Celiac Disease and Fertility

Infertility is one of the hardest things for couples who want children, and Celiac disease is frequently an overlooked cause.

It’s commonly known that around 1% of the population has Celiac disease, and we often think of it as a gastrointestinal disorder. But Celiac is 4-8 times more common in women who are experiencing infertility without any other known cause.  It’s particularly tricky, because many of these women are not experiencing any of the typical Celiac tummy troubles, and most don’t even have anemia, which is often the most visible sign of Celiac.

Many doctors now suggest screening for Celiac when there isn’t another obvious cause for infertility. It’s also a much simpler and less invasive test than many of the infertility procedures. If you’re reading this, most likely Celiac is on your radar screen, but you know as well as I do that this isn’t universal. Since there’s such a genetic link involved, if you have family members who are experiencing infertility or miscarriages, or if you know people experiencing infertility, do consider passing this information along! (gently of course, to people who you think might be open to it)

What’s causing the infertility?

Well, as you know, with untreated Celiac disease, every time the mom to be eats gluten, her body attacks the small intestine, which often causes nutritional deficiencies. Obviously this makes it harder to get pregnant and to have a healthy pregnancy. The nutrients people with Celiac aren’t absorbing well are the same ones that grow babies, such as iron, vitamin D, B vitamins, zinc, magnesium, calcium, etc.

But there’s more than that. An untreated autoimmune disease even without nutrient deficiencies isn’t good for mom or baby.  The same tissue transglutaminase antibodies that doctors look at to tell if we have active Celiac disease and how we’re responding to a gluten-free diet can actually interfere with pregnancy. According to Daniel Leffler, MD, MS, director of clinical research at the Celiac Center at Beth Israel Deaconess Medical Center in Boston “It turns out that antibodies affect the placenta in negative ways. We thought they were just good diagnostic markers, but they also seem to bind to and wreak havoc on many areas of the body.”

This also means that moms-to-be will have the best chance of a healthy pregnancy if they wait 6 months or until the tTg (tissue transglutaminase) levels are back to normal and nutritional deficiencies are corrected. Because at the end of the day, the goal is not just getting pregnant, but having a happy, healthy baby.

Don’t forget dad

We tend to focus on mom, but if Dad has untreated Celiac, HE may be the cause of infertility. Vitamins A, E and zinc are critical to sperm production. And one study even showed that Dads with untreated Celiac were five times more likely to have low-birth weight babies.

Smart steps & tips:

So, if you want to get pregnant and have Celiac disease, make sure you’ve checked with your doctor about nutritional deficiencies and your thyroid, too. People with Celiac are more likely to have autoimmune thyroid diseases, too, such as Hashimoto’s or Graves’, which often show up during and after pregnancy.

It’s also critical to make sure you’re eating a balanced diet. Most gluten-free products aren’t fortified the way regular products are, and many are both higher calorie and higher in empty, starchy carbs, too. The nutrients that are low in the diets of women with on a gluten-free diet (iron, B vitamins, calcium, fiber) are needed by both mom and baby.

Snacks can be the hardest, because it’s typical to reach for whatever is lying around, and for most people who are gluten-free, a little planning goes a long way. Fruit, chopped veggies, like carrots, celery, peppers, etc. are wonderful foods to pack and go. Nuts and seeds are always perfect options because they are shelf-stable. When refrigeration isn’t an issue, a yogurt or a cheese stick works well.

For packaged products, here are a few of my favorites:

  • Nuts.com has a variety of nuts, seeds, dried fruits and mixes that are tested gluten-free
  • Larabars are always a winner, and they’re just fruit and nuts
  • Roasted chickpeas, like the ones from the Nutty Bean are high in protein, fiber and packed with nutrients.
  • Mary’s Gone Crackers have whole grain and higher in protein and fiber crackers and snacks.

For more information or for health professionals and RDs,

Coming soon: infant feeding and Celiac—I’ll post that soon, I assume I have at least 9 months!

Want to learn more? These are great places to start:

  • I do have a CE course on having a healthy gluten-free pregnancy.
  • Shah S, Leffler D. Celiac Disease: an underappreciated issue in women’s health. Womens Health (Lond Engl) 2010 September’ 6(5): 753-766.
    • Warren R Greenblatt E. Celiac disease and fertility. In: Dennis M, Leffler D. Real Life with Celiac Disease. Bethesda, MD: AGA Press; 2010: 331-335.


Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist in private practice in Fairfax and Alexandria, VA. She is a speaker, freelance writer, gardener and meditation enthusiast. Her website is www.harriswholehealth.com and  her food blog is www.gfgoodness.com. Find her on Twitter @CherylHarrisRD

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