Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Medicine, SUNY Health Sciences University, Brooklyn, New York, USA.
Am J Gastroenterol. 2021 Mar 1;116(3):593-599. doi: 10.14309/ajg.0000000000001148.
Untreated symptomatic celiac disease (CD) adversely affects female reproduction; however, the effect of hidden CD autoimmunity is uncertain.
We identified women who were not previously diagnosed with CD and tested positive for tissue transglutaminase and endomysial antibodies between 2006 and 2011 in a community-based retrospective cohort study. We evaluated (i) the rate of adverse pregnancy outcomes and medical complications of pregnancy in successful singleton deliveries and (ii) reproductive characteristics in seropositive women without a clinical diagnosis of CD and age-matched seronegative women.
Among 17,888 women whose serum samples were tested for CD autoimmunity, 215 seropositive and 415 seronegative women were included. We reviewed 231 and 509 live singleton deliveries of 117 seropositive and 250 seronegative mothers, respectively. Menarche and menopausal age, gravidity, parity, and age at first child were similar in seropositive and seronegative women. CD seropositivity was not associated with an increased risk of maternal pregnancy complications. Maternal seropositivity was associated with small for gestational age in boys (OR 3.77, 95% CI: 1.47-9.71; P = 0.006), but not in girls (OR 0.57, 95% CI: 0.15-2.17; P = 0.41). CD serum positivity was not associated with prematurity, small for gestational age (birth weight <10th percentile), or 5-minute Apgar score of less than 7.
Although underpowered, the present study did not show any difference in reproductive characteristics or rates of adverse pregnancy outcomes in women with and without CD autoimmunity, except for birth weight in male offspring. Larger studies are needed to determine the effects of CD autoimmunity on female reproduction.
未经治疗的有症状乳糜泻（CD）会对女性生殖产生不良影响；然而，隐匿性 CD 自身免疫的影响尚不确定。
我们在一项基于社区的回顾性队列研究中，于 2006 年至 2011 年间鉴定了未曾被诊断患有 CD 且组织转谷氨酰胺酶和内肌膜抗体检测呈阳性的女性。我们评估了（i）在成功的单胎分娩中不良妊娠结局和妊娠合并症的发生率，以及（ii）血清阳性但无 CD 临床诊断的妇女和年龄匹配的血清阴性妇女的生殖特征。
在检测 CD 自身免疫的 17888 名女性的血清样本中，纳入了 215 名血清阳性和 415 名血清阴性女性。我们分别回顾了 117 名血清阳性和 250 名血清阴性母亲的 231 例和 509 例活产单胎分娩。血清阳性和血清阴性妇女的初潮和绝经年龄、孕次、产次和首次生育年龄相似。CD 血清阳性与母亲妊娠并发症的风险增加无关。母亲血清阳性与男孩的小于胎龄儿有关（OR 3.77，95%CI：1.47-9.71；P = 0.006），但与女孩无关（OR 0.57，95%CI：0.15-2.17；P = 0.41）。CD 血清阳性与早产、小于胎龄儿（出生体重<第 10 百分位）或 5 分钟 Apgar 评分<7 无关。
尽管研究力度不足，但本研究未显示 CD 自身免疫阳性和阴性妇女的生殖特征或不良妊娠结局发生率有任何差异，除了男胎的出生体重。需要更大规模的研究来确定 CD 自身免疫对女性生殖的影响。
