title: Fertility and pregnancy-related events in women with celiac disease: a population-based cohort study.
abstract: OBJECTIVE
  Previous studies have raised concern about reduced fertility and increased adverse pregnancy-related events in women with celiac disease, but none has estimated overall fertility compared with the general female population.
  
  
  METHODS
  We compared computerized primary care data for 1521 women with celiac disease with data for 7732 age- and practice-matched women without celiac disease. We estimated population-based rates of fertility and adverse pregnancy outcomes.
  
  
  RESULTS
  Crude fertility rates were 48.2 and 47.7 live births per 1000 person-years for women with and without celiac disease, respectively (rate ratio, 1.01; 95% confidence interval, 0.90-1.14). Age-specific fertility rates showed that women with celiac disease had lower fertility when younger but higher fertility when older compared with women without celiac disease. This increase in relative fertility with increasing age held whether women had treated or untreated celiac disease. Risks of cesarean section (odds ratio, 1.33; 95% confidence interval, 1.03-1.70) and miscarriage (rate ratio, 1.31; 95% confidence interval, 1.06-1.61) were moderately higher in women with celiac disease, but risks of assisted birth, breech birth, preeclampsia, postpartum hemorrhage, ectopic pregnancy, stillbirth, and termination were similar.
  
  
  CONCLUSIONS
  Overall, women with celiac disease have fertility similar to that of the general female population, but they have their babies at an older age. Although our findings may reflect a disease effect, the age shift in fertility rates and the increase in cesarean section risk is consistent with socioeconomic or educational advantages of women with celiac disease.
authors.affiliation: Epidemiology and Public Health, University of Nottingham, NG5 1PB Nottingham, UK. laila.tata@nottingham.ac.uk
authors.forename: L J
authors.initials: LJ
authors.lastname: Tata
authors.forename: T R
authors.initials: TR
authors.lastname: Card
authors.forename: R F A
authors.initials: RF
authors.lastname: Logan
authors.forename: R B
authors.initials: RB
authors.lastname: Hubbard
authors.forename: C J P
authors.initials: CJ
authors.lastname: Smith
authors.forename: J
authors.initials: J
authors.lastname: West
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001723:Birth Rate; D016022:Case-Control Studies; D002446:Celiac Disease / Q000503:physiopathology*; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D005298:Fertility; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies