Someone told me that celiac disease might be a cause of my recurrent miscarriages. Could that be true? Should I get tested for celiac disease?
One of many frustrating aspects of recurrent miscarriages is that there are more questions than answers as to why some couples find themselves facing multiple pregnancy losses. There are many theories but only a handful of recognized causes of recurrent pregnancy losses. One theory is that untreated celiac disease (intolerance of gluten proteins) could have some role in recurrent miscarriages.
But what's the evidence for this theory? Should you be tested for celiac disease if you've had recurrent miscarriages?
Here is what UpToDate, an electronic reference for doctors and patients, has to say about the matter:
"Untreated celiac disease, even when subclinical, has been associated with pregnancy loss, menstrual disorders, and infertility. Treatment of celiac disease appears to prevent these problems.
"The relationship between untreated celiac disease and pregnancy loss is not well defined. A population based cohort study of over 1500 women with celiac disease found the miscarriage rate among women with the disease was 1.31 higher than those without the disease (95% CI 1.06-1.61). In a smaller case-control study, a stronger association was found (95% CI 1.19-66.3). However, others could not confirm this association. In addition, no study has shown that celiac disease causes repeated pregnancy loss. Nevertheless, due to the effects of the disease to health in general, and the possible positive effects of treatment of the disease, we suggest screening women with RPL for celiac disease."
What that means is that there's not a whole lot of research fleshing out the specifics of exactly how celiac disease relates to recurrent miscarriages, but it seems like women with untreated or even subclinical celiac disease (who have no obvious symptoms of gluten intolerance) may face a higher risk of miscarriage.
It's not yet proven that celiac disease is a true cause of miscarriages rather than a possible risk factor, and the evidence is mixed on the level of risk involved. But it does appear that there is enough evidence of a link that you might want to ask your doctor about screening if you are having recurrent miscarriages and suspect you could have celiac disease, especially since undiagnosed celiac disease could cause other negative health effects.
Here are answers to some more questions you might have about recurrent miscarriages, celiac disease, and other undiagnosed health conditions:
If I don't have celiac disease symptoms, should I still ask about testing?
Celiac disease usually is associated with gastrointestinal problems such as gas and diarrhea -- when people have symptoms. But it's possible to have celiac disease without symptoms (subclinical celiac disease), and as stated above, some research suggests that subclinical celiac disease might be associated with miscarriages. It can't hurt to ask about testing.
What would it mean if I did turn out to have celiac disease?
If tests confirm that you definitely have celiac disease, your doctor will recommend that you go on a gluten-free diet. That would mean never eating anything with wheat or other grains that contain gluten.
Can't I just go on a gluten-free diet and see if my next pregnancy is successful?
Given the challenges of eliminating gluten, it's best to undertake a gluten-free diet only if it's really necessary. In addition, you have to be currently eating gluten in order to confirm a celiac disease diagnosis, so starting a gluten-free diet without undergoing the recommended tests can make it harder to get an accurate diagnosis later.
Are there other health conditions associated with miscarriages that I should be tested for?
Untreated diabetes and thyroid conditions may also be associated with recurrent miscarriages. You may or may not have obvious clinical symptoms; check with your doctor for more information on whether you should be tested.
What if I've had all the testing and my doctor can't figure out why I keep miscarrying?
Unfortunately, doctors can only find a clear cause in about half of couples who deal with recurrent miscarriages. This can be immensely frustrating and a source of major anxiety for couples who have had multiple pregnancy losses. The good news is that even with unexplained recurrent miscarriages, the odds are high that you will have a successful pregnancy in the future without treatment.
Want to learn more? See UpToDate's topic, "Definition and etiology of recurrent pregnancy loss," for additional in-depth medical information.
Tulandi, Togas and Haya M. Al-Fozan. "Definition and etiology of recurrent pregnancy loss." UpToDate. Accessed: Dec 2009.