Pregnancy tTG-IgA seropositivity and maternal and infant health in the Child Health and Development Studies.

Abstract

Background: We examined associations between pregnancy anti-tissue transglutaminase immunoglobulin A (tTG-IgA) seropositivity, a screening test for celiac disease, and celiac-related conditions in pregnancy and offspring health outcomes. We hypothesized that seropositivity would identify pregnant women and infants at risk of poor health.

Methods: The Child Health and Development Studies enrolled pregnant woman from 1959-1967 and prospectively followed their pregnancies and offspring. tTG-IgA was measured from stored pregnancy serum using QUANTA Lite R h-tTG IgA ELISA. Pregnant women were randomly selected into a "high-risk" (n=937), or background-risk (n=831) group based on high-risk markers of celiac comorbidity. We used logistic regression to compare associations between tTG-IgA seropositivity and high-risk markers in pregnancy, placental to birth weight ratio (PWR), and infant weight gain through one year.

Results: Overall prevalence of tTG-IgA seropositivity was 3%. Seropositivity was associated with having two or more maternal high-risk markers (OR=2.6, 95% confidence interval (CI) 1.2, 5.3, including diabetes, nutritional deficiency, gastrointestinal complications, Down syndrome child, cesarean delivery, and thyroiditis); lower PWR (OR=2.9, 95% CI 1.3, 6.0); and lower weight gain in late infancy (OR=2.3, 95% CI 1.0, 5.4). Offspring associations did not differ by maternal risk group, suggesting that seropositivity rather than comorbidity was the underlying risk factor.

Conclusions: tTG-IgA seropositivity was associated with the presence of two or more markers of celiac comorbidity. Offspring exposed to maternal seropositivity had poorer fetal growth and lower infant weight gain. Findings support the potential beneficial role of tTG-IgA screening during pregnancy, both for the pregnant woman and exposed offspring.