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Women’s health and Coeliac Disease

Women’s health and Coeliac Disease. Prof Pasquale Martinelli. Celiachia e salute della donna. Recurrent Abortions Intrauterine Growth retard Pre- eclampsia. Age at menarche Cycle Troubles Fertility. Age and symptoms at menopause. Celiachia and Women’s Health. Late Menarche

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Women’s health and Coeliac Disease

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  1. Women’s health and CoeliacDisease Prof Pasquale Martinelli

  2. Celiachia e salute della donna Recurrent Abortions Intrauterine Growth retard Pre- eclampsia Age at menarche CycleTroubles Fertility Age and symptoms at menopause

  3. Celiachia and Women’s Health • Late Menarche • Early Menopause 13,5 years vs 12 Molteni et al, 1990 Vasomotor symptoms, irritability, muscolar and joint pain more frequent in celiac women 47,6 years vs 50,1 Cher et al, 1996 Santonicola et al, 2011

  4. Celiachia e salute della donna • Cycle Disturbances Martinelli D, 2010

  5. Celiachia and infertilityOR= 5,06 General population

  6. Celiachia abortions OR = 5,82

  7. The majority of CD women with sine causa infertilty do not have classical symptoms of CD • Less tha half have anemia The majorityofthemwouldescapeordinary screening

  8. Isterosalpingografia negativa Isteroscopia negativa Dosaggi ormonali nella norma Laparoscopia negativa

  9. 11.097 donne con diagnosi di CD 54992 Controlli vs 399 Casi di Endometriosi (0,7%) 118 Casi di Endometriosi (1,06%) Increasedrisk the first yearafter the diagnosis

  10. Small Birth Weigth O.R. =8,73

  11. 1:70 donne gravide ammesse presso una struttura di III livello sono affette da celiachia

  12. abanti-tTGserumlevels and Birth Weight Kiefte De Jong et al, 2013

  13. And more … • CD may reduce Folic Acid absorption and expose the foetus to neural tube defects Hermann, 2011

  14. Ipotesi patogenetiche: azione diretta sulla placenta tTG espressa a livello di: Decidua Trofoblasto tTG a livello placentare possibile target degli Ab-antiTG

  15. Ipotesi patogenetiche: azione diretta sulla placenta Anticorpi anti transglutaminasi IgA si localizzano a livello del sinciziotrofoblasto inibendo l’attività della transglutaminasi tissutale

  16. Ipotesi patogenetiche: azione diretta sulla placenta • Gli anti-tTG legano le cellule trofoblastiche in maniera tempo e dose dipendente • Le cellule trofoblastiche, incubate con anti-tTG mostrano una ridotta invasività ( misurata come produzione di metalloproteinasi) Di Simone et al, 2010

  17. 5 folds risk to have a LBW son % di LBW

  18. Efficacy of Gluten-free diet Ludviggson, 2005

  19. Efficacia della dieta senza glutine • L’inizio della dieta almeno 10 anni prima ritarda l’insorgenza della menopausa • Una dieta priva di glutine riduce fino a 9 volte il rischio di aborto Santonicola, 2011 Foschi, 2002

  20. Efficacia della dieta senza glutine Greco et al, 2004

  21. Screening in gravidanza To screen… • Prevalenza: 1:70 gravide Martinelli, 2000

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