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FeaturesFeb/Mar 2013 Issue

Why Can’t We Have a Baby?

Nutritional Deficiencies and More

Liz Christopher didn’t have any of the classic symptoms of celiac—diarrhea, bloating and stomach pain. Instead she suffered from migraines and other neurologic problems. Marisa Horowitz-Jaffe had occasional stomach pains but they never seemed to be correlated to what she ate. To this day she maintains, “I wouldn’t have known I had celiac if I hadn’t tried to get pregnant.”

Marisa’s biopsy, which was performed to confirm her celiac diagnosis, showed that her intestinal villi were flattened. Villi are the fingerlike projections lining the small intestine that allow nutrients to be absorbed. When they’re blunted, nutritional deficiencies are common. (Marisa had abnormalities in her fingernails that, in retrospect, may have hinted at nutritional deficiencies.)

Although it’s not hard to imagine how a calorie- and nutrient-starved woman might have trouble getting pregnant, malnourishment probably isn’t the only mechanism behind celiac-induced infertility, says Leffler. A recent study suggested there’s something about the celiac process itself that could directly affect one’s ability to carry through a pregnancy. The study showed antibodies to tissue transglutaminase—one of the key markers of celiac—can have an effect on the placenta’s development. Tissue transglutaminase (tTG) is an enzyme found throughout the body. It helps repair and remodel tissue, keeping things in good working order.

“In the placenta, there’s tons of tTG activity since there’s not only repair but also very rapid growth to make what is, in essence, a whole new organ in only a matter of months,” says Leffler.

“Early on, the placenta is a little organ,” adds Anthony J. DiMarino, Jr., MD, chief of the Division of Gastroenterology and Hepatology at Thomas Jefferson University Hospital in Philadelphia. “If it’s being attacked by antibodies, you can see how it could directly affect its ability to sustain a pregnancy.”

Indeed, a higher rate of miscarriage, stillbirth and fetal growth problems like intrauterine growth restriction has been well documented in women with undiagnosed celiac disease. Treatment with the gluten-free diet seems to reduce these risks.

“We don’t yet have data to prove that fertility improves on the gluten-free diet,” says Leffler. “But just about every other outcome is better, so it’d be an outlier if it didn’t.”

Leffler recommends waiting until celiac symptoms—when present—are under control and tTG levels have returned to normal before planning to conceive, if possible. This may take six months to a year of strict adherence to the gluten-free diet.

Next: Counting the Costs

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