Celiac disease (gluten intolerance) is a systemic disease, which means that it can affect various organ systems. Abdominal cramps and diarrhea are therefore not the only typical symptoms of celiac disease. Today, so-called extraintestinal symptoms predominate, complaints that manifest themselves everywhere but in the gastrointestinal tract. One manifestation concerns reproduction: the spectrum of celiac disease ranges from delayed onset of menstruation during puberty or later absence of menstruation (amenorrhea) to repeated premature births and miscarriages to unwanted childlessness, but only if it remains undetected. If celiac disease is diagnosed and affected women change their diet as a result, their fertility also increases and pregnancy can be completely symptom-free.
Background: What is celiac disease?
Celiac disease is a chronic systemic disease based on a lifelong intolerance to the gluten protein, or its subfraction gliadin. Gluten/gliadin is found in cereals wheat, spelt, rye, barley, in commercial oats and the ancient wheat varieties called einkorn and emmer. In people with celiac disease, the intake of gluten leads to inflammation in the intestinal mucosa. As a result, the intestinal villi regress. As the surface area of the small intestine is reduced, it is also no longer possible for sufficient nutrients to be absorbed. Thus, nutrient deficiencies develop in the course of the disease, which can trigger a number of the symptoms described. However, some of the signs of the disease probably also arise from inflammatory processes in the body regardless of nutrient deficiencies. Since celiac disease is not limited to the intestine, it tends to be considered a disease of the entire body, i.e. a systemic disease.
Outbreak of the disease
In principle, an outbreak of the disease is possible at any age. However, two peaks of incidence are observed: The first is between the ages of 1 and 8 and the second between the ages of 20 and 50. Hereditary factors play a very important role in celiac disease, but the immune system, infections, diet and environmental factors also seem to influence the development of the disease. In some genetically predisposed women, celiac disease may also first develop as a result of the physical and hormonal changes that occur during pregnancy. Symptoms such as weight loss, diarrhea, abdominal cramps or even depression during pregnancy should always be taken seriously and not simply blamed on the new life situation.
Reduced fertility due to celiac disease
If a desire to have children remains unfulfilled for a long time, this is very stressful for those affected. Undetected celiac disease can also be the cause. Around 20-50% of those affected by celiac disease do not exhibit classic symptoms such as diarrhea or flatulence, but instead, have a variety of atypical complaints. In these cases, gluten intolerance often remains undetected! In many women, celiac disease is finally diagnosed only due to infertility or problems during pregnancy.
Possible first indications of reduced fertility due to an untreated celiac disease are, for example, an irregular menstrual cycle as well as a comparatively high age at the onset of menstruation during puberty. However, these symptoms are not a sure sign. It is also a fact that the medical background to the reduced fertility and increased risk of miscarriage associated with celiac disease has not yet been conclusively clarified. However, the decisive factor is likely to be the nutrient deficiency associated with untreated celiac disease due to inflammation of the mucous membrane of the small intestine. Other causes may be deficiencies of certain nutrients, e.g., folic acid, iron, protein, vitamins B6 and B12, vitamin E, vitamin K, selenium, and zinc. However, it is also discussed that the antibodies that are elevated in celiac disease (IgA transglutaminase antibodies) may adversely affect placental function.
Incidentally, undetected celiac disease can also lead to infertility in men. However, if the diet is changed after diagnosis, fertility increases in men as well.
In the case of a long-lasting unfulfilled desire to have children or repeated miscarriages, medical tests are required to diagnose celiac disease. It is important not to change the diet on one’s own initiative before the diagnosis. If an intolerance is suspected, a blood test and small intestine biopsy are performed while the patient continues to eat a diet containing gluten; otherwise, a reliable diagnosis cannot be guaranteed. Only after a positive result should the diet be changed. If the woman is already pregnant, it is recommended, with the doctor’s agreement, that if the antibody result in the blood is positive, the diet should first be changed to gluten-free and the biopsy should only be performed after breastfeeding and after a renewed exposure to gluten, in order to rule out possible complications from the biopsy during pregnancy.
Gluten-free during pregnancy
Many celiac sufferers are concerned that a gluten-free diet during pregnancy could harm their unborn child. But quite the opposite is true: expectant mothers affected by celiac disease should pay special attention to a strict gluten-free diet. Repeated dietary errors can damage the mucous membrane of the small intestine again and lead to a nutrient deficiency that is harmful for both mother and child. The good news is that with a balanced gluten-free diet, gluten intolerance is no obstacle to an uncomplicated pregnancy, as the German Celiac Society (DZG) emphasizes. Only in this way can the small intestine of the expectant mother remain healthy and absorb all the nutrients important for the development of the unborn child. Celiac disease is only problematic during pregnancy if it remains undetected and thus a gluten-free diet is not followed. By the way, a gluten-free diet has no advantages for healthy pregnant women. If you are concerned about suffering from undetected celiac disease, please seek comprehensive advice from your doctor!
Deutsche Zöliakie Gesellschaft e.V.: Themendienst: Zöliakie und Familienplanung. https://www.dzg-online.de/files/2017_05_dzg_themendienst_z__liakie_und_familienplanung.pdf Zugriff: 13.1.2019
Mein Allergie Portal: Kinderwunsch – unerkannte Zöliakie kann Fruchtbarkeit mindern. https://www.mein-allergie-portal.com/zoeliakie-und-glutensensitivitaet/1161-kinderwunsch-unerkannte-zoeliakie-kann-fruchtbarkeit-beeintraechtigen.html Zugriff: 13.1.2019
Glutenfrei in der Schwangerschaft. In: Gluten Free. Das Magazin für ein genussvolles Leben ohne Weizen und Gluten; 10: 2020. p.38 f.