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Editor,—We read with interest the paper by Martinelli et al (OpenUrlPubMedWeb of Science) in which the authors found that 12 of 845 (1 in 70) pregnant women were positive for antiendomysium antibody (AEA). We have conducted a similar study. We examined sera from 450 consecutive unselected pregnant women and 125 normal non-anaemic female blood donors as controls. We found that 2/450 and 0/125 women were AEA positive, respectively. Both AEA positive patients were anaemic (haemoglobin <11 g/dl). Hence in continuing the study we elected to examine only sera from anaemic pregnant women. Of a total of 216 consecutive samples, five were positive for AEA (1 in 43).
In the study of Martinelli et al, 9/12 women with AEA were anaemic by these criteria. The other three were associated with good outcome. In view of this and our own findings, we agree with the authors that pregnant women should be screened for coeliac disease but we would suggest that this could be made considerably more cost effective by screening only those who are anaemic. Women who are anaemic, whether pregnant of not, should be investigated for coeliac disease.1
Editor,—We are pleased that Dr Unsworth and colleagues have had a similar experience of undiagnosed coeliac patients among pregnant women. Their rate of 2/450 women is not very different from that observed in our study. It is also surprising that so many cases have been found in a country where coeliac disease has recently been reported as “disappearing”!
We agree that anaemic women should be screened for coeliac disease.
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