Латентная целиакия - еще одна причина повторного невынашивания (недавние публикации)

[Dr.Vad]

It has been shown that women with diagnosed coeliac disease more frequently experience recurrent spontaneous miscarriage, delayed menarche, early menopause, amenorrhoea and vaginal discharge. Fertility problems are also more common in both men and women with coeliac disease. Screening for coeliac disease should be part of the diagnostic scheme of women with unexplained infertility, because treatment of this disease is suggested to be a major predictor for favourable pregnancy outcome. In about 25% of patients suffering from coeliac disease hyperprolactinaemia is diagnosed, which may be one of the causes of impotence and loss of libido.

The importance of nutrition on reproduction is well established. It has been suggested that the reproductive disorders in coeliac disease patients are due to the nutritional deficiencies as a consequence of malabsorption.

Zinc is an essential trace element, which is required for DNA synthesis, cell division, protein synthesis and immune response. Approximately 300 enzymes are dependent on zinc for their activities. Zinc finger proteins are important for the transcription of steroid receptors.

Zinc deficiency is characterized by skin lesions, hair loss and failure to thrive. Maternal zinc deficiency has been associated with impaired synthesis/secretion of FSH and LH. Abnormal ovarian development, obstetrical disorders, such as spontaneous abortion, congenital malformations, still birth, pre-eclampsia and intra uterine growth retardation have been associated with a primary zinc deficiency, which may lead to secondary endocrine derangements. The importance of zinc and its deficiency as possible factor for male subfertility has been suggested by Wong et al. The zinc content is high in the adult testis and the prostate has a higher concentration of zinc than any other organ of the body. An increase of semen pH is correlated to zinc concentration decrement in the seminal fluid. Abnormalities in spermatozoal function and fertilising capacity appear to be related to major changes in the seminalplasma levels of zinc and other trace elements. Moreover, it has been shown that zinc deficiency impairs angiotensin converting enzyme (ACE) activity, which may lead to depletion of testosterone and inhibition of spermatogenesis. In men suffering from coeliac disease gonadal dysfunction is believed to be due to the reduced conversion of testosterone to dihydrotestosterone caused by low levels of the zinc dependent 5-alpha-reductase enzyme. This leads to a derangement of the hypothalamic-pituitary axis. The most striking endocrine findings in untreated coeliac disease patients are the increased plasma testosterone and free testosterone index, the reduced concentration of the active testosterone derivative dihydrotestosterone and the raised serum luteinising hormone level, which is a pattern indicative of androgen resistance. Investigation of the zinc status in coeliac disease patients might, therefore, be valuable in preconceptional counseling.

A selenium deficiency is often diagnosed in coeliac disease patients. Selenium is an important trace element in the reproduction process as well. Selenium deficiency in women is associated with subfertility and spontaneous abortion. The selenium requirements of a pregnant woman and lactating mother are increased as a result of the selenium transport to the fetus via the placenta or to the new born infant via breast milk. The concentration of selenium during pregnancy seems not to have an effect on the weight of the baby or length of pregnancy. Selenium is involved in spermatogenesis as well and a deficiency results in subfertility. The content of selenium increases in male gonads during pubertal maturation. Selenium is localised in the mitochondrial capsule protein (MCP) of the mid-piece of the spermatozoa.

Mild to severe anaemia in coeliac disease patients is mainly caused by an iron and/or folate deficiency. During pregnancy the requirement of both elements is enhanced. Therefore, coeliac disease patients in particular could be at an increased risk of developing iron and folate deficiency during pregnancy. Both deficiencies have been associated with an increased maternal and fetal morbidity and mortality due to the insufficient oxygen-carrying capacity of the blood. Additional folic acid supply has been demonstrated to be an important factor in the prevention of neural tube defects and possibly orofacial schisis and recurrent spontaneous abortion.

Coeliac disease and reproductive disorders: a neglected association.
Rostami K, Steegers EA, Wong WY, Braat DD, Steegers-Theunissen RP.
Eur J Obstet Gynecol Reprod Biol. 2001 Jun;96(2):146-9