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A nationwide population-based study to determine whether coeliac disease is associated with infertility
  1. Daniela Zugna1,
  2. Lorenzo Richiardi1,
  3. Olof Akre2,3,
  4. Olof Stephansson2,4,
  5. Jonas F Ludvigsson2,5
  1. 1Cancer Epidemiology Unit, Centre for Experimental Research and Medical Studies and Centre for Oncologic Prevention in Piedmont, University of Turin, Turin, Italy
  2. 2Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Karolinska, Sweden
  3. 3Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska, Sweden
  4. 4Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska, Sweden
  5. 5Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
  1. Correspondence to Dr Jonas F Ludvigsson, Department of Paediatrics, Örebro University Hospital, Örebro 70185, Sweden; jonasludvigsson{at}


Background and objective Previous studies suggest that women with coeliac disease (CD) have reproductive difficulties but the data are often inconclusive and contradictory. Fertility in women with biopsy-verified CD was examined.

Methods Swedish population-based cohort study. Duodenal/jejunal biopsy data on CD (Marsh III; villous atrophy (VA); n=18 005 unique women) were collected from all (n=28) pathology departments in Sweden. From this dataset, 11 495 women with CD, aged 18–45 years, were identified at some point before the end of follow-up. Multinomial logistic regression and Cox regression were used to estimate fertility in these women compared with that in 51 109 age-matched reference women. Fertility was defined as the number of children according to the Swedish Multi-Generation Register.

Results During follow-up, 16 309 births occurred in women with CD and 69 245 in the reference women. The cumulative number of children slightly increased in women with CD compared with the reference group. Adjusting for age, calendar period and parity and stratifying by education, the overall fertility hazard ratio (HR) in CD was 1.03 (95% CI 1.01 to 1.05). Specifically, the fertility HR was 1.05 (95% CI 0.96 to 1.14) for CD diagnosed in women before 18 years, 1.04 (95% CI 1.01 to 1.07) for CD diagnosed in women between 18 and 45 years and 1.02 (95% CI 0.99 to 1.04) for CD diagnosed in women > 45 years of age. Taking date of CD diagnosis into account, fertility was decreased 0–2 years before time of diagnosis (HR=0.63; 95% CI 0.57 to 0.70), was identical to that of controls 0–5 years subsequent to diagnosis and increased to 1.12 (95% CI 1.03 to 1.21) thereafter.

Conclusion Overall, women with CD had a normal fertility, but their fertility was decreased in the last 2 years preceding CD diagnosis.

  • Autoimmunity
  • coeliac
  • cohort
  • fertility
  • infertility
  • celiac disease
  • epidemiology

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  • Funding JFL was supported by a grant from the Örebro University Hospital while writing this article. This project was supported by a grant from the Swedish Society of Medicine, the Swedish Research Council, the Sven Jerring Foundation, the Örebro Society of Medicine, the Karolinska Institutet, the Clas Groschinsky Foundation, the Juhlin Foundation, the Majblomman Foundation, Uppsala-Örebro Regional Research Council and the Swedish Coeliac Society. OA is supported by a grant from Karolinska Institutet/Stockholm County Council. OS is supported by a post-doctoral scholarship from the Swedish Society of Medicine.

  • Competing interests None declared.

  • Ethics approval This study was conducted with the approval of the Karolinska Institutet/Stockholm, Sweden.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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