Smecuol E, Mauriño E, Vazquez H, Pedreira S, Niveloni S, Mazure R, Boerr L, Bai J C
Hospital Municipal de Gastroenterología, Salvador University, Buenos Aires, Argentina.
Eur J Gastroenterol Hepatol. 1996 Jan;8(1):63-89. doi: 10.1097/00042737-199601000-00012.
While gynaecological and obstetric disorders have been reported among women with coeliac sprue, their true prevalence and relationship to the coeliac disease process has not been completely elucidated. Our aims were to determine: (1) the prevalence of gynaecological and obstetric problems in patients with coeliac disease and the influence of strict gluten restriction on their occurrence, (2) the effect of pregnancy on the clinical course of coeliac disease and (3) the clinical features of those patients with onset of coeliac disease during pregnancy and the puerperium.
The gynaecological and obstetric history of 130 coeliac patients and 130 age-matched healthy female controls were compared in a case-control study.
In comparison to the controls, untreated coeliac disease patients exhibited significantly later menarche, an earlier menopause, an increased prevalence of secondary amenorrhoea and a greater incidence of spontaneous abortions. Patients who had adhered, in the long term, to a gluten-free diet had gynaecological and obstetric history indistinguishable from controls. Clinical deterioration of coeliac disease was observed in untreated patients during 17% of their pregnancies. In 14% of those untreated patients who were pregnant symptoms related to coeliac disease were manifested for the first time during either pregnancy (n = 7) or the puerperium (n = 4). Nine of these patients had underestimated features suggestive of coeliac disease.
The early diagnosis and treatment of coeliac disease may avoid significant gynaecological and obstetric complications in affected women. Celiac sprue must always be borne in mind among patients who develop diarrhoea and weight loss during pregnancy and/or the puerperium.
虽然已有报道称患有乳糜泻的女性存在妇科和产科疾病，但其真实患病率以及与乳糜泻病程的关系尚未完全阐明。我们的目的是确定：（1）乳糜泻患者中妇科和产科问题的患病率以及严格的麸质限制对其发生的影响；（2）妊娠对乳糜泻临床病程的影响；（3）在妊娠和产褥期发病的乳糜泻患者的临床特征。
在一项病例对照研究中，比较了130例乳糜泻患者和130例年龄匹配的健康女性对照的妇科和产科病史。
与对照组相比，未经治疗的乳糜泻患者月经初潮明显延迟，绝经较早，继发性闭经患病率增加，自然流产发生率更高。长期坚持无麸质饮食的患者的妇科和产科病史与对照组无差异。17%的未治疗患者在妊娠期间出现乳糜泻病情恶化。在14%的未治疗的妊娠患者中，与乳糜泻相关的症状首次出现在妊娠期间（n = 7）或产褥期（n = 4）。其中9例患者有提示乳糜泻的特征但被低估。
乳糜泻的早期诊断和治疗可避免受影响女性出现严重的妇科和产科并发症。对于在妊娠和/或产褥期出现腹泻和体重减轻的患者，必须始终考虑乳糜泻的可能。
