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306Introduction Celiac disease is an autoimmune inflammatory disorder with predominant intestinal involvement It gets triggered by diet containing gluten 1 Patients may present with wide spectrum of symptoms occurring due to malabsorption that include diarrhea abdominal pain abdominal bloating and weight loss The disease may present as delayed menarche early menopause secondary amenorrhea infertility recurrent abortions and intrauterine growth restriction This disease in females may affect the menstrual and reproductive health This can be prevented by an early diagnosis and treatment Celiac disease is associated with multiple systemic involvements such as gastroenterological neurological ophthalmic pancreatic and other systemic involvement 2 Hence celiac disease should be considered and screening tests should be performed in women presenting with menstrual and reproductive problems and treated accordingly 3 We present a case of celiac disease in pregnancy and its outcome CASE REPORT A 25 year old patient known case of celiac disease came to the antenatal outpatient department at 6 4 weeks of gestation for antenatal registration She had history of one spontaneous abortion At the age of 11 years patient presented with pain in abdomen vomiting and confusion Her blood pressure and pulse were within normal limits Sugars were in the range of 240mg L and urinary ketones were positive which was suggestive of diabetic ketoacidosis Patient was then diagnosed with type 1 diabetes mellitus
She was managed conservatively with human insulin along with intravenous fluids Since then the patient had regular follow up in endocrinology Patient was continued on insulin and followed diabetic diet Sugars were monitored regularly In 2015 during evaluation for hypothyroidism anti TPO and anti TTG antibodies were found to be positive suggestive of autoimmune thyroiditis Gastroenterologists were consulted for anti TTG positivity Patient was kept on gluten free diet and duodenal biopsy was performed in March 2015 which showed villi with normal architecture and minimal increase in intraepithelial lymphocytes and mild lymphocytic inflammation in lamina propria Repeat biopsy was done four months later after keeping the patient on gluten diet The Villi were found to be of normal architecture there was patchy increase in intraepithelial lymphocytes and moderate lymphoplasmacytic infiltrates with eosinophils This proved that patient had increased intraepithelial lymphocytes and lymphoplasmacytic inflammation when wheat products were taken Hence the patient was diagnosed with silent celiac disease in August 2015 and was advised gluten free diet Patient had a regular follow up in gastroenterology OPD In December 2016 patient conceived spontaneously and got registered at 6 weeks of gestation She was admitted in the antenatal ward for management of deranged sugar levels ranging up to 250mg dl Endocrinologists advised insulin dose adjustment injectable human insulin regular 8 8 8 8 units subcutaneously and Injectable Levimir 0 0 8 units subcutaneously