TL;DR 

Undiagnosed celiac disease can quietly affect fertility, pregnancy, and fetal development—even when symptoms are mild or nonexistent. Research shows higher risks of low birth weight, growth restriction, miscarriage, and preterm birth in women whose celiac disease is untreated. Screening before pregnancy is simple and may prevent complications. A gluten-free diet in diagnosed mothers significantly improves outcomes.

Educational only — not medical advice.  

Celiac disease is often thought of as a digestive condition—but its effects extend far beyond the gut. Many people with celiac disease have few or no classic symptoms, yet still sustain measurable intestinal damage (“mild enteropathy”). Even low-grade autoimmunity triggered by gluten can impair nutrient absorption, increase inflammation, and place additional physiological stress on both mother and fetus. Because celiac disease is binary—you have it or you don’t—even a “mild case” still requires a strict gluten-free diet to prevent complications.

For women trying to conceive or currently pregnant, undiagnosed celiac disease is an underappreciated risk factor. Growing research shows meaningful effects on fertility, fetal growth, and pregnancy outcomes.

Undiagnosed Celiac Disease and Fetal Growth

One of the largest investigations to date—published in Human Reproduction—evaluated 1,504,342 births to 836,241 mothers. Among these were:

  • 1105 births to mothers with diagnosed celiac disease

  • 346 births to mothers with undiagnosed celiac disease

Key findings:

  • Mothers with untreated celiac disease delivered smaller babies, with a significantly higher risk of VSGA (very small for gestational age).

  • Women diagnosed before pregnancy, who avoided gluten, did not show this increased risk.

  • Untreated celiac disease also increased the risk of preterm birth.

Reference:
Human Reproduction. 2010 Feb;25(2):528–34.

Reproductive Outcomes and Pregnancy Complications

Another cohort study in Gastroenterology followed women aged 15–44 with singleton live births:

  • 1149 babies were born to mothers diagnosed before pregnancy

  • 929 babies to mothers diagnosed after birth

  • 2078 total births in the celiac group

Women with undiagnosed celiac disease had increased risks of:

  • Intrauterine growth restriction

  • Low birth weight

  • Preterm birth

  • Cesarean delivery

Again, women diagnosed before pregnancy—who were already gluten-free—had significantly better outcomes.

Reference:
Gastroenterology. 2005 Aug;129(2):454–63.

Possible Neurological Effects on Offspring

Emerging research suggests maternal gluten-related immune activation may influence fetal neurodevelopment.

A study in The American Journal of Psychiatry examined IgG antibodies from neonatal dried blood spots. Researchers found:

  • Newborns with anti-gliadin IgG levels above the 90th percentile had a significantly higher risk of nonaffective psychosis later in life.

  • Anti-casein IgG showed no association.

  • Results were independent of maternal age, immigration status, delivery mode, birth weight, or gestational age.

This doesn’t prove causation—but the association suggests that maternal immune reactivity to gluten, even without celiac symptoms, may influence long-term neurodevelopment.

Reference:
Am J Psychiatry. 2012;169(6):625–632.

Additional Evidence: Miscarriage, Prematurity, Fertility Impacts

A larger clinical survey reinforced these concerns:

Women with celiac disease had:

  • Higher rates of spontaneous abortion (50.6% vs. 40.6% in controls; P=0.01)

  • More premature deliveries (23.6% vs. 15.9%; P=0.02)

  • Later menarche (12.7 vs. 12.4 years; P=0.01)

  • Fewer live births per pregnancy

Reference:
Ann Gastroenterol. 2015;28(2):236–240.

These patterns are often attributed to impaired nutrient absorption (especially iron, folate, B12, essential fatty acids), systemic inflammation, hormonal dysregulation, and gluten-triggered autoimmunity.

Takeaway for Women Trying to Conceive

Celiac disease is common (≈1% of the population), significantly underdiagnosed, and often silent.

Given the evidence linking untreated celiac disease to:

  • Preterm birth

  • Low birth weight

  • Growth restriction

  • Increased miscarriage

  • Potential neurodevelopmental effects

…it is worth screening for celiac disease before becoming pregnant, especially if you have:

  • Unexplained anemia

  • Fatigue

  • Brain fog

  • Bloating or IBS-like symptoms

  • Autoimmune disease

  • Family history of celiac

  • Infertility or repeated pregnancy loss

A simple blood test (tTG-IgA and total IgA) is the usual first step.

If positive, confirmatory testing and a medically supervised gluten-free diet can dramatically improve reproductive outcomes.