University of Oklahoma College of Medicine, Oklahoma City, Oklahoma.
American University of Beirut School of Medicine, Beirut, Lebanon.
Am J Reprod Immunol. 2019 Jul;82(1):e13127. doi: 10.1111/aji.13127. Epub 2019 Apr 29.
Celiac disease (CD) is an autoimmune intestinal inflammatory disease triggered by gluten in the diet. Untreated CD has been associated with pregnancy loss and infertility. The purpose of this study was to screen unselected women with recurrent pregnancy loss (RPL) for markers of CD to determine whether a correlation exists between RPL and CD serum markers.
Frequencies of three serum markers of CD [tissue transglutaminase (TTG) IgA, endomysial (EMA) IgA, and deaminated gliadin peptide (DGP) IgA] were determined by enzyme-linked immunoassay (ELISA). Seven hundred and eight women who had two or more failed clinical pregnancies (cases) and one hundred women with at least one live birth and no miscarriages (controls) were included in this study. All cases had a full workup for RPL based on the American Society for Reproductive Medicine 2013 guidelines. Antiphospholipid antibodies (aPL) were correlated with CD markers based on their potential prothrombotic role. Results The results show no significant difference in the prevalence of CD autoantibodies when comparing the RPL patients with the controls. Over half of the patients who tested positive for serum markers for CD also had positive aPL. Conclusion Screening unselected women with RPL who are asymptomatic for CD is not supported based on these data. Women who test positive for CD may be candidates for aPL testing based on the association of adverse pregnancy outcomes.
乳糜泻（CD）是一种由饮食中的麸质引发的自身免疫性肠道炎症性疾病。未经治疗的 CD 与流产和不孕有关。本研究的目的是筛查复发性流产（RPL）的未选择妇女的 CD 标志物，以确定 RPL 和 CD 血清标志物之间是否存在相关性。
通过酶联免疫吸附试验（ELISA）测定三种 CD 血清标志物[组织转谷氨酰胺酶（TTG）IgA、内肌膜（EMA）IgA 和脱酰胺麦胶肽（DGP）IgA]的频率。本研究纳入了 708 名有两次或两次以上临床妊娠失败（病例）和 100 名至少有一次活产且无流产（对照组）的妇女。所有病例均根据美国生殖医学学会 2013 年指南对 RPL 进行了全面检查。根据其潜在的促血栓形成作用，将抗磷脂抗体（aPL）与 CD 标志物相关联。结果显示，比较 RPL 患者和对照组时，CD 自身抗体的患病率无显著差异。检测到 CD 血清标志物阳性的患者中，超过一半也有阳性 aPL。结论：根据这些数据，不支持对无症状的 RPL 未选择妇女进行 CD 筛查。基于不良妊娠结局的相关性，对 CD 检测呈阳性的妇女可能是 aPL 检测的候选者。
