GYNECOLOGICAL AND OBSTETRIC IC DISORDERS IN CELIAC-DISEASE - FREQUENTCLINICAL ONSET DURING PREGNANCY OR THE PUERPERIUM

Background and aim: While gynaecological and obstetric disorders have been reported among women with coeliac sprue, their true prevalence an d relationship to the coeliac disease process has not been completely elucidated. Our aims were to determine: Il)the prevalence of gynaecolo gical and obstetric problems in patients with coeliac disease and the influence of strict gluten restriction on their occurrence, (2) the ef fect of pregnancy on the clinical course of coeliac disease and (3) th e clinical features of those patients with onset of coeliac disease du ring pregnancy and the puerperium. Patients and methods: The gynaecolo gical and obstetric history of 130 coeliac patients and 130 age-matche d healthy female controls were compared in a case-control study. Resul ts: In comparison to the controls, untreated coeliac disease patients exhibited significantly later menarche, an earlier menopause, an incre ased prevalence of secondary amenorrhoea and a greater incidence of sp ontaneous abortions. Patients who had adhered, in the long term, to a gluten-free diet had gynaecological and obstetric history indistinguis hable from controls. Clinical deterioration of coeliac disease was obs erved in untreated patients during 17% of their pregnancies. In 14% of those untreated patients who were pregnant symptoms related to coelia c disease were manifested for the first time during either pregnancy ( n = 7) or the puerperium (n = 4). Nine of these patients had underesti mated features suggestive of coeliac disease. Conclusion: The early di agnosis and treatment of coeliac disease may avoid significant gynaeco logical and obstetric complications in affected women. Celiac sprue mu st always be borne in mind among patients who develop diarrhoea and we ight loss during pregnancy and/or the puerperium.