Su1430 Risk of Congenital Anomaly in Children Born to Women With Coeliac Disease: A United Kingdom Population-Based Cohort Study

Abstract

INTRODUCTION Several studies have raised the spectre of infertility being associated with coeliac disease. These have primarily been carried out in small groups of women attending infertility specialist services and subsequently screened for coeliac disease. Although nutritional deficits can contribute to infertility, such study designs are highly prone to produce biased estimates of the risk of fertility problems in women with coeliac disease in the general population. We carried out a large population-based study to compare clinical reporting of fertility problems in women with and without coeliac disease in the United Kingdom (UK). METHODS In the UK, any first contact or treatment from specialist infertility services requires referral from a women's primary care doctor, so this is the first clinical contact for assessment of fertility problems. Using The Health Improvement Network, a large primary care database of patients from across the UK, we estimated age-specific rates of new clinically recorded fertility problems in women with and without coeliac disease (CD) during their childbearing years between 1990 and 2013. These rates were then stratified by whether the fertility problem was recorded before or after the CD diagnosis and were compared to the general population rates using Poisson regression with adjustments for socioeconomic status and calendar time. RESULTS Out of the total population of 2,426,225 women, 6,506 (0.3%) women had a diagnosis of CD. The age specific-rates of new clinically recorded fertility problems in women with CD were very similar to the general population rates (11.6/1,000 person years in women with CD and 12.6/1,000 person years in the general population in the 30-34 year age group) (table 1). Incident fertility problems were recorded a median of 2 months (interquartile range: 4 years before, 2.7 years after). When stratified by the time of CD diagnosis the rates of clinically recorded fertility problems were very similar to the general population in both the time before and after CD diagnosis. However these rates were 50% higher after CD diagnosis in women aged 25-29 years compared to the same age group in the general population (IRR 1.50, 95% CI 1.10-2.04). Approximately 25% of the fertility problems were reported within a year before/after the CD diagnosis (Figure 1). CONCLUSION Women with coeliac disease do not have a substantially greater likelihood of reporting fertility problems than women without the condition. Rates were slightly higher in younger women with diagnosed CD, however as this effect did not hold for women of other age groups, increased ascertainment of the condition rather than a causal association may explain this. Table 1 Age specific rates of incident fertility problem reporting in women with and without coeliac disease