Successful Pregnancy on a Gluten-Free Diet in a Woman with Seven Miscarriages and Nonceliac Gluten Sensitivity

ABSTRACT Objective: To describe a case in which a gluten-free diet led to a successful full-term delivery in a woman with recurrent miscarriages and nonceliac gluten sensitivity (NCGS). Methods: Reduced incidences of spontaneous abortions have been reported in patients with celiac disease who adhere to a gluten-free diet, but little is known about improvement in reproductive issues in women with NCGS. We present a case of a woman with multiple miscarriages who improved on a gluten-free diet. Results: A 33-year-old woman presented with history of hypothyroidism and recurrent first-trimester fetal loss. On exam, body mass index was 24.9 kg/m2, and she did not appear cushingoid. She was on levothyroxine, and thyroid function tests were within normal limits. Thyroid peroxidase antibody and anti-phospholipid antibody were negative. Although she denied gastrointestinal symptoms, undiagnosed celiac disease was considered, as she had family members with celiac disease. Anti-gliadin immunoglobulin (Ig)G antibody was elevated, while tissue transglutaminase IgA and anti-endomysial IgA were negative. Esophagogastroduodenoscopy and biopsy showed normal mucosa. These findings were consistent with a diagnosis of NCGS. A trial with a gluten-free diet was initiated. She became pregnant again and was able to carry the baby to full-term with delivery. Conclusion: While the exact effect of NCGS is yet to be determined, immunologic changes in placental function may account for recurrent fetal loss since gliadin is abundant in the extravillous trophoblast that attaches the placenta to the mother. Abbreviations: ACTH = adrenocorticotropic hormone; Ig = immunoglobulin; NCGS = nonceliac gluten sensitivity