S1792 Women’s Health Disorders in a Celiac Disease Population-A Nationwide Cohort Analysis

Introduction: There is a female predominance of diagnosed celiac disease (CD) with suggested gender-related differences in clinical presentation. Delayed menarche, infertility, and pregnancy complications have been linked to poor nutrition and autoimmune mechanisms. However, the scientific evidence for women’s health disorders remains scant and contradictory. In this study, we aim to examine the nationwide rates of women’s health disorders affecting female CD patients in the US. Methods: We performed a retrospective analysis using TriNetX, a database pulling real-time patient records from 80 healthcare organizations. CD was identified using International Classification of Diseases-10th Edition code (K 90.0) and positive celiac serology. Women between 10-60 years of age with CD were compared to ambulatory women without prior positive celiac serology. Exclusion criteria were patients seen >20 years ago. Results: The study included 25 million outpatient women without CD and 9,368 women with CD. CD patients, compared to non-CD, were predominantly white (83% vs 47%) and had a lower mean BMI (24.6 vs 26.1). CD women were found to have statistically significant higher odds of primary ovarian failure (0.96% vs 0.16% respectively, OR 6.25) including ovarian dysfunction (4.4% vs 1.25%, OR 3.64) and polycystic ovarian syndrome (PCOS) (3.3% vs 1%, OR 3.2), irregular menstruation (15.5% vs 6.9%, OR 2.45), and dysmenorrhea (10.9% vs 4.24%, OR 2.76). Menopausal and peri-menopausal disorder (4.3% vs 1.56%, OR 2.85), endometriosis (2.3% vs 0.93%, OR 2.53), infertility (1.44% vs 0.85%, OR 1.69), absent/rare menstruation (4.6% vs 2%, OR 2.34) and recurrent pregnancy loss (0.37% vs 1.78%, OR 2.1) occurred at higher rates in celiac women (Table 1). Conclusion: Women with CD may have a higher frequency of women’s health disorders such as primary ovarian failure, polycystic ovarian syndrome, irregular menstruation, dysmenorrhea, infertility, menopausal and perimenopausal disorder, endometriosis, and recurrent pregnancy loss. Clinicians should be aware of these associations both to screen for CD in women with these conditions and to detect the presence of these women’s health disorders in CD patients during routine longitudinal or follow-up care. Table 1. - Celiac Disease (n=9,368) No Celiac Disease (n=25,771,736) OR/CI Women’s Health Outcomes Primary Ovarian Failure 90 (0.96%) 41,429 (0.16%) 6.25 (4.89-7.41) Ovarian Dysfunction 416 (4.4%) 324,204 (1.25%) 3.64 (3.30-4.02) Polycystic ovary syndrome 310 (3.3%) 265,126 (1.0%) 3.2 (2.94-3.68) Irregular Menstruation (Excessive, frequent, and irregular or Abnormal uterine or vaginal bleeding) 1,460 (15.5%) 1,800,245 (6.9%) 2.45 (2.32-2.6) Pain associated with menstrual cycle 1,022 (10.90%) 1,094,924 (4.24%) 2.76 (2.58-2.94) Noninflammatory ovarian and fallopian and ligament 509 (5.43%) 618,622 (2.4%) 2.33 (2.13-2.55) Menopausal and per-menopausal disorder 406 (4.3%) 402,573 (1.56%) 2.85 (2.58-3.15) Endometriosis 218 (2.3%) 239,922 (0.93%) 2.53 (2.21-2.9) Infertility 135 (1.44%) 219,904 (0.85%) 1.69 (1.43-2.01) Absent and rare menstruation 435 (4.6%) 524,278 (2.0%) 2.34 (2.13-2.58) Recurrent pregnancy loss 35 (0.37%) 45,807 (1.78%) 2.1 (1.51-2.93)