The relationship between infertility and abortion with celiac disease in southern Iran: a cross-sectional study

Background: Celiac disease (CD) is a common disease caused by autoimmunity to the gluten protein. Although some studies have shown an association between infertility and abortion with CD, there are many risk factors that may influence this relationship that should be addressed in the researches. Therefore, we designed this study to evaluate this association with respect to these confounding factors. Methods: This study was designed to investigate the association between infertility and abortion with CD in women who were referred to the celiac clinic in Fars province, from October 2017 to April 2020. CD was defined as an increase in serum levels of tissue transglutaminase antibodies and histological confirmation of a small bowel specimen, infertility with no pregnancy after 12 months of unprotected sex, and abortion with spontaneous termination of pregnancy before the 20th week. Results: Out of 711 patients, 98 women with CD were eligible for inclusion. The mean age (SD) was 31.73 (7.52) ranging from 19 to 45 years. 27 (27.6%) and 39 (39.8%) patients had a history of infertility and abortion, respectively. According to Robust Poisson regression models, weight loss with a body mass index of less than 18.5 kg/m2 was significantly associated with infertility (PR=0.779, CI95%=0.640-0.950, P=0.013) and abortion (PR=0.794, CI95%=0.649-0.971, P=0.025), but other variables such as age, ethnicity, education level, gastrointestinal manifestations, tissue transglutaminase antibody level, histological severity, family history of CD, and history of cousin marriage were not significantly associated with infertility or abortion. Conclusion: In this study, weight loss due to long-term malnutrition was suggested as an important risk factor for fertility problems in CD. There was no significant association between infertility and abortion with other variables such as the level of anti-transglutaminase antibody and histological findings. Therefore, routine use of antibody levels and evaluation of the severity of histological findings as criteria for predicting the risk of abortion or infertility in these patients is not recommended until further research is performed.