Editor,—I read with interest the paper by Martinelli et al (Gut 2000;46:332–335) and letter by Unsworthet al (Gut 2000;47:598) which stress the high prevalence of coeliac disease in anaemic pregnant women. Untreated coeliac disease can adversely affect the reproductive system and result in infertility, multiple abortions, low birth weight babies, and short breast feeding periods.1 ,2 A low plasma level of folic acid is a common finding in newly diagnosed patients3: there are good theoretical reasons for hypothesising that coeliac disease could also be a maternal risk factor for birth defects.4 ,5 The seven coeliac women identified in the study of Martinelli et al had a further pregnancy and reached term. One of them had a boy with a major cardiac malformation; she was the only one on a gluten containing diet.

I examined sera …