Pregnancy outcome of patients with known celiac disease § Eyal Sheiner a, * , Roni Peleg b , Amalia Levy c a Departments of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, P.O. Box 151, Be’er-Sheva, Israel b Department of Family Medicine, Division of Community Health, Faculty of Health Sciences, Clalit Health Services, Ben Gurion University of the Negev, P.O. Box 151, Be’er-Sheva, Israel c Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 151, Be’er-Sheva, Israel Received 23 December 2004; received in revised form 27 July 2005; accepted 25 October 2005 Abstract Objective: Celiac disease is a permanent intolerance to gluten, probably induced by an autoimmune mechanism. Controversy exists regarding the association between celiac disease and infertility, abortions, intra-uterine growth restriction (IUGR) and stillbirths. The present study was designed to investigate pregnancy outcome of patients with celiac disease. Methods: A retrospective comparison between all pregnancies of women with and without known celiac disease, delivered during the years 1988–2002, was conducted. Results: During the study period there were 48 deliveries of patients with celiac disease and 143,663 pregnancies of patients without known celiac disease. No statistically significant differences were noted between the groups regarding maternal or perinatal outcomes, including fertility treatments (0% among patients with known celiac versus 2.5% among patients without known celiac sprue; p = 0.267), recurrent abortions (0 versus 5.2%; p = 0.103), perinatal mortality (2.1 versus 1.4%; p = 0.668). However, higher rates of labor induction (29.2 versus 11.9%; p < 0.001) and IUGR (6.3 versus 2.1%; p = 0.042) were found among patients with celiac disease as compared to patients without known celiac disease. Conclusion: The course of pregnancy of patients with celiac disease including perinatal outcomes is favorable. Since we found higher rates of IUGR, careful surveillance should be performed for early detection of IUGR. Further, prospective studies should focus on screening for celiac disease among patients presenting with IUGR of an unknown etiology. # 2005 Elsevier Ireland Ltd. All rights reserved. Keywords: Celiac disease; Intra-uterine growth restriction; Pregnancy outcome; Infertility; Abortions 1. Introduction Celiac disease is a permanent intolerance to gluten. It is commonly manifested by malnutrition resulting from inflammatory injury causing pathological changes in the small intestinal mucosa following the ingestion of wheat gluten or related rye and barley deleterious proteins [1]. These changes are usually reversible on a strict gluten-free diet [1]. Celiac disease probably results from an inappropri- ate T-cell mediated autoimmune response against ingested gluten in genetically susceptible patients [2]. Celiac disease has a wide spectrum of non-gastrointest- inal symptoms [1]. Controversy exists regarding the association between celiac disease and reproductive performance [3–16]. Several authors suggested higher rates of infertility, recurrent abortions, intra-uterine growth restriction (IUGR) and stillbirths among patients with celiac disease [3–13]. However, most studies rely on celiac sprue investigation among patients with an unfavorable pregnancy outcome and not on population-based screening results. On the contrary, other studies reported a neglected association between celiac and reproductive disorders and even comparable perinatal outcome of patients with and without celiac sprue [14–17]. www.elsevier.com/locate/ejogrb European Journal of Obstetrics & Gynecology and Reproductive Biology xxx (2005) xxx–xxx § Presented in part at the Society for Maternal-Fetal Medicine SMFM 25th Annual Scientific Meeting Reno, Nevada, February 7–12, 2005. * Corresponding author. Tel.: +972 8 6400774; fax: +972 8 6275338. E-mail address: sheiner@bgumail.bgu.ac.il (E. Sheiner). 0301-2115/$ – see front matter # 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejogrb.2005.10.023 EURO-5557; No of Pages 5