Does Celiac Disease Cause Infertility?

 

Infertility is one of the hardest things for couples who want children, and celiac disease is frequently an overlooked cause.

 

It’s commonly known that around 1 percent of the population has celiac disease — a severe autoimmune reaction to gluten — and we often think of it as a gastrointestinal disorder. But celiac is four to eight times more common in women who are experiencing infertility without any other known cause. This is a particularly tricky issue, because many of these women are not experiencing any of the typical celiac tummy troubles, and most don’t even have anemia, which is often the most visible sign of celiac.

Many doctors now suggest screening for celiac when there isn’t another obvious cause for infertility. It’s also a much simpler and less invasive test than many of the infertility procedures. If you’re reading this, most likely celiac already is on your radar screen, but you know as well as I do that this isn’t universal. Since there’s such a genetic link involved, if you have family members who are experiencing infertility or miscarriages, or if you know people experiencing infertility, do consider passing this information along! (Gently, of course, to people who you think might be open to it.)

What’s Causing the Infertility?

With untreated celiac disease, every time the mom-to-be eats gluten, her body attacks the small intestine, which often causes nutritional deficiencies. Obviously this makes it harder to get pregnant and to have a healthy pregnancy. The nutrients people with celiac aren’t absorbing well are the same ones that grow babies: such as iron, vitamin D, B vitamins, zinc, magnesium, calcium, etc.

But there’s more than that. An untreated autoimmune disease even without nutrient deficiencies isn’t good for mom or baby.  The same tissue transglutaminase antibodies that doctors look at to identify active celiac disease and how patients are responding to a gluten-free diet can actually interfere with pregnancy. According to Daniel Leffler, MD, MS, director of clinical research at the Celiac Center at Beth Israel Deaconess Medical Center in Boston, “It turns out that antibodies affect the placenta in negative ways. We thought they were just good diagnostic markers, but they also seem to bind to and wreak havoc on many areas of the body.”

This also means that moms-to-be will have the best chance of a healthy pregnancy if they wait six months or until the tTg (tissue transglutaminase) levels are back to normal and nutritional deficiencies are corrected. Because, at the end of the day, the goal is not just getting pregnant, but having a happy, healthy baby.

Don’t Forget Dad

We tend to focus on the mom, but if the dad has untreated celiac, he may be the cause of infertility. Vitamins A and E and zinc are critical to sperm production. And one study even showed that fathers with untreated celiac were five times more likely to have low-birth weight babies.

Smart Steps and Tips

So, if you want to get pregnant and have celiac disease, make sure you’ve checked with your doctor about nutritional deficiencies and your thyroid, too. People with celiac are more likely to have autoimmune thyroid diseases, too, such as Hashimoto’s or Graves’, which often show up during and after pregnancy.

It’s also critical to make sure you’re eating a balanced diet. Most gluten-free products aren’t fortified the way regular products are, and many are both higher calorie and higher in empty, starchy carbs, too. The nutrients that are low in the diets of women with on a gluten-free diet (iron, B vitamins, calcium, fiber) are needed by both mom and baby.

Snacks can be the hardest, because it’s typical to reach for whatever is lying around. But for most people who eat gluten-free, a little planning goes a long way. Chopped fruits and veggies like carrots, celery, peppers, etc. are wonderful foods to pack and go. Nuts and seeds are always perfect options because they are shelf-stable. When refrigeration isn’t an issue, a yogurt or a cheese stick works well.

Want to learn more? Check out these sources:

  • Shah S, Leffler D. Celiac Disease: an underappreciated issue in women’s health. Women’s Health (Lond Engl) 2010 September’ 6(5): 753-766.
  • Warren R Greenblatt E. celiac disease and fertility. In: Dennis M, Leffler D. Real Life with celiac Disease. Bethesda, MD: AGA Press; 2010: 331-335.
  • And I do have a CE course on having a healthy gluten-free pregnancy.
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Cheryl Harris
Cheryl Harris, MPH, RD, is a nutritionist and mindfulness coach in Fairfax, VA. She runs a private practice focused on digestive & autoimmune health, Harris Whole Health. She blogs at www.gfgoodness.com. Connect with her on Facebook, LinkedIn and Twitter.