The fetus contains foreign genetic material coming from the father, but in normal circumstances it does not get rejected. However, in some women the immune system may reject the fetus and cause a miscarriage either by being high in numbers or by abnormal hostile activity. There are several immune disorders:-
Miscarriage Causes: Immune Mechanisms
What are Gliadin antibodies?
The incidence of miscarriage, birth weight babies, is higher among women with coeliac disease. This is effectively corrected by gluten-free diet in this group of women. Coeliac disease has been associated with numerous unfavourable health outcomes, including pregnancy complications such as miscarriages, infertility, preterm birth, and preeclampsia. In one study positive results for IgA gliadin antibodies were different in women with and without recurrent miscarriages.
In the case-control study, comparison of 94 untreated with 31 treated celiac women indicated that the relative risk of miscarriages 8.90 times higher, the relative risk of low birth weight baby was 5.84 times higher, and duration of breast feeding was 2.54 times shorter in untreated mothers. Abortion, low birth weight of baby, and duration of breast feeding did not significantly relate to the severity of celiac disease among untreated women. In the before-after study, 12 pregnant celiac women in either treated or untreated condition were compared. Results indicated that the gluten-free diet reduced the relative risk of miscarriage by 9.18 times, reduced the number of low birth weight babies from 29.4% down to zero, and increased duration of breast feeding 2.38 times. Both case-control and before-after studies indicated that threatened abortion and premature delivery did not significantly relate to treatment of celiac disease. CONCLUSIONS: The high incidence of abortion, of low birth weight babies, and of short breast-feeding periods is effectively corrected by gluten-free diet in women with celiac disease.
The study included 132 women (average age 38.5 years) with celiac disease observed in the period from 2000 to 2010. Comparison group consisted 105 women (average age 38.7 years) with predominantly functional bowel disorders (irritable bowel syndrome, functional constipation, functional bloating, inert colon). RESULTS: The average age of onset of menses was 14.3 years, and in the control group 13.0 years. In 61.3% of patients with celiac disease was irregular menstrual cycle while in the comparison group such violations were noted in 13.3%. Prolonged periods of amenorrhea we observed in women with newly diagnosed celiac disease 3 times more likely than the comparison group: 43.9% and 11.4% respectively. They also had nearly 3 times more likely to occur spontaneous miscarriage: at 46.9% and 14.3% respectively. The frequency of reproductive disorders increased with the growth of the severity of malabsorption syndrome. In 43% of women after 6-8 months of strict adherence to a gluten free diet had disappeared amenorrhea and there were regular menses. Three women of childbearing age, strictly abided the gluten free diet and had a history of repeated spontaneous abortion during the year managed to get pregnant and give birth to healthy full-term baby.
Gluten free diet normalizes miscarriage risk in celiac disease
The mean number of children born to patients with celiac disease was significantly less at 1.9 compared to 2.5 in controls. Beforediagnosis the mean number of children born to patients was 1.4 and 1.8 in controls. After diagnosis and treatment, patients had 0.5 children compared to 0.7 in controls. It seems likely that the overall difference in fertility is due to relative infertility prior to diagnosis and its correction by a gluten-free diet. Significantly more conceptions amongst women with celiac disease (15%) ended in miscarriage prior to diagnosis than amongst controls (6%). After diagnosis and treatment the rate of miscarriage was similar. There were 120 live babies and 7 stillbirths to patients compared with 161 live babies and 1 stillbirth to controls. CONCLUSIONS: Patients with celiac disease are subfertile and have an increased incidence of stillbirths and perinatal deaths.
Gluten free diet improves pregnancy outcome in coeliacs
Available literature data show that celiac disease is a frequent cause of recurrent miscarriage. However, data are lacking for pregnancy outcome when the patient is on a gluten free diet. A case-control study about the effect of gluten free diet on pregnancy was conducted from 1995 to 2006. A cohort of 13 women (mean age 32 years, range 22-38 years) affected by celiac disease with recurrent miscarriages was observed. In all of them several causes of miscarriage (gynaecological, endocrine, haematological, etc.) were excluded. All patients were started on a gluten free diet and were reassessed throughout a long-term follow-up period to evaluate the outcome of pregnancy. RESULTS: Six of 13 became pregnant as follows: 1 patient 1 year after gluten free diet was started, 3 patients 2 years after gluten free diet was started, 1 patient after 3 years, and finally 1 4 years after GFD was started. Moreover, two patients had multiple pregnancies (one had had two childbirths and another had undergone three births within a 7-year follow-up period under gluten free diet). CONCLUSIONS: Gluten free diet seems to favour a positive outcome of pregnancy in most celiac disease patients with recurrent miscarriage.
Seventy-six adult celiac patients were analysed according to nutritional status and to gluten-free diet adherence. As controls, 84 adults and 22 adolescents with irritable bowel syndrome were used. The significant findings were observed as follow: adult celiac patients, irrespective of the nutritional status, were younger than controls, presented delayed menarche, secondary amenorrhea, a higher percentage of spontaneous abortions, anaemia and hypoalbuminemia. No differences were observed regarding the number of pregnancies, age at menopause and duration of the reproductive period. After treatment, patients presented with normal pregnancies and one patient presented spontaneous abortion. The adolescents who were not adherent to gluten-free diet presented delayed menarche and secondary amenorrhea. In conclusion, gluten per se could explain the disturbances and malnutrition would worsen the disease in a consequent vicious cycle. Therefore, celiac disease should be included in the screening of reproductive disorders.
The effect of celiac disease and its treatment on fertility and pregnancy in 74 patients is reported. Those on a normal diet had a shorter reproductive period, were relatively infertile, and had a higher incidence of miscarriage than those on a gluten free diet. Although maternal health did not appear to be seriously impaired by pregnancy in undiagnosed coeliacs, those on a gluten free diet had significantly fewer symptoms and had heavier babies.
Celiac disease more common in recurrent miscarriage
To determine the presence or absence of subclinical autoimmunity in Caucasian Argentine healthy women with first trimester recurrent miscarriage, the sera of healthy women with a history of three or more consecutive abortions and fertile control women without abortions and two children were analysed for the presence of autoantibodies. RESULTS: There was no significant difference between controls and patients with antinuclear, antismooth muscle, antimitocondrial, antiliver-kidney-microsomal fraction, antineutrophil cytoplasmatic and antigastric parietal cells. The prevalence of anticardiolipin antibodies in recurrent miscarriage was significantly higher than controls and the prevalence of positive antibodies for antigliadina type IgA and IgG and IgA antitransglutaminase in recurrent miscarriage was significantly higher than controls. CONCLUSION: We show that Caucasian Argentine women with recurrent miscarriage showed significantly higher incidence of anticardiolipin antibodies than normal controls and finally we recommended the screening of IgA and IgG antigliadina and IgA antitransglutaminase antibodies in pregnancy, because of the high prevalence of subclinical celiac disease in recurrent miscarriage and the chance of reversibility through consumption of a gluten free diet.