Original ResearchFull Report: Clinical-Alimentary TractLevels of Antibodies Against Tissue Transglutaminase During Pregnancy Are Associated With Reduced Fetal Weight and Birth Weight
Section snippets
Study Design
This study was embedded within the framework of the Generation R Study, a population-based prospective cohort study in The Netherlands from fetal life onward that has been described in detail previously.24, 25 A total of 8880 mothers with a delivery date between April 2002 and January 2006 were included in this study (Figure 2). Enrollment was aimed at early pregnancy but was allowed until the birth of the child.
Ethics approval for the study was obtained from the Medical Ethical Committee of
Results
Maternal and child characteristics are shown in Table 1. The mean (SD) age of the mothers at enrollment was 30 (5) years. Of the 7046 mothers enrolled in the study, 0.5% had positive anti-tTG levels during pregnancy and 4.4% had intermediate anti-tTG levels (Table 1 and Figure 2). Of the mothers with positive anti-tTG levels, 93% of the total study group and 100% of the Western mothers carried the HLA-DQ2 or -DQ8 molecule. Among the mothers with intermediate anti-tTG, 61% to 62% carried the
Discussion
This prospective observational study showed that both positive and intermediate anti-tTG titers during pregnancy have consequences on fetal growth and birth outcomes. The effect of intermediate anti-tTG levels on birth weight was 2 times greater among mothers carrying the HLA-DQ2 or -DQ8 molecule.
It has been debated whether general population screening for celiac disease is warranted, because large subsets of patients with celiac disease often remain undiagnosed.2, 11, 40 On the one hand, the
Acknowledgments
The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with the Erasmus University Rotterdam School of Law and Faculty of Social Sciences, the Municipal Health Service Rotterdam area, Rotterdam, the Rotterdam Homecare Foundation, Rotterdam, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR), Rotterdam. The authors gratefully acknowledge the contribution of general practitioners, hospitals, midwives, and pharmacies in Rotterdam and thank
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Celiac disease or positive tissue transglutaminase antibodies in patients undergoing renal biopsies
2018, Digestive and Liver DiseaseCitation Excerpt :In this study we wanted to focus on the immunologic reactivity and celiac disease autoimmunity, not only on the biopsy-proven celiac disease, and hence the small bowel biopsy was not conducted to patients having positive tTGA levels. This kind of approach has also been applied in recent epidemiological studies where celiac disease autoimmunity defined by tTGA-positivity has been linked to clinical outcomes and prognosis of celiac disease [34,35]. Even if we applied highly sensitive and specific tTGA-test in this study, it is possible that some cases with low positive antibody values might not express celiac disease autoimmunity.
Abnormalities in CD57 + cytotoxic T cells and Vδ1 + γδT cells in subclinical celiac disease in childhood are affected by cytomegalovirus. The Generation R Study
2017, Clinical ImmunologyCitation Excerpt :Sera with a TG2A level of 7 U/ml or higher were considered to be positive per manufacturer's instructions. HLA-DQ2 or HLA-DQ8 carriership in the total cohort was assessed based on DNA from cord blood cells, using a tag single nucleotide polymorphism (SNP) approach [28], as described in detail previously [29]. Of 13 TG2A positive children who carried one of the genetic risk alleles and anti-endomysial antibodies (EMA), 12 children were diagnosed with celiac disease according to the ESPGHAN guideline [30].
Effects of nongenetic factors on immune cell dynamics in early childhood: The Generation R Study
2017, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Six determinants were related to prenatal maternal lifestyle and evaluated by using questionnaires in the first, second, and third trimesters of pregnancy26: maternal age and body mass index before pregnancy, education, net household income, and smoking or alcohol use during pregnancy. Three determinants were related to prenatal maternal immune-mediated diseases: data on maternal atopy were obtained by means of maternal reported questionnaires during pregnancy,26 and serum anti–thyroid peroxidase IgG (anti-TPO) and anti–tissue transglutaminase IgA antibody levels were measured in the second trimester of pregnancy (mean ± SD: 13.4 ± 2.0 and 20.6 ± 1.2 weeks, respectively).28,29 Information on 6 birth-related determinants (ie, sex, gestational age [preterm birth, <37 weeks], birth weight [low birth weight, <2500 g], premature ruptures of the membranes, mode of delivery, and birth season) was obtained from obstetric records assessed in midwife practices and hospitals.25,26
Mother celiac disease and low birthweight
2017, Reproducao e ClimaterioMucosal Healing in Patients With Celiac Disease and Outcomes of Pregnancy: A Nationwide Population-Based Study
2015, Clinical Gastroenterology and HepatologyCitation Excerpt :Both Swedish14 and Danish11,16 studies have shown an increased risk of IUGR or low birth weight in undiagnosed CD. In contrast, a recent study from The Netherlands found no increased risk of low birth weight in women with positive tissue transglutaminase (tTG) antibody levels.24 The failure to detect an increased prevalence of low birth weight in the study from The Netherlands probably was owing to insufficient statistical power, and when grouping mothers with positive and intermediate tTG levels the OR for low birth weight offspring was 1.59 (95% CI, 1.04–2.42).24
Growth trajectories and bone mineral density in anti-tissue transglutaminase antibody-positive children: The generation R study
2015, Clinical Gastroenterology and Hepatology
Conflicts of interest The authors disclose no conflicts.
Funding This phase of the Generation R Study was made possible by financial support from the Erasmus Medical Center Rotterdam, the Erasmus University Rotterdam, and the Netherlands Organization for Health Research and Development (ZonMw) and an unrestricted grant from European Container Terminals (ECT). The funding sources had no role in the study design, implementation, analysis, interpretation, and preparation of the manuscript.