Editorial: Coeliac Disease and Women's Reproductive Health: A Lifelong Challenge

Abstract

For decades, researchers have recognised that women with coeliac disease face an additional battle: their reproductive life. However, the heterogeneity in study size, experimental design, and the number and quality of control groups have produced a large body of data with significant discrepancies among findings.

The manuscript by Nanah et al. [1] presents a retrospective observational analysis using a real-world clinical database of 80 healthcare organisations, focusing on differences in the frequency of women's health disorders between women with coeliac disease and controls. The study's strength lies in its large sample size: more than 9000 women with coeliac disease compared with 25 million women without coeliac disease. The use of propensity score matching helped control for major confounders, making the analysis statistically robust. The results of the study by Nanah et al. [1] indicate that women with coeliac disease are at higher risk of multiple gynaecological and reproductive disorders across all ages, supporting previous findings [2-6]. The study's comparison between groups and ages is well-structured, showing how coeliac disease impacts women's health disorders across four distinct life stages: paediatric, reproductive, later reproductive, and pre-menopausal, peri-menopausal, and post-menopausal.

What are the main consequences for the health of women with coeliac disease? The impact of complex ovarian dysfunction, nutritional deficiencies, and chronic inflammation on women's general health is far from fully understood. The reproductive lifespan confirms that women with coeliac disease in the study have a shortened fertile window [4], which might increase the need for assisted reproductive technologies [5], despite one study suggesting the contrary [6]. The reported higher rates of premature ovarian failure and menopausal disorders may increase the risk of osteoporosis and cardiovascular disease [7, 8]. The combination of fertility issues, chronic pain, and menstrual irregularities could also negatively impact mental health [9]. Women with coeliac disease indeed face a double challenge compared to men.

Among the study's limitations, Nanah et al. mentioned the lack of information on whether patients were following a gluten-free diet, the lack of control for comorbidities, lifestyle, and socioeconomic conditions. Yet, the study shows a low representation of non-Caucasian women, which likely reflects a combination of genetic, diagnostic, and healthcare disparities rather than biological differences. While coeliac disease is more common in white populations due to genetic predisposition [10], underdiagnosis due to limited access to testing in non-Caucasian populations may be exaggerating the disparity. Non-Caucasian women with coeliac disease are more likely to rely on community health centres rather than primary care, where diagnostic resources for coeliac disease may be limited. Consequently, being a woman, being non-Caucasian, and having unrecognised coeliac disease likely presents a triple challenge.

The study by Nanah et al. [1] teaches us that coeliac disease not only jeopardises digestive health but also significantly disrupts women's reproductive well-being across all life stages, underscoring the need for early detection, targeted intervention, and more equitable healthcare access. Once again, it is crucial to reach a diagnosis of coeliac disease as early as possible, but it is equally essential to improve diagnosis for underrepresented groups by implementing more inclusive screening programmes and providing culturally sensitive medical education for practitioners.

C. Ciacci: conceptualization, writing – review and editing, supervision. A. Santonicola: writing – original draft, visualization, resources.

This article is linked to Nanah et al. papers. To view these articles, visit https://onlinelibrary.wiley.com/doi/10.1111/apt.70053.