1
|
Prasad S, Singh P, Singh A, Mehtab W, Rajput S, Dang S, Chauhan A, Rajput MS, Kachhawa G, Jagannath S, Ahuja V, Makharia GK. Reproductive functions and pregnancy outcome in female patients with celiac disease. J Gastroenterol Hepatol 2024. [PMID: 38632832 DOI: 10.1111/jgh.16555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/13/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND AIM Abnormalities in the reproductive functions are often ignored while evaluating a patient with celiac disease (CeD). We evaluated the entire reproductive functions in female patients with CeD. METHODS In a case control study between 2020 and 2021 using detailed questionnaire, we evaluated reproductive functions (age at menarche, menstrual pattern, fertility, pregnancy outcome and menopause) in biopsy-proven female patients with CeD of age >10 years. The questionnaire was administered either in person or telephonically. Age-matched healthy female controls (twice the number) were also recruited. RESULTS Of 1086 CeD patients, 470 were females and 288 were included. As compared with controls (n = 586), females with CeD had higher age at menarche (14.6 ± 2.0 vs 13.6 ± 1.5 years; P = 0.001), delayed menarche (30.8% vs 11.4%; P = 0.001), abnormal menstrual pattern (39.7% vs 25.8%; P < 0.001), involuntary delay in conception at > 1 year (33.8% vs 11.8%; P = 0.01), current infertility rate (10.5% vs 5.2%;P = 0.028), and poorer overall pregnancy outcomes (abortion [23.5% vs 12.8%; P = 0.001], pre-term birth [16.3% vs 3.7%; P = 0.001]). CONCLUSIONS Either one or more aspect of reproductive functions and pregnancy outcome is affected adversely in three-fourth female patients with CeD.
Collapse
Affiliation(s)
- Shubham Prasad
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Singh
- Department of Medicine, Lady Harding Medical College, New Delhi, India
| | - Alka Singh
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Wajiha Mehtab
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Simple Rajput
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Sana Dang
- Department of Medicine, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ashish Chauhan
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Mahendra Singh Rajput
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Soumya Jagannath
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
2
|
Adams DW, Moleski S, Jossen J, Tye-Din JA. Clinical Presentation and Spectrum of Gluten Symptomatology in Celiac Disease. Gastroenterology 2024:S0016-5085(24)00417-7. [PMID: 38636679 DOI: 10.1053/j.gastro.2024.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 04/20/2024]
Abstract
Views on the clinical presentation and symptomatology of celiac disease have evolved alongside advances in disease detection and understanding of disease pathogenesis. Although historically regarded as a pediatric illness characterized by malabsorption, it is now better viewed as an immune illness of gluten-specific T cells with systemic manifestations affecting all ages. Its broad presentation, including frequent extraintestinal manifestations and asymptomatic disease, contributes to suboptimal disease detection. Adverse symptoms greatly impact patient quality of life and can result from chronic gluten exposure in untreated disease or those poorly responsive to the gluten-free diet and can also present as acute symptoms after episodic gluten exposure. Functional gastrointestinal disease is a common comorbidity. Biomarkers like interleukin-2 that are highly sensitive and specific for celiac disease highlight a role for gluten-specific T cells in acute gluten symptomatology. A mechanistic understanding of symptoms will inform approaches to better measure and treat them effectively.
Collapse
Affiliation(s)
- Dawn W Adams
- Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephanie Moleski
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jacqueline Jossen
- Departments of Medicine and Pediatrics, The Celiac Disease Center at Columbia University, New York, New York
| | - Jason A Tye-Din
- Immunology Division, Walter and Eliza Hall Institute, Melbourne, Victoria, Australia; Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia; Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| |
Collapse
|
3
|
Razaghi M, Gharibeh N, Vanstone CA, Sotunde OF, Wei SQ, McNally D, Rauch F, Jones G, Weiler HA. Maternal excess adiposity and serum 25-hydroxyvitamin D < 50 nmol/L are associated with elevated whole body fat mass in healthy breastfed neonates. BMC Pregnancy Childbirth 2022; 22:83. [PMID: 35093026 PMCID: PMC8801116 DOI: 10.1186/s12884-022-04403-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/11/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Vitamin D status of pregnant women is associated with body composition of the offspring. The objective of this study was to assess whether the association between maternal vitamin D status and neonatal adiposity is modified by maternal adiposity preconception. METHODS Healthy mothers and their term appropriate weight for gestational age (AGA) infants (n = 142; 59% male, Greater Montreal, March 2016-2019) were studied at birth and 1 month postpartum (2-6 weeks). Newborn (24-36 h) serum was collected to measure total 25-hydroxyvitamin D [25(OH)D] (immunoassay); maternal pre-pregnancy BMI was obtained from the medical record. Anthropometry, body composition (dual-energy X-ray absorptiometry) and serum 25(OH)D were measured at 2-6 weeks postpartum in mothers and infants. Mothers were grouped into 4 categories based on their vitamin D status (sufficient 25(OH)D ≥ 50 nmol/L vs. at risk of being insufficient < 50 nmol/L) and pre-pregnancy BMI (< 25 vs. ≥25 kg/m2): insufficient-recommended weight (I-RW, n = 24); insufficient-overweight/obese (I-OW/O, n = 21); sufficient-recommended weight (S-RW, n = 69); and sufficient-overweight/obese (S-OW/O, n = 28). Partial correlation and linear fixed effects model were used while adjusting for covariates. RESULTS At birth, infant serum 25(OH)D mean concentrations were below 50 nmol/L, the cut-point for sufficiency, for both maternal pre-pregnancy BMI categories; 47.8 [95%CI: 43.8, 51.9] nmol/L if BMI < 25 kg/m2 and 38.1 [95%CI: 33.5, 42.7] nmol/L if BMI ≥25 kg/m2. Infant serum 25(OH)D concentrations at birth (r = 0.77; P < 0.0001) and 1 month (r = 0.59, P < 0.0001) were positively correlated with maternal postpartum serum 25(OH)D concentrations. Maternal serum 25(OH)D concentration was weakly correlated with maternal percent whole body fat mass (r = - 0.26, P = 0.002). Infants of mothers in I-OW/O had higher fat mass versus those of mothers in S-OW/O (914.0 [95%CI: 766.4, 1061.6] vs. 780.7 [95%CI: 659.3, 902.0] g; effect size [Hedges' g: 0.42]; P = 0.04 adjusting for covariates) with magnitude of difference of 220.4 g or ~ 28% difference. CONCLUSIONS Maternal and neonatal vitamin D status are positively correlated. In this study, maternal adiposity and serum 25(OH)D < 50 nmol/L are dual exposures for neonatal adiposity. These findings reinforce the importance of vitamin D supplementation early in infancy irrespective of vitamin D stores acquired in utero and maternal weight status.
Collapse
Affiliation(s)
- Maryam Razaghi
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
| | - Nathalie Gharibeh
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
| | - Catherine A Vanstone
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
| | - Olusola F Sotunde
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
| | - Shu Qin Wei
- Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Dayre McNally
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Frank Rauch
- Shriners Hospital for Children, Montréal, Québec, Canada
| | - Glenville Jones
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Hope A Weiler
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada.
- Nutrition Research Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, 251 Sir Frederick Banting Driveway, Room E338, Ottawa, Ontario, K1A 0K9, Canada.
| |
Collapse
|
4
|
Celdir MG, Choung RS, Rostamkolaei SK, Jansson-Knodell CL, King KS, Larson JJ, Absah I, Murray JA. Reproductive Characteristics and Pregnancy Outcomes in Hidden Celiac Disease Autoimmunity. Am J Gastroenterol 2021; 116:593-9. [PMID: 33560653 DOI: 10.14309/ajg.0000000000001148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Untreated symptomatic celiac disease (CD) adversely affects female reproduction; however, the effect of hidden CD autoimmunity is uncertain. METHODS We identified women who were not previously diagnosed with CD and tested positive for tissue transglutaminase and endomysial antibodies between 2006 and 2011 in a community-based retrospective cohort study. We evaluated (i) the rate of adverse pregnancy outcomes and medical complications of pregnancy in successful singleton deliveries and (ii) reproductive characteristics in seropositive women without a clinical diagnosis of CD and age-matched seronegative women. RESULTS Among 17,888 women whose serum samples were tested for CD autoimmunity, 215 seropositive and 415 seronegative women were included. We reviewed 231 and 509 live singleton deliveries of 117 seropositive and 250 seronegative mothers, respectively. Menarche and menopausal age, gravidity, parity, and age at first child were similar in seropositive and seronegative women. CD seropositivity was not associated with an increased risk of maternal pregnancy complications. Maternal seropositivity was associated with small for gestational age in boys (OR 3.77, 95% CI: 1.47-9.71; P = 0.006), but not in girls (OR 0.57, 95% CI: 0.15-2.17; P = 0.41). CD serum positivity was not associated with prematurity, small for gestational age (birth weight <10th percentile), or 5-minute Apgar score of less than 7. DISCUSSION Although underpowered, the present study did not show any difference in reproductive characteristics or rates of adverse pregnancy outcomes in women with and without CD autoimmunity, except for birth weight in male offspring. Larger studies are needed to determine the effects of CD autoimmunity on female reproduction.
Collapse
|
5
|
Abecassis A, Wainstock T, Sheiner E, Pariente G. Perinatal Outcome and Long-Term Gastrointestinal Morbidity of Offspring of Women with Celiac Disease. J Clin Med 2019; 8:E1924. [PMID: 31717472 DOI: 10.3390/jcm8111924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 10/13/2019] [Accepted: 11/06/2019] [Indexed: 01/03/2023] Open
Abstract
The aim of this study was to evaluate perinatal outcome and long-term offspring gastrointestinal morbidity of women with celiac disease. Perinatal outcomes, as well as long-term gastrointestinal morbidity of offspring of mothers with and without celiac disease were assessed. The study groups were followed until 18 years of age for gastrointestinal-related morbidity. For perinatal outcomes, generalized estimation equation (GEE) models were used. A Kaplan–Meier survival curve was used to compare cumulative incidence of long-term gastrointestinal morbidity, and Cox proportional hazards models were constructed to control for confounders. During the study period, 243,682 deliveries met the inclusion criteria, of which 212 (0.08%) were to mothers with celiac disease. Using GEE models, maternal celiac disease was noted as an independent risk factor for low birth weight and cesarean delivery. Offspring born to mothers with celiac disease had higher rates of gastrointestinal related morbidity (Kaplan–Meier log rank test p < 0.001). Using a Cox proportional hazards model, being born to a mother with celiac disease was found to be an independent risk factor for long-term gastrointestinal morbidity of the offspring. Pregnancy of women with celiac disease is independently associated with adverse perinatal outcome as well as higher risk for long-term gastrointestinal morbidity of offspring.
Collapse
|
6
|
Elliott B, Czuzoj-Shulman N, Spence AR, Mishkin DS, Abenhaim HA. Effect of celiac disease on maternal and neonatal outcomes of pregnancy. J Matern Fetal Neonatal Med 2019; 34:2117-2123. [PMID: 34016019 DOI: 10.1080/14767058.2019.1658733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Celiac disease (CD) is a permanent immune reaction to gluten that is likely related to genetic factors. Some studies have linked CD to adverse maternal and/or neonatal outcomes but the data has been contradictory. The purpose of this study was to evaluate the effect of CD on pregnancy outcomes. MATERIALS AND METHODS We used data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (NIS) of the USA to conduct a population-based retrospective cohort study of women who delivered between 1999 and 2014. Pregnancies were categorized as having CD if corresponding ICD-9 code was present. Unconditional logistic regression models were used to estimate the adjusted effect on maternal and fetal outcomes. RESULTS There were 14,513,587 births during the study period of which 2755 were to women with CD, for an overall prevalence of 1.9 cases/10,000 births and with rates increasing over the study period. Women with CD tended to be older, Caucasian and to have pre-existing comorbidities, especially other autoimmune diseases. Women with CD were at greater risk of hyperemesis gravidarum, 4.52 (3.68-5.57), Clostridium difficile colitis, 7.56 (3.14-18.20), and venous thromboembolic events, 2.93 (2.07-4.15), as well as, hospital stays >3 d, 2.06 (1.75-2.43). Infants of women with CD were more likely to be growth restricted, 1.80 (1.46-2.21) and have congenital malformations, 3.51 (2.68-4.58). CONCLUSIONS CD in pregnancy is associated with increased adverse maternal and newborn complications. These pregnancies should be considered high risk and may benefit from increased surveillance.
Collapse
Affiliation(s)
- Brittney Elliott
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Nicholas Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
| | - Andrea R Spence
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
| | | | - Haim Arie Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada.,Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
| |
Collapse
|
7
|
Schiepatti A, Sprio E, Sanders DS, Lovati E, Biagi F. Coeliac disease and obstetric and gynaecological disorders: where are we now? Eur J Gastroenterol Hepatol 2019; 31:425-33. [PMID: 30676472 DOI: 10.1097/MEG.0000000000001361] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Coeliac disease (CD) is a chronic gluten-dependent enteropathy very common in the general population and characterized by an extremely heterogeneous clinical picture. Although its prevalence is growing worldwide, case-finding strategy remains the mainstay to diagnosis. Thus, correct identification of high-risk categories of patients who need to be tested for CD is an essential part of medical knowledge to a large number of specialists and primary care providers. In this regard, although CD might have a serious effect on women's reproductive health, a widespread consensus is lacking on which categories of obstetric and gynaecological disorders should be tested for CD. The aim of this review is to critically summarize the current literature relevant to CD and obstetric and gynaecological disorders and to provide practical proposals that may be helpful to clinicians involved in the management of these patients.
Collapse
|
8
|
Saccone G, Berghella V, Sarno L, Maruotti GM, Cetin I, Greco L, Khashan AS, McCarthy F, Martinelli D, Fortunato F, Martinelli P. Celiac disease and obstetric complications: a systematic review and metaanalysis. Am J Obstet Gynecol 2016; 214:225-34. [PMID: 26432464 DOI: 10.1016/j.ajog.2015.09.080] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/11/2015] [Accepted: 09/21/2015] [Indexed: 02/03/2023]
Abstract
The aim of this metaanalysis was to evaluate the risk of the development of obstetric complications in women with celiac disease. We searched electronic databases from their inception until February 2015. We included all cohort studies that reported the incidence of obstetric complications in women with celiac disease compared with women without celiac disease (ie, control group). Studies without a control group and case-control studies were excluded. The primary outcome was defined a priori and was the incidence of a composite of obstetric complications that included intrauterine growth restriction, small for gestational age, low birthweight, preeclampsia and preterm birth. Secondary outcomes included the incidence of preterm birth, intrauterine growth restriction, stillbirth, preeclampsia, small for gestational age, and low birthweight. The review was registered with PROSPERO (CRD42015017263) before data extraction. All authors were contacted to obtain the original databases and perform individual participant data metaanalysis. Primary and secondary outcomes were assessed in the aggregate data analysis and in the individual participant data metaanalysis. We included 10 cohort studies (4,844,555 women) in this metaanalysis. Four authors provided the entire databases for the individual participant data analysis. Because none of the included studies stratified data for the primary outcome (ie, composite outcome), the assessment of this outcome for the aggregate analysis was not feasible. Aggregate data analysis showed that, compared with women in the control group, women with celiac disease (both treated and untreated) had a significantly higher risk of the development of preterm birth (adjusted odds ratio, 1.35; 95% confidence interval, 1.09-1.66), intrauterine growth restriction (odds ratio, 2.48; 95% confidence interval, 1.32-4.67), stillbirth (odds ratio, 4.84; 95% confidence interval, 1.08-21.75), low birthweight (odds ratio, 1.63; 95% confidence interval, 1.06-2.51), and small for gestational age (odds ratio, 4.52; 95% confidence interval, 1.02-20.08); no statistically significant difference was found in the incidence of preeclampsia (odds ratio, 2.45; 95% confidence interval, 0.90-6.70). The risk of preterm birth was still significantly higher both in the subgroup analysis of only women with diagnosed and treated celiac disease (odds ratio, 1.26; 95% confidence interval, 1.06-1.48) and in the subgroup analysis of only women with undiagnosed and untreated celiac disease (odds ratio, 2.50; 95% confidence interval; 1.06-5.87). Women with diagnosed and treated celiac disease had a significantly lower risk of the development of preterm birth, compared with undiagnosed and untreated celiac disease (odds ratio, 0.80; 95% confidence interval, 0.64-0.99). The individual participant data metaanalysis showed that women with celiac disease had a significantly higher risk of composite obstetric complications compared with control subjects (odds ratio, 1.51; 95% confidence interval, 1.17-1.94). Our individual participant data concurs with the aggregate analysis for all the secondary outcomes. In summary, women with celiac disease had a significantly higher risk of the development of obstetric complications that included preterm birth, intrauterine growth restriction, stillbirth, low birthweight, and small for gestational age. Since the treatment with gluten-free diet leads to a significant decrease of preterm delivery, physicians should warn these women about the importance of a strict diet to improve obstetric outcomes. Future studies calculating cost-effectiveness of screening for celiac disease during pregnancy, which could be easily performed, economically and noninvasively, are needed. In addition, further studies are required to determine whether women with adverse pregnancy outcomes should be screened for celiac disease, particularly in countries where the prevalence is high.
Collapse
|
9
|
Lebwohl B, Stephansson O, Green PHR, Ludvigsson JF. Mucosal healing in patients with celiac disease and outcomes of pregnancy: a nationwide population-based study. Clin Gastroenterol Hepatol 2015; 13:1111-7.e2. [PMID: 25460563 PMCID: PMC4440846 DOI: 10.1016/j.cgh.2014.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 11/10/2014] [Accepted: 11/13/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Studies have associated undiagnosed celiac disease with adverse outcomes of pregnancy. We investigated the association between persistent villous atrophy and outcomes of pregnancy in women with celiac disease. METHODS We collected data on 337 women with celiac disease who gave birth (to 460 infants) within 5 years of a follow-up biopsy, from 28 pathology departments in Sweden. We compared birth outcomes from women whose follow-up biopsy showed persistent villous atrophy (Marsh score, 3; n = 142; 31% of study population) with those of women with mucosal recovery (n = 318; 69%). We used multivariable logistic regression (adjusted for maternal age, parity, country of birth, smoking, infant sex, and calendar year of birth) to evaluate the association between persistent villous atrophy and pregnancy outcomes. RESULTS Intrauterine growth restriction occurred during 3.5% of pregnancies in women with persistent villous atrophy vs 3.8% of those with mucosal healing (adjusted odds ratio [OR], 0.61; 95% confidence interval [CI], 0.19-1.99). There was no significant association between persistent villous atrophy and low birth weight (OR, 0.98; 95% CI, 0.41-2.39), preterm birth (OR, 1.66; 95% CI, 0.72-3.83), or cesarean section (OR, 0.86; 95% CI, 0.51-1.46). CONCLUSIONS Although undiagnosed celiac disease has been associated with adverse outcomes of pregnancy, we found no evidence from a nationwide population-based study that persistent villous atrophy, based on analysis of follow-up biopsies, increases risk compared with mucosal healing.
Collapse
Affiliation(s)
- Benjamin Lebwohl
- Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden,Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Peter HR Green
- Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Jonas F. Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Pediatrics, Örebro University Hospital, Sweden,Correspondence and reprint requests: Jonas F Ludvigsson, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden,
| |
Collapse
|
10
|
Kahveci H, Turan MI, Cayir A, Laloglu F, Ertekin V, Orbak Z. The Evaluation of The Effects of Paternal And Maternal Silent Coeliac Disease on Birthweight and Gestational Age in Newborns. W INDIAN MED J 2014; 63:470-3. [PMID: 25781285 DOI: 10.7727/wimj.2013.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 10/16/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Coeliac disease is a chronic disease and is common all over the world. It has many other associated systemic side effects. This study investigated the effect of paternal and maternal silent coeliac disease on birthweight and gestational age in newborns. METHODS The study group consisted of 81 newborns who were hospitalized for prematurity or term-intrauterine growth retardation. The parents of premature and/or small for gestational age babies born with coeliac disease-specific antigens were investigated. RESULTS The differences were not statistically significant in fathers' tissue transglutaminase levels between premature appropriate gestational age, premature small gestational age and term small gestational age infants (p > 0.05), but statistically significant in mothers (p < 0.05). CONCLUSIONS Silent coeliac disease may occur in parents, especially in mothers of preterm and small for gestational age infants, even in the absence of apparent clinical indications.
Collapse
|
11
|
Ban L, West J, Abdul Sultan A, Dhalwani NN, Ludvigsson JF, Tata LJ. Limited risks of major congenital anomalies in children of mothers with coeliac disease: a population-based cohort study. BJOG 2014; 122:1833-41. [DOI: 10.1111/1471-0528.13102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2014] [Indexed: 01/08/2023]
Affiliation(s)
- L Ban
- Division of Epidemiology & Public Health; School of Medicine; Nottingham City Hospital; University of Nottingham; Nottingham UK
| | - J West
- Division of Epidemiology & Public Health; School of Medicine; Nottingham City Hospital; University of Nottingham; Nottingham UK
| | - A Abdul Sultan
- Division of Epidemiology & Public Health; School of Medicine; Nottingham City Hospital; University of Nottingham; Nottingham UK
| | - NN Dhalwani
- Division of Epidemiology & Public Health; School of Medicine; Nottingham City Hospital; University of Nottingham; Nottingham UK
| | - JF Ludvigsson
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
- Department of Paediatrics; Örebro University Hospital; Örebro Sweden
| | - LJ Tata
- Division of Epidemiology & Public Health; School of Medicine; Nottingham City Hospital; University of Nottingham; Nottingham UK
| |
Collapse
|
12
|
Abdul Sultan A, Tata LJ, Fleming KM, Crooks CJ, Ludvigsson JF, Dhalwani NN, Ban L, West J. Pregnancy complications and adverse birth outcomes among women with celiac disease: a population-based study from England. Am J Gastroenterol 2014; 109:1653-61. [PMID: 25091060 DOI: 10.1038/ajg.2014.196] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 05/31/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Evidence-based information about adverse birth outcomes and pregnancy complications is crucial when counseling women with celiac disease (CD); however, limited population-based data on such risks exist. We estimated these for pregnant women with CD diagnosed before and after delivery. METHODS We included all singleton pregnancies between 1997 and 2012 using linked primary care data from the Clinical Practice Research Datalink and secondary care Hospital Episode Statistics data. Risks of pregnancy complications (antepartum and postpartum hemorrhage, pre-eclampsia, and mode of delivery) and adverse birth outcomes (preterm birth, stillbirth, and low birth weight) were compared between pregnancies of women with and without CD using logistic/multinomial regression. Risks were stratified on the basis of whether women were diagnosed or yet undiagnosed before delivery. RESULTS Of 363,930 pregnancies resulting in a live birth or stillbirth, 892 (0.25%) were among women with CD. Diagnosed CD was not associated with an increased risk of pregnancy complications or adverse birth outcomes compared with women without CD. However, the risk of postpartum hemorrhage and assisted delivery was slightly higher among pregnant women with diagnosed CD (adjusted odds ratio (aOR)=1.34). We found no increased risk of any pregnancy complication among those with undiagnosed CD. We only observed a 1% absolute excess risk of preterm birth and low birth weight among undiagnosed CD mothers corresponding to aOR=1.24 (95% confidence interval (CI)=0.82-1.87) and aOR=1.36 (95% CI=0.83-2.24), respectively. CONCLUSIONS Whether diagnosed or undiagnosed during pregnancy, CD is not associated with a major increased risk of pregnancy complications and adverse birth outcomes. These findings are reassuring to both women and clinicians.
Collapse
Affiliation(s)
- Alyshah Abdul Sultan
- Division of Epidemiology and Public Health, City Hospital Campus, The University of Nottingham, Nottingham, UK
| | - Laila J Tata
- Division of Epidemiology and Public Health, City Hospital Campus, The University of Nottingham, Nottingham, UK
| | - Kate M Fleming
- Division of Epidemiology and Public Health, City Hospital Campus, The University of Nottingham, Nottingham, UK
| | - Colin J Crooks
- Division of Epidemiology and Public Health, City Hospital Campus, The University of Nottingham, Nottingham, UK
| | - Jonas F Ludvigsson
- 1] Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden [2] Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
| | - Nafeesa N Dhalwani
- Division of Epidemiology and Public Health, City Hospital Campus, The University of Nottingham, Nottingham, UK
| | - Lu Ban
- Division of Epidemiology and Public Health, City Hospital Campus, The University of Nottingham, Nottingham, UK
| | - Joe West
- Division of Epidemiology and Public Health, City Hospital Campus, The University of Nottingham, Nottingham, UK
| |
Collapse
|
13
|
Shah S, Akbari M, Vanga R, Kelly CP, Hansen J, Theethira T, Tariq S, Dennis M, Leffler DA. Patient perception of treatment burden is high in celiac disease compared with other common conditions. Am J Gastroenterol 2014; 109:1304-11. [PMID: 24980880 PMCID: PMC4159418 DOI: 10.1038/ajg.2014.29] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/22/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The only treatment for celiac disease (CD) is life-long adherence to a gluten-free diet (GFD). Noncompliance is associated with signs and symptoms of CD, yet long-term adherence rates are poor. It is not known how the burden of the GFD compares with other medical treatments, and there are limited data on the socioeconomic factors influencing treatment adherence. In this study, we compared treatment burden and health state in CD compared with other chronic illnesses and evaluated the relationship between treatment burden and adherence. METHODS Survey was mailed to participants with CD, gastroesophageal reflux disease (GERD), irritable bowel syndrome, inflammatory bowel disease, hypertension (HTN), diabetes mellitus (DM), congestive heart failure, and end-stage renal disease (ESRD) on dialysis. Surveys included demographic information and visual analog scales measuring treatment burden, importance of treatment, disease-specific health status, and overall health status. RESULTS We collected surveys from 341 celiac and 368 non-celiac participants. Celiac participants reported high treatment burden, greater than participants with GERD or HTN and comparable to ESRD. Conversely, patients with CD reported the highest health state of all groups. Factors associated with high treatment burden in CD included poor adherence, concern regarding food cost, eating outside the home, higher income, lack of college education, and time limitations in preparing food. Poor adherence in CD was associated with increased symptoms, income, and low perceived importance of treatment. CONCLUSIONS Participants with CD have high treatment burden but also excellent overall health status in comparison with other chronic medical conditions. The significant burden of dietary therapy for CD argues for the need for safe adjuvant treatment, as well as interventions designed to lower the perceived burden of the GFD.
Collapse
Affiliation(s)
- Sveta Shah
- Celiac Center and Department of Gastroenterology, Beth Israel Deaconess Medical Center
| | - Mona Akbari
- Celiac Center and Department of Gastroenterology, Beth Israel Deaconess Medical Center
| | - Rohini Vanga
- Celiac Center and Department of Gastroenterology, Beth Israel Deaconess Medical Center
| | - Ciaran P. Kelly
- Celiac Center and Department of Gastroenterology, Beth Israel Deaconess Medical Center
| | - Joshua Hansen
- Celiac Center and Department of Gastroenterology, Beth Israel Deaconess Medical Center
| | - Thimmaiah Theethira
- Celiac Center and Department of Gastroenterology, Beth Israel Deaconess Medical Center
| | - Sohaib Tariq
- Celiac Center and Department of Gastroenterology, Beth Israel Deaconess Medical Center
| | - Melinda Dennis
- Celiac Center and Department of Gastroenterology, Beth Israel Deaconess Medical Center
| | - Daniel A. Leffler
- Celiac Center and Department of Gastroenterology, Beth Israel Deaconess Medical Center
| |
Collapse
|
14
|
Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A, Scambia G, Di Simone N. Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Hum Reprod Update 2014; 20:582-93. [PMID: 24619876 DOI: 10.1093/humupd/dmu007] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND An increased risk of reproductive failures in women with celiac disease (CD) has been shown by several studies but a comprehensive evaluation of this risk is lacking. Furthermore, the pathogenic mechanisms responsible for obstetric complications occurring in CD have not been unraveled. METHODS To better define the risk of CD in patients with reproductive disorders as well as the risk in known CD patients of developing obstetric complications, we performed an extensive literature search of Medline and Embase databases. Odds ratio (OR) and relative risk (RR) with 95% confidence intervals (95% CI) were used in order to combine data from case-control and cohort studies, respectively. All data were analyzed using Review Manager software. In addition, we summarized and discussed the current hypotheses of pathogenic mechanisms potentially responsible for obstetric complications occurring in CD. RESULTS Patients with unexplained infertility, recurrent miscarriage or intrauterine growth restriction (IUGR) were found to have a significantly higher risk of CD than the general population. The OR for CD was 5.06 (95% CI 2.13-11.35) in patients with unexplained infertility, 5.82 (95% CI 2.30-14.74) in women experiencing recurrent miscarriage and 8.73 (95% CI 3.23-23.58) in patients with IUGR. We did not observe an increased risk of CD in women delivering small-for-gestational age or preterm babies. Furthermore, we found that in celiac patients, the risk of miscarriage, IUGR, low birthweight (LBW) and preterm delivery is significantly higher with an RR of 1.39 (95% CI 1.15-1.67), 1.54 (95% CI 1.22-1.95), 1.75 (95% CI 1.23-2.49) and 1.37 (95% CI 1.19-1.57), respectively. In addition, we observed that the risk for IUGR, LBW and preterm delivery was significantly higher in untreated patients than in treated patients. No increased risk of recurrent miscarriage, unexplained stillbirth or pre-eclampsia was found in celiac patients. In vitro studies have provided two main pathogenic models of placental damage at the feto-maternal interface. On the embryonic side of the placenta, a direct binding of anti-transglutaminase (-TG) antibodies to trophoblast cells and, thus, invasiveness reduction via an apoptotic damage, has been proposed. Anti-TG antibodies may also be detrimental to endometrial angiogenesis as shown in vitro in human endometrial endothelial cells (cultures and in vivo in a murine model). The angiogenesis inhibition seems to be the final effect of anti-TG antibody-mediated cytoskeletal damage in endometrial endothelial cells. CONCLUSIONS Physicians should investigate women with unexplained infertility, recurrent miscarriage or IUGR for undiagnosed CD. Women with CD show an increased risk of miscarriage, IUGR, LBW and preterm delivery. However, the risk is significantly reduced by a gluten-free diet. These patients should therefore be made aware of the potential negative effects of active CD also in terms of reproductive performances, and of the importance of a strict diet to ameliorate their health condition and reproductive health. Different mechanisms seem to be involved in determining placental tissue damage in CD patients.
Collapse
Affiliation(s)
- Chiara Tersigni
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Roberta Castellani
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Chiara de Waure
- Institute of Public Health, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Fattorossi
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Marco De Spirito
- Institute of Physics, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine, Università Cattolica Del Sacro Cuore, Policlinico A. Gemelli, 00168 Rome, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Nicoletta Di Simone
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168 Rome, Italy
| |
Collapse
|
15
|
Abstract
Celiac disease (CD) is characterized by an abnormal immune response in susceptible individuals to dietary gluten derived from wheat, rye and barley. The disease affects not only the small bowel mucosa, but also many other extraintestinal organs resulting bone, liver, neurologic, skin and reproductive system disorders. The details of the pathogenic mechanism are not perfectly clear yet, but it is now proved that both humoral and cellular immune responses are triggered and autoimmune mechanisms are implicated. Studies have shown association of different pregnancy outcomes with maternal celiac disease. In this review, the most frequent fetal and neonatal outcome related to CD are presented, with a special focus on intrautherine growth restriction (IUGR) and prematurity. The need of active case finding of CD is discussed.
Collapse
Affiliation(s)
- Nicolae Suciu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Carol Davila" , Bucharest , Romania
| | | | | | | | | | | |
Collapse
|
16
|
Zugna D, Richiardi L, Stephansson O, Cnattingius S, Ludvigsson JF. Mortality rate in children born to mothers and fathers with celiac disease: a nationwide cohort study. Am J Epidemiol 2013; 177:1348-55. [PMID: 23620240 DOI: 10.1093/aje/kws397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Celiac disease (CD) is associated with increased mortality rate and adverse pregnancy outcome, but little is known about offspring mortality rate. In this nationwide retrospective cohort study, we identified persons whose biopsy-verified CD was diagnosed in Sweden in 1969-2008. We compared mortality rates in children born to mothers with and without CD (n = 16,121 vs. n = 61,782) and children born to fathers with and without CD (n = 9,289 vs. n = 32,984). Median age of offspring at end of follow-up was 28.7 (range, 16.7-39.7) years. We also examined mortality rates in children born to mothers with undiagnosed CD (later CD diagnosis; n = 12,919) and diagnosed CD (n = 3,202) to determine if intrauterine exposures associated with CD could affect offspring mortality rate. We estimated hazard ratios for death by using Cox regression. Death rates were independent of maternal CD (60 deaths per 100,000 person-years in children of mothers with CD, vs. 54 in controls) and paternal CD (53 deaths per 100,000 person-years in children of fathers with CD, vs. 53 in controls). Corresponding adjusted hazard ratios were 1.09 (95% confidence interval: 0.95, 1.26) for maternal CD and 1.02 (95% confidence interval: 0.85, 1.23) for paternal CD. Death rates were similar in children born to mothers with undiagnosed CD and in children whose mothers had diagnosed CD during pregnancy. Parental CD does not seem to influence mortality rate in offspring, which suggests that neither genetic influences of CD nor intrauterine conditions have adverse effects on offspring mortality rate.
Collapse
Affiliation(s)
- Daniela Zugna
- Cancer Epidemiology Unit, Centro di Rieferimento per L’Epidemiologia e la Prevenzione Oncologica in Piemonte and University of Turin, Turin, Italy
| | | | | | | | | |
Collapse
|
17
|
Abstract
This guideline presents recommendations for the diagnosis and management of patients with celiac disease. Celiac disease is an immune-based reaction to dietary gluten (storage protein for wheat, barley, and rye) that primarily affects the small intestine in those with a genetic predisposition and resolves with exclusion of gluten from the diet. There has been a substantial increase in the prevalence of celiac disease over the last 50 years and an increase in the rate of diagnosis in the last 10 years. Celiac disease can present with many symptoms, including typical gastrointestinal symptoms (e.g., diarrhea, steatorrhea, weight loss, bloating, flatulence, abdominal pain) and also non-gastrointestinal abnormalities (e.g., abnormal liver function tests, iron deficiency anemia, bone disease, skin disorders, and many other protean manifestations). Indeed, many individuals with celiac disease may have no symptoms at all. Celiac disease is usually detected by serologic testing of celiac-specific antibodies. The diagnosis is confirmed by duodenal mucosal biopsies. Both serology and biopsy should be performed on a gluten-containing diet. The treatment for celiac disease is primarily a gluten-free diet (GFD), which requires significant patient education, motivation, and follow-up. Non-responsive celiac disease occurs frequently, particularly in those diagnosed in adulthood. Persistent or recurring symptoms should lead to a review of the patient's original diagnosis to exclude alternative diagnoses, a review of the GFD to ensure there is no obvious gluten contamination, and serologic testing to confirm adherence with the GFD. In addition, evaluation for disorders associated with celiac disease that could cause persistent symptoms, such as microscopic colitis, pancreatic exocrine dysfunction, and complications of celiac disease, such as enteropathy-associated lymphoma or refractory celiac disease, should be entertained. Newer therapeutic modalities are being studied in clinical trials, but are not yet approved for use in practice. Given the incomplete response of many patients to a GFD-free diet as well as the difficulty of adherence to the GFD over the long term, development of new effective therapies for symptom control and reversal of inflammation and organ damage are needed. The prevalence of celiac disease is increasing worldwide and many patients with celiac disease remain undiagnosed, highlighting the need for improved strategies in the future for the optimal detection of patients.
Collapse
Affiliation(s)
- Alberto Rubio-Tapia
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Ivor D Hill
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ciarán P Kelly
- Celiac Center, Division of Gastroenterology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts
| | - Audrey H Calderwood
- Gastroenterology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
18
|
Kiefte-de Jong JC, Jaddoe VWV, Uitterlinden AG, Steegers EAP, Willemsen SP, Hofman A, Hooijkaas H, Moll HA. Levels of antibodies against tissue transglutaminase during pregnancy are associated with reduced fetal weight and birth weight. Gastroenterology 2013; 144:726-735.e2. [PMID: 23313966 DOI: 10.1053/j.gastro.2013.01.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 12/10/2012] [Accepted: 01/01/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Celiac disease in pregnant women has been associated with poor growth of the fetus, but little is known about how the level of celiac disease affects fetal growth or birth outcomes. We assessed the associations between levels of antibodies against tissue transglutaminase (anti-tTG, a marker of celiac disease) and fetal growth and birth outcomes for pregnant women. METHODS We performed a population-based prospective birth cohort study of 7046 pregnant women. Serum samples were collected during the second trimester of pregnancy and analyzed for levels of anti-tTG. Based on these levels, the women were categorized into 3 groups: negative anti-tTG (≤0.79 U/mL; n = 6702), intermediate anti-tTG (0.8 to ≤6 U/mL; n = 308), or positive anti-tTG (>6 U/mL; n = 36). Data on fetal growth and birth outcomes were collected from ultrasound measurements and medical records. RESULTS Fetuses of women in the positive anti-tTG group weighed 16 g less than those of women in the negative anti-tTG group (95% confidence interval [CI], -32 to -1 g) during the second trimester and weighed 74 g less (95% CI, -140 to -8 g) during the third trimester. Newborns of women in the intermediate and positive anti-tTG groups weighed 53 g (95% CI, -106 to -1 g) and 159 g (95% CI, -316 to -1 g) less at birth, respectively, than those of women in the negative anti-tTG group. The reduction in birth weight in offspring of mothers in the intermediate anti-tTG group was 2-fold greater among mothers who carried HLA-DQ2 or -DQ8 than among those without HLA-DQ2 or -DQ8. CONCLUSIONS Levels of anti-tTG in pregnant women are inversely associated with fetal growth. Growth was reduced to the greatest extent in fetuses of women with the highest levels of anti-tTG (>6 U/mL). Birth weight was also reduced in women with intermediate levels of anti-tTG (0.8 to ≤6 U/mL) and further reduced in those carrying HLA-DQ2 and -DQ8.
Collapse
|
19
|
Abstract
OBJECTIVE An association between small for gestational age (SGA) and risk for celiac disease (CD) in childhood has previously been reported. However, this association may reflect residual confounding by genetic or environmental factors. For example, presence of subclinical CD in the mother might be a common cause of both SGA and CD in the offspring. We investigate whether SGA is causally associated with CD before age six years by applying both conventional population-based regression models and sibling analysis that investigates the association in siblings discordant for SGA. MATERIAL AND METHODS Using the Swedish Medical Birth Registry, we identified all singleton children born in Sweden during 1987-1993 (792,401). Of these we included 681,954 children in the study and identified 2641 cases of CD using the Swedish National In-Hospital Registry. We applied both conventional Cox regression analysis and a quasi-experimental sibling design that to some extent simulates a counterfactual situation of exposure, reducing possible confounding effects of genetic and shared environmental factors. RESULTS We identified an increased risk of CD in both boys (hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.25-2.32) and girls (HR 1.30, 95% CI 0.99-1.70) using conventional Cox regression models. Using sibling analysis, the association between SGA and CD was confirmed in boys (HR 4.23, 95% CI 1.19-15.04) but not in girls (HR 1.00, 95% CI 0.45-2.20). CONCLUSIONS Our results support a causal association between SGA and CD risk in boys but not in girls, although the mechanisms underlying this difference are still unclear.
Collapse
Affiliation(s)
- Carl Johan Wingren
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Unit for Social Epidemiology, Malmö, Sweden.
| | | | | |
Collapse
|
20
|
Abstract
Malabsorption syndrome encompasses numerous clinical entities that result in chronic diarrhea, abdominal distention, and failure to thrive. These disorders may be congenital or acquired and include cystic fibrosis and Shwachman-Diamond syndrome; the rare congenital lactase deficiency; glucose-galactose malabsorption; sucrase-isomaltase deficiency; adult-type hypolactasia leading to acquired lactose intolerance. The pathology may be due to impairment in absorption or digestion of nutrients resulting in Nutritional deficiency, gastrointestinal symptoms, and extra gastrointestinal symptoms. Treatment is aimed at correcting the deficiencies and symptoms to improve quality of life. Common disorders of malabsorption celiac disease, pernicious anemia, and lactase deficiency are discussed in this article.
Collapse
Affiliation(s)
- Zafreen Siddiqui
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, 5909 Harry Hines Boulevard, Suite 100, Dallas, TX 75390-9067, USA.
| | | |
Collapse
|
21
|
Soler-Bel J, Veganzones I, Navarro A, Ramos F, Serra-Buxeda E, Ferreres JC. Raquitismo fetal mortal y celiaquía materna no diagnosticada. Gastroenterología y Hepatología 2011; 34:678-82. [DOI: 10.1016/j.gastrohep.2011.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 05/06/2011] [Accepted: 05/12/2011] [Indexed: 11/26/2022]
|
22
|
Abstract
OBJECTIVE We evaluated menopause-associated disorders and fertile life span in women with celiac disease (CD) under untreated conditions and after long-term treatment with a gluten-free diet. METHODS The participants were 33 women with CD after menopause (untreated CD group), 25 celiac women consuming a gluten-free diet at least 10 years before menopause (treated CD group), and 45 healthy volunteers (control group). The Menopause Rating Scale questionnaire was used to gather information on menopause-associated disorders. The International Physical Activity Questionnaire was used to acquire information on physical activity. RESULTS Untreated celiac women had a shorter duration of fertile life span than did the control women because of an older age of menarche and a younger age of menopause (P < 0.01). The scores for hot flushes, muscle/joint problems, and irritability were higher in untreated celiac women than in the control women (higher by 49.4%, 121.4%, and 58.6%, respectively; P < 0.05). In comparison with untreated CD, long-lasting treatment of CD was not associated with a significant difference in the duration of fertile life span, but was only associated with a significant reduction in muscle/joint problems (a reduction of 47.1%; P < 0.05). CONCLUSIONS Late menarche and early menopause causes a shorter fertile period in untreated celiac women compared with control women. A gluten-free diet that started at least 10 years before menopause prolongs the fertile life span of celiac women. The perception of intensity of hot flushes and irritability is more severe in untreated celiac women than in controls. Low physical exercise and/or poorer quality of life frequently reported by untreated celiac women might be the cause of reduced discomfort tolerance, thus increasing the subjective perception of menopausal symptoms.
Collapse
Affiliation(s)
- Antonella Santonicola
- Department of Clinical and Experimental Medicine, University Federico II of Naples, Naples, Italy
| | | | | | | | | | | |
Collapse
|
23
|
Özgör B, Selimoğlu MA, Temel İ, Seçkin Y, Kafkaslı A. Prevalence of celiac disease in parents of preterm or low birthweight newborns. J Obstet Gynaecol Res 2011; 37:1615-9. [DOI: 10.1111/j.1447-0756.2011.01584.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
24
|
Abstract
Coeliac disease is a gluten-sensitive enteropathy affecting up to 1% of the population. An accumulating body of evidence supports the association of coeliac disease with adverse pregnancy outcomes, including increased risk of miscarriage and intrauterine growth restriction. Reports differ regarding the extent and severity of these associations, in addition to the exact pathophysiology underlying these associations. Overall, coeliac disease is believed to be a significant condition in pregnancy and reproductive medicine with some advocating the screening of coeliac disease in all pregnant women or some specific high-risk groups.
Collapse
Affiliation(s)
- M M Butler
- Anu Research Center, Department of Obstetrics and Gynaecology, University College Cork , Cork , Ireland
| | - L C Kenny
- Anu Research Center, Department of Obstetrics and Gynaecology, University College Cork , Cork , Ireland
| | - F P McCarthy
- Anu Research Center, Department of Obstetrics and Gynaecology, University College Cork , Cork , Ireland
| |
Collapse
|
25
|
Abstract
Celiac disease (CD) is an immune-mediated enteropathy that is secondary to gluten ingestion and classically associated with gastrointestinal symptoms. Diagnosis is based on serology and confirmatory duodenal biopsy, and the only treatment is lifelong avoidance of gluten. CD has been increasingly recognized to encompass a wide variety of manifestations that are relevant to women’s health, including infertility, adverse pregnancy outcomes and reduced BMD. Currently, CD is underdiagnosed, largely owing to lack of recognition of the diverse manifestations by general practitioners. Increased awareness of the clinical spectrum of this disease, as well as targeted testing in at-risk individuals (including women with unexplained infertility and previous adverse pregnancy outcomes, and in specific populations with reduced BMD) is greatly needed in order to improve rates of diagnosis.
Collapse
Affiliation(s)
- Sveta Shah
- The Celiac Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | | |
Collapse
|
26
|
Abstract
Celiac disease is a mucosal disorder of the small intestine that may be triggered by dietary exposure to gluten in genetically-susceptible individuals. The disorder is often associated with diarrhea, malabsorption and weight loss along with other extra-intestinal complications. Reproductive changes have been described, including impaired fertility and adverse pregnancy outcomes possibly related to immune-mediated mechanisms or nutrient deficiency. Other possible pathogenetic factors that may alter placental function include maternal celiac disease autoantibodies binding to placental transglutaminase, and genetic mutations that may facilitate microthrombus formation. Reports noting activation during pregnancy or the puerperium may be important, and suggest that celiac disease may also be hypothetically precipitated by maternal exposure to one or more fetal antigens.
Collapse
|
27
|
Abstract
Celiac disease is one of the most common chronic diseases encountered in the Western world with a serological prevalence of approximately 1%. Since it is so common, much comorbidity will occur either as associations or simply by chance, or as complications of the disorder. Many of the published studies purporting to establish the frequency of these occurrences have been limited by factors such as the source and number of patients considered, choice of control groups and ascertainment bias. Recent epidemiological studies have attempted to minimize these sources of error and provide more reliable information. Autoimmune diseases constitute clinically important associations, of which Type 1 diabetes mellitus and thyroid disorders are the most important. Several liver disorders, including primary biliary cirrhosis and primary sclerosing cholangitis, are also associated. The frequency of malignant complications of celiac disease is much lower than earlier studies have indicated, with lymphoma increased by approximately fivefold and the absolute number of tumors is small. The increase in fracture risk in celiac disease is only modest. Although neurological and psychiatric conditions affect celiac patients, no disorder specifically associated with celiac disease has been identified. Reproductive problems have been overexaggerated. It is important that these co-morbidities are recognized because if not, symptoms will be falsely attributed to deliberate or inadvertent ingestion of gluten, rather than prompt a search for a second diagnosis. Furthermore, in a patient with an established diagnosis that is considered falsely to account for the whole clinical picture, celiac disease is likely to remain undetected.
Collapse
Affiliation(s)
- Nina R Lewis
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | | |
Collapse
|
28
|
Di Simone N, Silano M, Castellani R, Di Nicuolo F, D'Alessio MC, Franceschi F, Tritarelli A, Leone AM, Tersigni C, Gasbarrini G, Silveri NG, Caruso A, Gasbarrini A. Anti-tissue transglutaminase antibodies from celiac patients are responsible for trophoblast damage via apoptosis in vitro. Am J Gastroenterol 2010; 105:2254-61. [PMID: 20571491 DOI: 10.1038/ajg.2010.233] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The association between maternal celiac disease (CD) and both reduced fertility and increased risk of adverse pregnancy-related events has been long documented. However, no evidences are available regarding the pathogenic mechanisms of this link. The aim of this study was to determine whether anti-tissue transglutaminase (anti-tTG) antibodies are involved in the damage of trophoblastic cells in vitro. METHODS Human primary trophoblastic cells, isolated from term placenta, were exposed to anti-tTG immunoglobulin G (IgG) antibodies, both commercially available and separated from sera of three untreated celiac women. The ability of anti-tTG antibodies to bind to trophoblastic cells, invasiveness of placental cells through a layer of extracellular matrix, and the activity of cellular matrix metalloprotease (MMP) and cellular apoptosis were evaluated, as indicators of trophoblast damage, by TdT-mediated dUTP digoxigenin nick end labeling (TUNEL) and annexin V expression. RESULTS Anti-tTG IgG showed a specific dose- and time-dependent binding to human trophoblast. In addition, trophoblastic cells, after being exposed to anti-tTG IgG antibodies, both commercially available and separated from sera of celiac women, showed an impaired invasiveness, a decreased activity of cellular MMP, and a greater percentage of TUNEL positivity and annexin V positivity. CONCLUSIONS We showed that the binding of anti-tTG antibodies to trophoblast might represent a key mechanism by which the embryo implantation and pregnancy outcome are impaired in untreated celiac pregnant women. Because healthy trophoblast development is essential for placental and fetal development, these data provide a novel mechanism for CD-induced infertility, early pregnancy loss, and intrauterine growth retardation.
Collapse
|
29
|
Khashan AS, Kenny LC, McNamee R, Mortensen PB, Pedersen MG, McCarthy FP, Henriksen TB. Undiagnosed coeliac disease in a father does not influence birthweight and preterm birth. Paediatr Perinat Epidemiol 2010; 24:363-9. [PMID: 20618726 DOI: 10.1111/j.1365-3016.2010.01125.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
There is conflicting evidence regarding the effect of coeliac disease (CD) in the father on birthweight and preterm birth. We investigated the association between paternal CD and birthweight and preterm birth. Medical records of all singleton live-born children in Denmark between 1 January 1979 and 31 December 2004 were linked to information about parents' diseases. Fathers who were diagnosed with CD were then identified. Fathers with CD were considered treated if they were diagnosed before pregnancy and untreated if they were diagnosed after the date of conception. The outcome measures were: birthweight, small-for-gestational age (birthweight<10th centile for gestational age) and preterm birth (<37 weeks). We compared the offspring of men without CD (n = 1 472 352) and offspring of those with CD [untreated (n = 138) and treated (n = 473)]. There was no significant association between untreated CD in the father and birthweight (adjusted mean difference = -3 g; [95% CI -46, 40]) or preterm birth (adjusted odds ratio (OR) = 0.86, [95% CI 0.53, 1.37]) (compared with no CD). There was some evidence for an association between treated paternal CD and birthweight (adjusted mean difference = -81 g; [95% CI -161, -3]), but not preterm birth (adjusted OR = 1.76, [95% CI 0.95, 3.26]). Untreated paternal CD was not associated with an increased risk of reduced birthweight, or of preterm birth. There was some evidence that diagnosis and presumed treatment of paternal CD with a gluten-free diet is associated with reduced birthweight.
Collapse
Affiliation(s)
- Ali S Khashan
- Anu Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Ireland.
| | | | | | | | | | | | | |
Collapse
|
30
|
Sud S, Marcon M, Assor E, Palmert MR, Daneman D, Mahmud FH. Celiac disease and pediatric type 1 diabetes: diagnostic and treatment dilemmas. Int J Pediatr Endocrinol 2010; 2010:161285. [PMID: 20652072 PMCID: PMC2905696 DOI: 10.1155/2010/161285] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 04/01/2010] [Indexed: 02/08/2023]
Abstract
Despite the advent of sensitive and specific serologic testing, routine screening for celiac disease (CD) in diabetic populations may not be universal practice, and many clinicians struggle to find the optimal approach to managing CD in pediatric Type 1 diabetes (T1D) patients. While some clinicians advocate screening for CD in all patients with T1D, others are unsure whether this is warranted. The diagnosis of patients who present with symptomatic CD, including malabsorption and obvious pathology upon biopsy, remains straightforward, with improvements noted on a gluten-free diet. Many patients identified by screening, however, tend to be asymptomatic. Evidence is inconclusive as to whether the benefits of screening and potentially treating asymptomatic individuals outweigh the harms of managing a population already burdened with a serious illness. This review focuses on current knowledge of CD in children and youth with T1D, highlighting important elements of the disease's pathophysiology, epidemiology, clinical presentation, and diagnostic challenges.
Collapse
Affiliation(s)
- Shama Sud
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada M5G 1X8
| | - Margaret Marcon
- Division of Gastroenterology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada M5G 1X8
| | - Esther Assor
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada M5G 1X8
| | - Mark R. Palmert
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada M5G 1X8
| | - Denis Daneman
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada M5G 1X8
| | - Farid H. Mahmud
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada M5G 1X8
| |
Collapse
|
31
|
Rajput R, Chatterjee S. Primary infertility as a rare presentation of celiac disease. Fertil Steril 2010; 94:2771.e5-7. [PMID: 20537625 DOI: 10.1016/j.fertnstert.2010.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 04/09/2010] [Accepted: 04/15/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To report a case of a woman presenting with primary infertility who on investigation was found to have celiac disease and had a successful conception when on a gluten-free diet for a period of 8 months. DESIGN Case report. SETTING Tertiary care university hospital. PATIENT(S) A 30-year-old female patient with primary infertility. INTERVENTION(S) Gluten-free diet. MAIN OUTCOME MEASURE(S) Successful pregnancy. RESULT(S) On investigation she had microcytic hypochromic anemia and high titers of IgA tissue transglutaminase. Duodenal biopsy was done and histology was suggestive of celiac disease. The patient was put on gluten-free diet. Eight months later she had a successful conception. CONCLUSION(S) We suggest that celiac disease should be checked in infertile patients of unexplainable etiology with anemia, as just changing their diet can solve their fertility problem.
Collapse
Affiliation(s)
- Rajesh Rajput
- Department of Medicine and Endocrinology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India.
| | | |
Collapse
|
32
|
Abstract
Reproductive problems, such as delayed menarche, amenorrhea, early menopause, infertility, impotence, hypogonadism, recurrent abortions, and low-birth-weight or preterm deliveries, are now known to be among the atypical symptoms of coeliac disease (CD). The pathogenesis of reproductive disorders in CD is unclear, but some hypotheses have been suggested, including autoimmunity and macro- and/or micronutrient deficiency. Recent investigations which have focused on tissue transglutaminase are promising with respect to the clarification of the mechanism of infertility and poor pregnancy outcomes in CD. In this review, the effects of CD on male and female reproductive disorders and pregnancy outcomes are discussed and the need for CD screening in the case of reproductive problems is emphasized.
Collapse
Affiliation(s)
- Bilge Ozgör
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Faculty of Medicine, Inönü University, Malatya, Turkey
| | | |
Collapse
|
33
|
Khashan AS, Henriksen TB, Mortensen PB, McNamee R, McCarthy FP, Pedersen MG, Kenny LC. The impact of maternal celiac disease on birthweight and preterm birth: a Danish population-based cohort study. Hum Reprod 2009; 25:528-34. [PMID: 19939833 DOI: 10.1093/humrep/dep409] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Adverse pregnancy outcomes have been associated with maternal celiac disease (CD). In this study, we investigate the effect of treated and untreated maternal CD on infant birthweight and preterm birth. METHODS A population-based cohort study consisted of all singleton live births in Denmark between 1 January 1979 and 31 December 2004 was used. A total of 1,504,342 babies were born to 836,241 mothers during the study period. Of those, 1105 babies were born to women with diagnosed CD and 346 were born to women with undiagnosed CD. Women with diagnosed CD were considered as treated with a gluten free diet while women with undiagnosed CD were considered as untreated. The outcome measures were: birthweight, small for gestational age (SGA: birthweight <10th centile), very small for gestational age (VSGA: birthweight <5th centile) and preterm birth. We compared these measures in treated and untreated women with those of a reference group (no history of CD). RESULTS Women with untreated CD delivered smaller babies [difference = -98 g (95% CI: -130, -67)], with a higher risk of SGA infants [OR = 1.31 (95% CI: 1.06, 1.63)], VSGA infants [OR = 1.54 (95% CI: 1.17, 2.03)] and preterm birth [OR = 1.33 (95% CI: 1.02, 1.72)] compared with women without CD. Women with treated CD had no increased risk of reduced mean birthweight, risk of delivering SGA and VSGA infants or preterm birth compared with women without CD. CONCLUSION Untreated maternal CD increases the risk of reduced birthweight, the risk of delivering SGA and VSGA infants and preterm birth. Diagnosis and presumed treatment of maternal CD with a gluten-free diet appeared to result in a birthweight and preterm birth rate similar to those in women without CD.
Collapse
Affiliation(s)
- A S Khashan
- Anu Research Centre, Department of Obstetrics and Gynecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland.
| | | | | | | | | | | | | |
Collapse
|
34
|
Atladóttir HO, Pedersen MG, Thorsen P, Mortensen PB, Deleuran B, Eaton WW, Parner ET. Association of family history of autoimmune diseases and autism spectrum disorders. Pediatrics 2009; 124:687-94. [PMID: 19581261 DOI: 10.1542/peds.2008-2445] [Citation(s) in RCA: 274] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Recent studies suggest that familial autoimmunity plays a part in the pathogenesis of ASDs. In this study we investigated the association between family history of autoimmune diseases (ADs) and ASDs/infantile autism. We perform confirmatory analyses based on results from previous studies, as well as various explorative analyses. METHODS The study cohort consisted of all of the children born in Denmark from 1993 through 2004 (689 196 children). Outcome data consisted of both inpatient and outpatient diagnoses reported to the Danish National Psychiatric Registry. Information on ADs in parents and siblings of the cohort members was obtained from the Danish National Hospital Register. The incidence rate ratio of autism was estimated by using log-linear Poisson regression. RESULTS A total of 3325 children were diagnosed with ASDs, of which 1089 had an infantile autism diagnosis. Increased risk of ASDs was observed for children with a maternal history of rheumatoid arthritis and celiac disease. Also, increased risk of infantile autism was observed for children with a family history of type 1 diabetes. CONCLUSIONS Associations regarding family history of type 1 diabetes and infantile autism and maternal history of rheumatoid arthritis and ASDs were confirmed from previous studies. A significant association between maternal history of celiac disease and ASDs was observed for the first time. The observed associations between familial autoimmunity and ASDs/infantile autism are probably attributable to a combination of a common genetic background and a possible prenatal antibody exposure or alteration in fetal environment during pregnancy.
Collapse
Affiliation(s)
- Hjördís O Atladóttir
- Nanea, Department of Epidemiology, Institute of Public Health, bNational Centre for Register-Based Research, and eInstitute of Medical Microbiology and Immunology, University of Aarhus, Aarhus, Denmark.
| | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
OBJECTIVES To verify the existence of possible relation between maternal celiac disease (CD) and the appearance of neural tube defects (NTD) in the newborn serological testing in 208 mothers with NTD-affected pregnancy were performed. METHODS All sera were tested for total serum immunoglobulin A (IgA) levels and for IgA class endomysial antibody using indirect immunofluorescence technique. Participant age ranged from 19 to 43 years (mean: 33 years). None had been previously investigated for or had a family history of CD. RESULTS Immunoglobulin levels were normal and results of the IgA-endomysial antibody tests were negative in all women tested. CONCLUSION This study, although nonconclusive, did not corroborate earlier findings described in the literature of increased frequency of CD in mothers with a history of NTD-affected pregnancy. At this moment we feel that a routine screening for CD in pregnant women to avoid a possible pregnancy aggravated by NTD would not be justifiable.
Collapse
|
36
|
Abstract
BACKGROUND While gluten-free diet is an effective treatment for coeliac disease, the need for and goals of long-term management of patients are poorly defined. AIM To review systematically the complications and associations of coeliac disease, to identify potential risk factors, to define ways of assessing risk factors and to provide a strategy for management. METHODS Review of medical literature from 1975. RESULTS There is an increasing list of potential complications and/or conditions associated with coeliac disease, in particular, autoimmune disease, malignancy and bone disease. Risk factors that may predict or influence long-term outcomes include genetic susceptibility, environmental factors predominantly gluten ingestion, persistent small intestinal inflammation/injury and nutritional deficiencies. Genotyping of patients is yet to have an established clinical role in long-term management. Assessment of adherence to the gluten-free diet largely relies upon skilled dietary history, but the ultimate test is duodenal histopathology, which is the only currently established means of assessing healing. Symptoms, serology or other non-invasive means are poor predictors of healing and the likelihood of complications. CONCLUSION Evidence (albeit limited) that adherence to a gluten-free diet and mucosal healing prevent and/or ameliorate complications indicates that a planned long-term strategy for follow-up is essential.
Collapse
Affiliation(s)
- M L Haines
- Department of Gastroenterology, Monash University Department of Medicine, Box Hill Hospital, Box Hill, and Walter and Eliza Hall Institute, Parkville, Vic., Australia
| | | | | |
Collapse
|
37
|
Pope R, Sheiner E. Celiac disease during pregnancy: to screen or not to screen? Arch Gynecol Obstet 2009; 279:1-3. [DOI: 10.1007/s00404-008-0803-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 09/09/2008] [Indexed: 10/21/2022]
|
38
|
Abstract
OBJECTIVE To review the association of celiac disease and various endocrine disorders and present the related clinical experience of a 3-physician adult endocrinology practice. METHODS We provide an overview of the pertinent literature, discuss the clinical manifestations, genetics, and pathogenesis of celiac disease, and describe our clinical experience during a 5-year period. RESULTS Celiac disease has been associated with numerous disorders, including several conditions treated by endocrinologists-type 1 diabetes mellitus, autoimmune thyroid disease, Addison disease, osteomalacia, secondary hyperparathyroidism, vitamin D or iron deficiency, fertility problems, hypogonadism in men, and autoimmune hypopituitarism. After our clinical awareness was raised about these potential comorbidities, 18 patients were newly diagnosed with celiac disease in our clinical practice during a 5-year interval. All patients had been referred for endocrine evaluation or were undergoing follow-up for ongoing management of endocrine disorders. When a "celiac-associated" endocrine disorder coexists with other factors associated with celiac disease, we recommend performance of IgA class antibody testing, and either antiendomysial or anti-tissue transglutaminase antibodies provide high specificity and sensitivity for the diagnosis of celiac disease. CONCLUSION Endocrinologists have an opportunity to diagnose celiac disease, a relatively common disorder with profound clinical implications that can often be associated with various endocrinopathies.
Collapse
Affiliation(s)
- Arthur H Fisher
- Endocrinology and Diabetes Associates of Long Island, Rockville Centre, New York 11570, USA
| | | | | | | |
Collapse
|
39
|
Wolf H, Ilsen A, van Pampus MG, Sahebdien S, Pena S, Von Blomberg ME. Celiac serology in women with severe pre-eclampsia or delivery of a small for gestational age neonate. Int J Gynaecol Obstet 2008; 103:175-7. [DOI: 10.1016/j.ijgo.2008.05.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 05/04/2008] [Accepted: 05/08/2008] [Indexed: 11/30/2022]
|
40
|
Abstract
Assessment of fetal growth and wellbeing is one of the major purposes of antenatal care. Some fetuses have smaller than expected growth in utero and while some of these fetuses are constitutionally small, others have failed to meet their growth potential, that is they are growth restricted. While severe growth restriction is uncommon, the consequences of it being undetected may include perinatal death or severe morbidity. It is, therefore, important to have strategies in place to detect the fetus at risk of growth restriction. These would include an assessment of 'prior risk' from maternal history and examination combined with the results of biochemical and ultrasound investigations, the most promising of which are uterine artery Doppler and biochemistry. We discuss some of the factors to consider when stratifying the obstetric population into degrees of likelihood for growth restriction, and discuss aspects of the management and outcome of pregnancies complicated by growth restriction.
Collapse
Affiliation(s)
- Andrew C G Breeze
- Division of Fetal-Maternal Medicine, Box 228, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | | |
Collapse
|
41
|
Robinson NJ, Baker PN, Jones CJP, Aplin JD. A role for tissue transglutaminase in stabilization of membrane-cytoskeletal particles shed from the human placenta. Biol Reprod 2007; 77:648-57. [PMID: 17625111 DOI: 10.1095/biolreprod.107.061747] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Tissue transglutaminase (TGM2; also known as TG2 or tTG) localizes to the syncytial microvillous membrane (MVM) of the human placenta, the primary interface between maternal and fetal tissue. To identify TGM2 substrates in the MVM, membrane vesicles were prepared and labeled with biotinylated acyl donor or acceptor probes. Biotinylated species were selected on an avidin affinity matrix and identified by mass spectrometry of tryptic peptides. The most abundant were cytoskeletal (actin, tubulin, and cytokeratin) and membrane-associated (annexins, integrins, and placental alkaline phosphatase) proteins. During pregnancy, apoptotic particulate material, the end product of the trophoblast life cycle, is shed from the MVM into maternal circulation. Shed material was isolated from primary trophoblast cultures in which syncytial-like masses develop by fusion. A substantial fraction of actin in the particles was in the form of covalent polymeric aggregates, in contrast to cellular actin, which dissociated completely into monomer in SDS-PAGE. When cells were cultured in the presence of transglutaminase inhibitors, actin in the shed particles remained exclusively in monomeric form, and a reduction in trophoblast intercellular fusion and differentiation was observed. These findings suggest that transglutaminase-mediated cross-linking stabilizes the particulate material shed from the placenta.
Collapse
Affiliation(s)
- Nicola J Robinson
- Maternal and Fetal Health Research Centre, Division of Human Development, University of Manchester, St. Mary's Hospital, Manchester M13 0JH, United Kingdom
| | | | | | | |
Collapse
|
42
|
Cranney A, Zarkadas M, Graham ID, Butzner JD, Rashid M, Warren R, Molloy M, Case S, Burrows V, Switzer C. The Canadian Celiac Health Survey. Dig Dis Sci 2007; 52:1087-95. [PMID: 17318390 DOI: 10.1007/s10620-006-9258-2] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2005] [Accepted: 02/13/2006] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to characterize the diagnostic process, frequency of associated disorders, family history, and impact of a gluten-free diet in individuals with celiac disease. All members of the Canadian Celiac Association (n=5240) were surveyed with a questionnaire. Respondents included 2681 adults with biopsy-proven celiac disease. The mean age was 56 years. Most common presenting symptoms included abdominal pain (83%), diarrhea (76%), and weight loss (69%). The mean delay in diagnosis was 11.7 years. Diagnoses made prior to celiac disease included anemia (40%), stress (31%), and irritable bowel syndrome (29%). Osteoporosis was common. Prior to diagnosis, 27% of respondents consulted three or more doctors about their symptoms. Delays in diagnosis of celiac disease remain a problem. Associated medical conditions occur frequently. More accurate food labeling is needed. Improved awareness of celiac disease and greater use of serological screening tests may result in earlier diagnosis and reduced risk of associated conditions.
Collapse
Affiliation(s)
- Ann Cranney
- Department of Medicine, Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Affiliation(s)
- M Luisa Mearin
- Department of Pediatrics, Leiden University Medical Center and Free University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
44
|
|
45
|
Salvatore S, Finazzi S, Radaelli G, Lotzniker M, Zuccotti GV. Prevalence of undiagnosed celiac disease in the parents of preterm and/or small for gestational age infants. Am J Gastroenterol 2007; 102:168-73. [PMID: 17100963 DOI: 10.1111/j.1572-0241.2006.00958.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to estimate the prevalence of undiagnosed celiac disease (CD) in the parents of preterm and/or small for gestational age (SGA) infants. METHODS A sample of 1,714 parents (868 women, 846 men) of 905 preterm (<37 wk of gestational age) and/or SGA (<10th percentile of birthweight) infants consecutively born in Lombardy, Northern Italy, and not diagnosed with CD prior to pregnancy, were tested for CD. Diagnosis was based on antitissue transglutaminase and anti-endomysial antibodies and confirmed by duodenal biopsy. RESULTS The overall prevalence of undiagnosed CD was 0.64% (95% confidence interval [CI] 0.32-1.15%), 0.92% (0.40-1.81%) in women and 0.35% (0.07-1.03%) in men. In the mothers of preterm infants prevalence of CD was 0.39% (0.05-1.39%). In the mothers of SGA infants prevalence of CD was 1.60% (0.64-3.27%), and the observed number of mothers with CD was 2.25 times higher than the expected one in the Italian female population (P = 0.039). Undiagnosed CD in mothers was associated with an increased risk of SGA birth (odds ratio 6.97, 95% CI 1.11-43.55%). CONCLUSIONS While additional powered studies are needed, the present results suggest that the prevalence of undiagnosed CD in the mothers of SGA infants is higher than in the general female population.
Collapse
|
46
|
Abstract
Coeliac disease is a common condition that is increasingly being recognised as a result of the development of sensitive and specific serology. The diagnosis of coeliac disease and its subsequent treatment with a gluten-free diet have implications for the patient, not just for symptom control but also for the possible effect on quality of life and risk of complications. Whether the mode of presentation of coeliac disease has an effect on survival or risk of complication is yet unclear. This article reviews the available evidence regarding these issues.
Collapse
Affiliation(s)
- C J R Goddard
- St John's Hospital, Howden Road West, Livingston, West Lothian EH54 6PP, UK
| | | |
Collapse
|
47
|
Sheiner E, Peleg R, Levy A. Pregnancy outcome of patients with known celiac disease. Eur J Obstet Gynecol Reprod Biol 2006; 129:41-5. [PMID: 16310304 DOI: 10.1016/j.ejogrb.2005.10.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Revised: 07/27/2005] [Accepted: 10/25/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Celiac disease is a permanent intolerance to gluten, probably induced by an autoimmune mechanism. Controversy exists regarding the association between celiac disease and infertility, abortions, intra-uterine growth restriction (IUGR) and stillbirths. The present study was designed to investigate pregnancy outcome of patients with celiac disease. METHODS A retrospective comparison between all pregnancies of women with and without known celiac disease, delivered during the years 1988-2002, was conducted. RESULTS During the study period there were 48 deliveries of patients with celiac disease and 143,663 pregnancies of patients without known celiac disease. No statistically significant differences were noted between the groups regarding maternal or perinatal outcomes, including fertility treatments (0% among patients with known celiac versus 2.5% among patients without known celiac sprue; p=0.267), recurrent abortions (0 versus 5.2%; p=0.103), perinatal mortality (2.1 versus 1.4%; p=0.668). However, higher rates of labor induction (29.2 versus 11.9%; p<0.001) and IUGR (6.3 versus 2.1%; p=0.042) were found among patients with celiac disease as compared to patients without known celiac disease. CONCLUSION The course of pregnancy of patients with celiac disease including perinatal outcomes is favorable. Since we found higher rates of IUGR, careful surveillance should be performed for early detection of IUGR. Further, prospective studies should focus on screening for celiac disease among patients presenting with IUGR of an unknown etiology.
Collapse
Affiliation(s)
- Eyal Sheiner
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, P.O. Box 151, Be'er-Sheva, Israel.
| | | | | |
Collapse
|
48
|
Abstract
Celiac disease is multifaced autoimmune disorder with several extraintestinal manifestations and connections to other autoimmune diseases and other conditions. The recognition of the complex clinical picture of the disease helps doctors to search and diagnose celiac disease even if the gastrointestinal symptoms are lacking. Individuals at risk for celiac disease should be thoroughly investigated and individuals with unusual manifestations of the disease should be screened actively.
Collapse
Affiliation(s)
- K Mustalahti
- Paediatric Research Centre, Medical School, University of Tampere, Finland.
| |
Collapse
|
49
|
Abstract
BACKGROUND For young people with celiac disease, adherence to the gluten-free diet may be difficult to achieve and gluten restriction may lead to insufficient nutrient intake and unbalanced food intake resulting in overweight. In The Netherlands, no nutritional information is available. Therefore, we evaluated the nutritional management and nutritional state in young celiac patients. METHODS The Dutch Celiac Society invited all its members aged 12 to 25 years to complete a food record and a questionnaire. Nutrient intakes were compared with the recommendations and the intake in the general population. Total immunoglobin A, endomysial antibody, tissue transglutaminase and IgA gliadin were determined, and height and weight were assessed. RESULTS Strict dietary compliance was reported by 75%. The fiber and iron intakes were significantly lower, and the saturated fat intake significantly higher than recommended but comparable with the general population. Most of the patients (61%) found the diet easy to follow. Regular medical controls were reported by 86% but regular dietary controls by only 7% of the patients. Mean and SD scores for height and body mass index were -0.3 +/- 1.1 and -0.3 +/- 0.8, respectively. CONCLUSIONS The dietary compliance in this group is high, the nutritional state is adequate, but the nutrient intake is not. Better medical and dietary support is necessary to prevent long-term complications and to achieve an ongoing satisfying management in this group of young patients with a chronic disorder.
Collapse
Affiliation(s)
- Erica G D Hopman
- Department of Dietetics and Nutrition, Leiden University Medical Centre, The Netherlands.
| | | | | | | |
Collapse
|
50
|
Zarkadas M, Cranney A, Case S, Molloy M, Switzer C, Graham ID, Butzner JD, Rashid M, Warren RE, Burrows V. The impact of a gluten-free diet on adults with coeliac disease: results of a national survey. J Hum Nutr Diet 2006; 19:41-9. [PMID: 16448474 DOI: 10.1111/j.1365-277x.2006.00659.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
UNLABELLED OBJECTIVE We sought to evaluate the impact of the gluten-free diet on the 5,240 members of the Canadian Celiac Association (CCA). Data are presented on 2,681 adults (>or=16 years) with biopsy-proven celiac disease (CD). METHODS A mail-out survey was used. Quality of life was evaluated using the 'SF12', and celiac-specific questions. RESULTS Mean age was 56 years, mean age at diagnosis was 45 years, and 75% were female. The 'SF12' summary scores were similar to normative Canadian data, but were significantly lower for females and newly diagnosed patients. Respondents reported: following a gluten-free (GF) diet (90%), improvement on the diet (83%), and difficulties following the diet (44%), which included: determining if foods were GF (85%), finding GF foods in stores (83%), avoiding restaurants (79%), and avoiding travel (38%). Most common reactions to consumed gluten (among 73%) included pain, diarrhea, bloating, fatigue, nausea, and headache. Excellent information on CD and its treatment was provided by the CCA (64%), gastroenterologists (28%), dietitians (26%) and family doctor (12%). CONCLUSIONS Quality of life in those with CD could be increased with early diagnosis, increased availability of gluten-free foods, improved food labelling, and better dietary instruction. Education of physicians and dietitians about CD and its treatment is essential.
Collapse
Affiliation(s)
- M Zarkadas
- Canadian Celiac Association, University of Ottawa, Ottawa, ON, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|