclinical celiac and screening should be considered.
I was struck by a potentially significant detail about the study: biopsies weren’t done. This isn’t altogether surprising since at least some of the women were pregnant at the time of the study. When a pregnant woman tests positive for celiac, she’s typically told to start the gluten-free diet immediately and to undergo a gluten challenge and biopsy to confirm the diagnosis after delivery of the baby and breastfeeding ends.
Rather, the biopsy piece didn’t sit well with me because the women were described as having “latent celiac disease” throughout the study. According to the National Institutes of Health’s (NIH) 2004 consensus statement on celiac, latent celiac is defined by positive celiac antibodies but no villous atrophy--intestinal damage characteristic of active celiac disease. How did we know these women didn’t have villous atrophy?
I reached out to the study’s lead investigator who said only that the women in the study had no symptoms suggestive of celiac. Did the team simply not distinguish between latent and asymptomatic celiac?
How much does this matter? Are women with latent celiac disease different from women with asymptomatic celiac disease? Are their experiences with infertility and pregnancy different? Should we still cover the study?
I think so.
Even if the study didn’t satisfy NIH’s definition for latent celiac disease, the research suggests reproductive problems may be the first sign of celiac, a finding that may help countless otherwise asymptomatic women reach a diagnosis and achieve a healthy pregnancy. In addition, recent studies suggest treatment with the gluten-free diet has a beneficial effect on fertility and pregnancy outcomes.
And that is news our readers can use.