101
|
Eriksen KG, Andersson M, Hunziker S, Zimmermann MB, Moore SE. Effects of an Iodine-Containing Prenatal Multiple Micronutrient on Maternal and Infant Iodine Status and Thyroid Function: A Randomized Trial in The Gambia. Thyroid 2020; 30:1355-1365. [PMID: 32183608 PMCID: PMC7482118 DOI: 10.1089/thy.2019.0789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Iodine supplementation is recommended to pregnant women in iodine-deficient populations, but the impact in moderate iodine deficiency is uncertain. We assessed the effect of an iodine-containing prenatal multiple micronutrient (MMN) supplement in a rural Gambian population at risk of moderate iodine deficiency. Materials and Methods: This study uses data and samples collected as a part of the randomized controlled trial Early Nutrition and Immune Development (ENID; ISRCTN49285450) conducted in Keneba, The Gambia. Pregnant women (<20 weeks gestation) were randomized to either a daily supplement of MMNs containing 300 μg of iodine or an iron and folic acid (FeFol) supplement. Randomization was double blinded (participants and investigators). The coprimary outcomes were maternal urinary iodine concentration (UIC) and serum thyroglobulin (Tg), assessed at baseline and at 30 weeks' gestation. Secondary outcomes were maternal serum thyrotropin (TSH), total triiodothyronine (TT3), total thyroxine (TT4) (assessed at baseline and at 30 weeks' gestation), breast milk iodine concentration (BMIC) (assessed at 8, 12, and 24 weeks postpartum), infant serum Tg (assessed at birth [cord], 12, and 24 weeks postpartum), and serum TSH (assessed at birth [cord]). The effect of supplementation was evaluated using mixed effects models. Results: A total of 875 pregnant women were enrolled between April 2010 and February 2015. In this secondary analysis, we included women from the MMN (n = 219) and FeFol (n = 219) arm of the ENID trial. At baseline, median (interquartile range or IQR) maternal UIC and Tg was 51 μg/L (33-82) and 22 μg/L (12-39), respectively, indicating moderate iodine deficiency. Maternal MMN supplement increased maternal UIC (p < 0.001), decreased maternal Tg (p < 0.001), and cord blood Tg (p < 0.001) compared with FeFol. Maternal thyroid function tests (TSH, TT3, TT4, and TT3/TT4 ratio) and BMIC did not differ according to maternal supplement group over the course of the study. Median (IQR) BMIC, maternal UIC, and infant Tg in the MMN group were 51 μg/L (35-72), 39 μg/L (25-64), and 87 μg/L (59-127), respectively, at 12 weeks postpartum, and did not differ between supplement groups. Conclusions: Supplementing moderately iodine-deficient women during pregnancy improved maternal iodine status and reduced Tg concentration. However, the effects were not attained postpartum and maternal and infant iodine nutrition remained inadequate during the first six months after birth. Consideration should be given to ensuring adequate maternal status through pregnancy and lactation in populations with moderate deficiency.
Collapse
Affiliation(s)
- Kamilla G. Eriksen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Address correspondence to: Kamilla G. Eriksen, PhD, Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg, Copenhagen, Denmark
| | - Maria Andersson
- Division of Gastroenterology and Nutrition, Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - Sandra Hunziker
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland
| | - Michael B. Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland
| | - Sophie E. Moore
- Department of Women and Children's Health, King's College London, London, United Kingdom
| |
Collapse
|
102
|
Abel MH, Caspersen IH, Sengpiel V, Jacobsson B, Meltzer HM, Magnus P, Alexander J, Brantsæter AL. Insufficient maternal iodine intake is associated with subfecundity, reduced foetal growth, and adverse pregnancy outcomes in the Norwegian Mother, Father and Child Cohort Study. BMC Med 2020; 18:211. [PMID: 32778101 PMCID: PMC7418397 DOI: 10.1186/s12916-020-01676-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/23/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Severe iodine deficiency impacts fertility and reproductive outcomes. The potential effects of mild-to-moderate iodine deficiency are not well known. The aim of this study was to examine whether iodine intake was associated with subfecundity (i.e. > 12 months trying to get pregnant), foetal growth, and adverse pregnancy outcomes in a mild-to-moderately iodine-deficient population. METHODS We used the Norwegian Mother, Father and Child Cohort Study (MoBa) and included 78,318 pregnancies with data on iodine intake and pregnancy outcomes. Iodine intake was calculated using an extensive food frequency questionnaire in mid-pregnancy. In addition, urinary iodine concentration was available in a subsample of 2795 pregnancies. Associations were modelled continuously by multivariable regression controlling for a range of confounding factors. RESULTS The median iodine intake from food was 121 μg/day and the median urinary iodine was 69 μg/L, confirming mild-to-moderate iodine deficiency. In non-users of iodine supplements (n = 49,187), low iodine intake (< 100-150 μg/day) was associated with increased risk of preeclampsia (aOR = 1.14 (95% CI 1.08, 1.22) at 75 vs. 100 μg/day, p overall < 0.001), preterm delivery before gestational week 37 (aOR = 1.10 (1.04, 1.16) at 75 vs. 100 μg/day, p overall = 0.003), and reduced foetal growth (- 0.08 SD (- 0.10, - 0.06) difference in birth weight z-score at 75 vs. 150 μg/day, p overall < 0.001), but not with early preterm delivery or intrauterine death. In planned pregnancies (n = 56,416), having an iodine intake lower than ~ 100 μg/day was associated with increased prevalence of subfecundity (aOR = 1.05 (1.01, 1.09) at 75 μg/day vs. 100 μg/day, p overall = 0.005). Long-term iodine supplement use (initiated before pregnancy) was associated with increased foetal growth (+ 0.05 SD (0.03, 0.07) on birth weight z-score, p < 0.001) and reduced risk of preeclampsia (aOR 0.85 (0.74, 0.98), p = 0.022), but not with the other adverse pregnancy outcomes. Urinary iodine concentration was not associated with any of the dichotomous outcomes, but positively associated with foetal growth (n = 2795, p overall = 0.017). CONCLUSIONS This study shows that a low iodine intake was associated with restricted foetal growth and a higher prevalence of preeclampsia in these mild-to-moderately iodine-deficient women. Results also indicated increased risk of subfecundity and preterm delivery. Initiating iodine supplement use in pregnancy may be too late.
Collapse
Affiliation(s)
- Marianne Hope Abel
- Department of Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, NO-0213, Oslo, Norway
| | - Ida Henriette Caspersen
- Department of Environmental Health, Division of Infection Control, Environment and Health, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, NO-0213, Oslo, Norway
| | - Verena Sengpiel
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, SE 416 85, Gothenburg, Sweden
| | - Bo Jacobsson
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, SE 416 85, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, University of Gothenburg, SE 416 85, Gothenburg, Sweden
- Department of Genetics and Bioinformatics, Division of Health Data and Digitalisation, Institute of Public Health, P.O. Box 222, Skøyen, NO-0213, Oslo, Norway
| | - Helle Margrete Meltzer
- Division of Infection Control, Environment and Health, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, NO-0213, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, NO-0213, Oslo, Norway
| | - Jan Alexander
- Division of Infection Control, Environment and Health, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, NO-0213, Oslo, Norway
| | - Anne Lise Brantsæter
- Department of Environmental Health, Division of Infection Control, Environment and Health, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, NO-0213, Oslo, Norway.
| |
Collapse
|
103
|
Gárate-Escamilla AK, Garza-Padilla E, Carvajal Rivera A, Salas-Castro C, Andrès E, Hajjam El Hassani A. Cluster Analysis: A New Approach for Identification of Underlying Risk Factors and Demographic Features of First Trimester Pregnancy Women. J Clin Med 2020; 9:E2247. [PMID: 32679845 PMCID: PMC7408845 DOI: 10.3390/jcm9072247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/31/2022] Open
Abstract
Thyroid pathology is reported internationally in 5-10% of all pregnancies. The overall aim of this research was to determine the prevalence of hypothyroidism and risk factors during the first trimester screening in a Mexican patients sample. We included the records of 306 patients who attended a prenatal control consultation between January 2016 and December 2017 at the Women's Institute in Monterrey, Mexico. The studied sample had homogeneous demographic characteristics in terms of age, weight, height, BMI (body mass index) and number of pregnancies. The presence of at least one of the risk factors for thyroid disease was observed in 39.2% of the sample. Two and three clusters were identified, in which patients varied considerably among risk factors, symptoms and pregnancy complications. Compared to Cluster 0, one or more symptoms or signs of hypothyroidism occurred, while Cluster 1 was characterized by healthier patients. When three clusters were used, Cluster 2 had a higher TSH (thyroid stimulating hormone) value and pregnancy complications. There were no significant differences in perinatal variables. In addition, high TSH levels in first trimester pregnancy are characterized by pregnancy complications and decreased newborn weight. Our findings underline the high degree of disease heterogeneity with existing pregnant hypothyroid patients and the need to improve the phenotyping of the syndrome in the Mexican population.
Collapse
Affiliation(s)
| | - Edelmiro Garza-Padilla
- Monterrey Institute of Technology and Higher Education, Monterrey 64700, Mexico; (E.G.-P.); (A.C.R.); (C.S.-C.)
| | - Agustín Carvajal Rivera
- Monterrey Institute of Technology and Higher Education, Monterrey 64700, Mexico; (E.G.-P.); (A.C.R.); (C.S.-C.)
| | - Celina Salas-Castro
- Monterrey Institute of Technology and Higher Education, Monterrey 64700, Mexico; (E.G.-P.); (A.C.R.); (C.S.-C.)
| | - Emmanuel Andrès
- Service de Médecine Interne, Diabète et Maladies Métaboliques de la Clinique Médicale B, CHRU de Strasbourg, 67091 Strasbourg, France;
| | | |
Collapse
|
104
|
Mills JL, Reische EC, Kannan K, Gao C, Shaw GM, Sundaram R. Newborn Iodine Status Is Not Related to Congenital Hypothyroidism. J Nutr 2020; 150:2429-2434. [PMID: 32633779 PMCID: PMC7540063 DOI: 10.1093/jn/nxaa178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/02/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Severe iodine deficiency or excess during pregnancy can cause congenital hypothyroidism (CH). Iodine deficiency is common in pregnant women in the United States. OBJECTIVES We conducted a nested case-control study in a cohort of ∼2.5 million births in California to determine whether iodine status is related to CH in a US population. METHODS Dried blood spots from 907 newborns with CH identified by newborn screening and 909 unaffected controls matched by month of birth were obtained from the California Newborn Screening Program to measure whole-blood iodine concentration. Iodine status was compared between cases and controls, and logistic regression was used to assess the association between CH status and blood iodine concentrations. Iodine status was also compared between cases and controls among infants treated in a neonatal intensive care unit (NICU) because CH has been reported in infants exposed to high levels of iodine in the NICU. RESULTS Blood iodine concentrations did not differ significantly between cases (median: 20.0 ng/mL; IQR: 12.1-29.8 ng/mL) and controls (median: 20.3 ng/mL; IQR: 12.5-30.9 ng/mL; P = 0.59). Neither extremely high nor extremely low blood iodine concentrations (1st, 5th, 95th, and 99th percentiles of the distribution) were more common in cases. Among infants treated in NICUs, however, cases had significantly (P = 0.01) higher iodine (median: 22.7 ng/mL; IQR: 16.4-32.1 ng/mL) compared with controls (median: 17.3 ng/mL; IQR: 8.3-26.6 ng/mL). CONCLUSIONS CH cases did not have significantly higher or lower iodine in this population, which is reassuring given that maternal iodine deficiency is common in the United States. Among newborns in the NICU, CH cases had higher blood iodine concentrations compared with controls, suggesting that excess iodine exposure in the NICU could be causing CH. It may be beneficial to monitor iodine exposure from surgical procedures, imaging, and iodine-containing disinfectants and to consider non-iodine alternatives.
Collapse
Affiliation(s)
| | - Elijah C Reische
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Chongjing Gao
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Rajeshwari Sundaram
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| |
Collapse
|
105
|
Effects of repetitive Iodine thyroid blocking on the foetal brain and thyroid in rats: a systems biology approach. Sci Rep 2020; 10:10839. [PMID: 32616734 PMCID: PMC7331645 DOI: 10.1038/s41598-020-67564-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 06/03/2020] [Indexed: 12/20/2022] Open
Abstract
A single administration of an iodine thyroid blocking agent is usually sufficient to protect thyroid from radioactive iodine and prevent thyroid cancer. Repeated administration of stable iodine (rKI) may be necessary during prolonged or repeated exposure to radioactive iodine. We previously showed that rKI for eight days offers protection without toxic effects in adult rats. However, the effect of rKI administration in the developing foetus is unknown, especially on brain development, although a correlation between impaired maternal thyroid status and a decrease in intelligence quotient of the progeny has been observed. This study revealed distinct gene expression profiles between the progeny of rats receiving either rKI or saline during pregnancy. To understand the implication of these differentially expressed (DE) genes, a systems biology approach was used to construct networks for each organ using three different techniques: Bayesian statistics, sPLS-DA and manual construction of a Process Descriptive (PD) network. The PD network showed DE genes from both organs participating in the same cellular processes that affect mitophagy and neuronal outgrowth. This work may help to evaluate the doctrine for using rKI in case of repetitive or prolonged exposure to radioactive particles upon nuclear accidents.
Collapse
|
106
|
Azzeh F, Refaat B. Iodine adequacy in reproductive age and pregnant women living in the Western region of Saudi Arabia. BMC Pregnancy Childbirth 2020; 20:370. [PMID: 32571259 PMCID: PMC7310473 DOI: 10.1186/s12884-020-03057-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 06/16/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite the serious maternal and foetal complications associated with iodine deficiency during pregnancy, surveys related to pregnant women in the Kingdom of Saudi Arabia (KSA) are lacking. This study, therefore, measured urine iodine concentrations (UIC) alongside the potential socioeconomic factors contributing towards iodine inadequacy in reproductive age and pregnant Saudi women from the Western province of KSA. METHODS Spot urine samples were collected from 1222 pregnant and 400 age-matched non-pregnant/non-lactating reproductive age women. The socioeconomic characteristics were obtained through a structured questionnaire. The WHO criteria for iodine sufficiency in non-pregnant (100-199 μg/L) and pregnant (150-249 μg/L) women were applied. RESULTS The median UIC in the non-pregnant women (101.64 μg/L; IQR: 69.83-143.55) was at the lowermost WHO recommended cut-off, whereas the pregnant group was iodine deficient (112.99 μg/L; IQR: 81.01-185.57). Moreover, the median UIC was below adequacy across the different trimesters. The use of non-iodised salt significantly increased the risk of iodine deficiency in the non-pregnant (OR = 2.052; 95%CI: 1.118-3.766) and pregnant women (OR = 3.813; 95%CI: 1.992-7.297), whereas taking iodine supplements significantly lowered the risk in both groups (OR = 0.364; 95%CI: 0.172-0.771 and OR = 0.002; 95%CI: 0.001-0.005, respectively). Passive smoking was also an independent risk factor for iodine deficiency in the non-pregnant (OR = 1.818; 95%CI: 1.097-3.014) and pregnant (OR = 1.653; 95%CI: 1.043-2.618) groups. Additionally, BMI correlated independently and significantly with median UIC in the non-pregnant and pregnant populations. However, multiparity (OR = 3.091; 95%CI: 1.707-5.598) and earning below the minimum wage (2.520; 95%CI: 1.038-6.119) significantly increased the risk of iodine deficiency only in the non-pregnant women. CONCLUSIONS This study is the first to show borderline iodine sufficiency in reproductive age Saudi women from the Western province, whereas mild iodine deficiency was observed in the pregnant population and could represent a serious public health problem. This study also advocates the necessity to establish routine iodine dietary advice services by the health authorities to foster adequate iodine intake in pregnant women to avoid the perilous consequences of iodine deficiency on maternal-foetal health.
Collapse
Affiliation(s)
- Firas Azzeh
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, PO Box 7607, Makkah, Saudi Arabia
| | - Bassem Refaat
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, Holy Makkah, PO Box 7607, Makkah, Saudi Arabia.
| |
Collapse
|
107
|
Current iodine nutrition status in Poland (2017): is the Polish model of obligatory iodine prophylaxis able to eliminate iodine deficiency in the population? Public Health Nutr 2020; 23:2467-2477. [PMID: 32476639 DOI: 10.1017/s1368980020000403] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The monitoring of the populations' iodine status is an essential part of successful programmes of iodine deficiency elimination. The current study aimed at the evaluation of current iodine nutrition in school children, pregnant and lactating women as a marker of the effectiveness and sustainability of mandatory iodine prophylaxis in Poland. DESIGN The following iodine nutrition indicators were used: urinary iodine concentration (UIC) (all participants) and serum thyroglobulin (pregnant and lactating women). SETTING The study was conducted in 2017 within the National Health Programme in five regions of Poland. PARTICIPANTS The research included 300 pregnant women, 100 lactating women and 1000 school children (aged 6-12 years). RESULTS In pregnant women, median UIC was 111·6 µg/l; there was no significant difference in median UIC according to the region of residence. In 8 % of pregnant women, thyroglobulin level was >40 ng/ml (median thyroglobulin 13·3 ng/ml). In lactating women, median UIC was 68·0 µg/l. A significant inter-regional difference was noted (P = 0·0143). In 18 % of breastfeeding women, thyroglobulin level was >40 ng/ml (median thyroglobulin 18·5 ng/ml). According to the WHO criteria, the investigated sample of pregnant and lactating women was iodine-deficient. Median UIC in school children was 119·8 µg/l (with significant inter-regional variation; P = 0·0000), which is consistent with iodine sufficiency. Ninety-four children (9·4 %) had UIC < 50 µg/l. CONCLUSIONS Mandatory iodisation of household salt in Poland has led to a sustainable optimisation of iodine status in the general population. However, it has failed to assure adequate iodine nutrition during pregnancy and lactation.
Collapse
|
108
|
Iodine nutritional status of pregnant women in an urban area of northern Taiwan in 2018. PLoS One 2020; 15:e0233162. [PMID: 32413050 PMCID: PMC7228086 DOI: 10.1371/journal.pone.0233162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/29/2020] [Indexed: 11/19/2022] Open
Abstract
Pregnant women are considered as one of the most vulnerable groups for iodine deficiency. The Nutrition and Health Survey in Taiwan 2013 revealed that the median urinary iodine concentration (UIC) of non-pregnant women of child-bearing age of 15-44 years was 124 μg/L, which was adequate in general, but insufficient according to pregnancy criteria. The aim of this study was to determine the iodine nutritional status of pregnant women in an urban area of Northern Taiwan. A hospital-based cross-sectional survey was conducted in Taipei Veterans General Hospital. Random spot urine samples were collected from January to October, 2018 and UIC was determined by inductively coupled plasma mass-spectrometry. A food frequency questionnaire was also delivered to the participants. The overall median UIC was 225.3 μg/L (IQR: 109.1-514.2 μg/L) for 257 pregnant women ranging from 21-47 years-old. The distribution of UIC was as follows: 35.4% with UIC <150 μg/L, 17.1% with UIC within 150-249 μg/L, 21.8% with UIC within 250-499 μg/L, and 25.7% with UIC ≥500 μg/L. The use of prenatal multivitamin was very common among the participants: 79.4% (n = 204) took multivitamin either every day or less frequently, with 52.5% (n = 135) taking one pill every day, and only 20.6% (n = 53) never took multivitamin during their pregnancy. Other commonly consumed iodine-containing foods were dairy products and fish. Our results indicate that the iodine status in the studied women is adequate. However, efforts are still needed to avoid iodine deficiency as well as iodine excess.
Collapse
|
109
|
Nazeri P, Shab-Bidar S, Pearce EN, Shariat M. Thyroglobulin Concentration and Maternal Iodine Status During Pregnancy: A Systematic Review and Meta-Analysis. Thyroid 2020; 30:767-779. [PMID: 31910106 DOI: 10.1089/thy.2019.0712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Literature to date has been inconclusive regarding the value of thyroglobulin (Tg) as a marker of iodine status in pregnant women. This systematic review and meta-analysis is one of the first to assess whether Tg concentration accurately reflects iodine status among pregnant women. Methods: We searched MEDLINE, the Web of Science, the Cochrane Library, Scopus, and other relevant databases to identify relevant studies published in the English language, between January 1988 and December 2018. The criteria for study inclusion in the systematic review were human studies, healthy pregnant women as participants, and available data for maternal urinary iodine concentration (UIC) and Tg level. Each study was assessed for quality and risk of bias. The pooled mean Tg values, and 95% confidence intervals were estimated in a population of women with UIC <150 and UIC ≥150 μg/L during pregnancy. Potential linear or nonlinear dose-response associations between maternal UIC and Tg concentration were examined. Results: Of 814 identified studies, 25 were eligible for inclusion in the meta-analysis. Studies included were conducted in Africa, Asia, Europe, South America, and the Oceania. The pooled mean (95% confidence interval [CI]) Tg concentration in iodine-deficient pregnant women was higher than that in iodine-sufficient pregnant women (10.73 μg/L [5.65-15.82] vs. 7.34 μg/L [2.20-12.47]); a comparison of the 95% CI showed that none of these values was significantly different. No significant differences were observed in Tg concentration between the two groups in each trimester of pregnancy. Dose-response meta-analyses revealed a significant nonlinear association between maternal UIC and Tg concentration during pregnancy. Among populations of pregnant women, an inverse association was found between UIC values <100 μg/L and Tg concentration (p-linearity = 0.007; p-nonlinearity = 0.027); however, higher values of UIC were not associated with Tg concentration. Conclusions: Our meta-analysis showed that Tg concentration can be a sensitive indicator of iodine deficiency, specifically in populations of pregnant women with median UIC <100 μg/L. Further studies are warranted to determine the sensitivity of Tg at different degrees of iodine deficiency during pregnancy.
Collapse
Affiliation(s)
- Pantea Nazeri
- Family Health Institute, Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Mamak Shariat
- Family Health Institute, Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
110
|
Villanger GD, Drover SSM, Nethery RC, Thomsen C, Sakhi AK, Øvergaard KR, Zeiner P, Hoppin JA, Reichborn-Kjennerud T, Aase H, Engel SM. Associations between urine phthalate metabolites and thyroid function in pregnant women and the influence of iodine status. ENVIRONMENT INTERNATIONAL 2020; 137:105509. [PMID: 32044443 DOI: 10.1016/j.envint.2020.105509] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND Human populations, including susceptible subpopulations such as pregnant women and their fetuses, are continuously exposed to phthalates. Phthalates may affect the thyroid hormone system, causing concern for pregnancy health, birth outcomes and child development. Few studies have investigated the joint effect of phthalates on thyroid function in pregnant women, although they are present as a mixture with highly inter-correlated compounds. Additionally, no studies have investigated if the key nutrient for thyroid health, iodine, modifies these relationships. METHODS In this study, we examined the cross-sectional relationships between concentrations of 12 urinary phthalate metabolites and 6 plasma thyroid function biomarkers measured mid-pregnancy (~17 week gestation) in pregnant women (N = 1072), that were selected from a population-based prospective birth cohort, The Norwegian Mother, Father and Child Cohort study (MoBa). We investigated if the phthalate metabolite-thyroid function biomarker associations differed by iodine status by using a validated estimate of habitual dietary iodine intake based on a food frequency questionnaire from the 22nd gestation week. We accounted for the phthalate metabolite mixture by factor analyses, ultimately reducing the exposure into two uncorrelated factors. These factors were used as predictors in multivariable adjusted linear regression models with thyroid function biomarkers as the outcomes. RESULTS Factor 1, which included high loadings for mono-iso-butyl phthalate (MiBP), mono-n-butyl phthalate (MnBP), and monobenzyl phthalate (MBzP), was associated with increased total triiodothyronine (TT3) and free T3 index (fT3i). These associations appeared to be driven primarily by women with low iodine intake (<150 µg/day, ~70% of our sample). Iodine intake significantly modified (p-interaction < 0.05) the association of factor 1 with thyroid stimulating hormone (TSH), total thyroxine (TT4) and free T4 index (fT4i), such that only among women in the high iodine intake category (≥150 µg/day, i.e. sufficient) was this factor associated with increased TSH and decreased TT4 and FT4i, respectively. In contrast, factor 2, which included high loadings for di-2-ethylhexyl phthalate metabolites (∑DEHP) and di-iso-nonyl phthalate metabolites (∑DiNP), was associated with a decrease in TT3 and fT3i, which appeared fairly uniform across iodine intake categories. CONCLUSION We find that phthalate exposure is associated with thyroid function in mid-pregnancy among Norwegian women, and that iodine intake, which is essential for thyroid health, could influence some of these relationships.
Collapse
Affiliation(s)
- Gro D Villanger
- Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway.
| | - Samantha S M Drover
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina and Chapel Hill, Chapel Hill, NC, USA
| | | | - Cathrine Thomsen
- Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway
| | - Amrit K Sakhi
- Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway
| | - Kristin R Øvergaard
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Pal Zeiner
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jane A Hoppin
- Department of Biological Sciences, NC State University, Raleigh, NC, USA
| | - Ted Reichborn-Kjennerud
- Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Heidi Aase
- Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway
| | - Stephanie M Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina and Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
111
|
Serrano-Nascimento C, Morillo-Bernal J, Rosa-Ribeiro R, Nunes MT, Santisteban P. Impaired Gene Expression Due to Iodine Excess in the Development and Differentiation of Endoderm and Thyroid Is Associated with Epigenetic Changes. Thyroid 2020; 30:609-620. [PMID: 31801416 DOI: 10.1089/thy.2018.0658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Thyroid hormone (TH) synthesis is essential for the control of development, growth, and metabolism in vertebrates and depends on a sufficient dietary iodine intake. Importantly, both iodine deficiency and iodine excess (IE) impair TH synthesis, causing serious health problems especially during fetal/neonatal development. While it is known that IE disrupts thyroid function by inhibiting thyroid gene expression, its effects on thyroid development are less clear. Accordingly, this study sought to investigate the effects of IE during the embryonic development/differentiation of endoderm and the thyroid gland. Methods: We used the murine embryonic stem (ES) cell model of in vitro directed differentiation to assess the impact of IE on the generation of endoderm and thyroid cells. Additionally, we subjected endoderm and thyroid explants obtained during early gestation to IE and evaluated gene and protein expression of endodermal markers in both models. Results: ES cells were successfully differentiated into endoderm cells and, subsequently, into thyrocytes expressing the specific thyroid markers Tshr, Slc5a5, Tpo, and Tg. IE exposure decreased the messenger RNA (mRNA) levels of the main endoderm markers Afp, Crcx4, Foxa1, Foxa2, and Sox17 in both ES cell-derived endoderm cells and embryonic explants. Interestingly, IE also decreased the expression of the main thyroid markers in ES cell-derived thyrocytes and thyroid explants. Finally, we demonstrate that DNA methyltransferase expression was increased by exposure to IE, and this was accompanied by hypermethylation and hypoacetylation of histone H3, pointing to an association between the gene repression triggered by IE and the observed epigenetic changes. Conclusions: These data establish that IE treatment is deleterious for embryonic endoderm and thyroid gene expression.
Collapse
Affiliation(s)
- Caroline Serrano-Nascimento
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Instituto de Investigaciones Biomédicas "Alberto Sols," CSIC-UAM, Madrid, Spain
- CIBERONC Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jesús Morillo-Bernal
- Instituto de Investigaciones Biomédicas "Alberto Sols," CSIC-UAM, Madrid, Spain
- CIBERONC Instituto de Salud Carlos III, Madrid, Spain
| | - Rafaela Rosa-Ribeiro
- Instituto de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Maria Tereza Nunes
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Pilar Santisteban
- Instituto de Investigaciones Biomédicas "Alberto Sols," CSIC-UAM, Madrid, Spain
- CIBERONC Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
112
|
Nazarpour S, Ramezani Tehrani F, Amiri M, Simbar M, Tohidi M, Bidhendi Yarandi R, Azizi F. Maternal Urinary Iodine Concentration and Pregnancy Outcomes: Tehran Thyroid and Pregnancy Study. Biol Trace Elem Res 2020; 194:348-359. [PMID: 31359332 DOI: 10.1007/s12011-019-01812-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
Iodine is essential for the production of thyroid hormones, and its deficiency during pregnancy may be associated with poor obstetric outcomes. The aim of this study was to investigate the relationship between maternal iodine statuses with pregnancy outcomes among pregnant Iranian women, considering their baseline thyrotropin (TSH) status. We used data from the Tehran Thyroid and Pregnancy Study (TTPS), a two-phase population-based study carried out among pregnant women receiving prenatal care. By excluding participants with overt thyroid dysfunction and those receiving levothyroxine, the remaining participants (n = 1286) were categorized into four groups, according to their urine iodine status: group 1, urine iodine concentration (UIC) < 100 μg/L; group 2, UIC between 100 and 150 μg/L; group 3, UIC between 150 and 250 μg/L; and group 4, UIC ≥ 250 μg/L. Primary outcome was preterm delivery. Preterm delivery occurred in 29 (9%), 19 (7%), 15 (5%), and 8 (4%) women, and neonatal admission was documented in 22 (7%), 30 (12%), 28 (11%), and 6 (3%) women of groups 1, 2, 3, and 4, respectively. Generalized linear regression model (GLM) demonstrated that the odds ratio of preterm delivery was significantly higher in women with urinary iodine < 100 μg/L and TSH ≥ 4 μIU/mL than those with similar urinary iodine with TSH < 4 μIU/mL (OR 2.5 [95% CI 1.1, 10], p = 0.024). Adverse pregnancy outcomes are increased among women with UIC < 100 μg/L, with serum TSH concentrations ≥ 4 μIU/mL.
Collapse
Affiliation(s)
- Sima Nazarpour
- Department of Midwifery, Islamic Azad University, Varamin-Pishva Branch, Tehran, Iran
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mina Amiri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Razieh Bidhendi Yarandi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
113
|
Abstract
Iodine deficiency during pregnancy is an important global public health issue and the leading preventable cause of neurodevelopmental impairments worldwide. The effects of severe iodine deficiency during pregnancy, including adverse obstetric outcomes and decreased child intelligence quotient, have been clearly established. However, the effects of mild-to-moderate deficiency remain less well understood. Pregnant and lactating women have higher iodine requirements than other adults; intakes of 220 to 250 µg/d in pregnancy and 250 to 290 µg/d in lactation. In this article, we describe iodine metabolism, iodine requirements in pregnancy and lactation, the effects of both iodine deficiency and excessive iodine intakes in pregnancy, and the efficacy of iodine supplementation.
Collapse
|
114
|
Case Studies in Thyroid Dysfunction and Pregnancy. Clin Obstet Gynecol 2020; 62:388-397. [PMID: 30921002 DOI: 10.1097/grf.0000000000000446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This chapter represents a selection of 8 clinical scenarios that may commonly be encountered. They help summarize some of the literature and teaching points of the previous chapters. They are not meant to represent every possible presentation of thyroid disease, but rather to present common symptoms and findings that may aid a clinician in making a diagnosis or in selecting initial treatment.
Collapse
|
115
|
Buffenstein R, Lewis KN, Gibney PA, Narayan V, Grimes KM, Smith M, Lin TD, Brown-Borg HM. Probing Pedomorphy and Prolonged Lifespan in Naked Mole-Rats and Dwarf Mice. Physiology (Bethesda) 2020; 35:96-111. [DOI: 10.1152/physiol.00032.2019] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Pedomorphy, maintenance of juvenile traits throughout life, is most pronounced in extraordinarily long-lived naked mole-rats. Many of these traits (e.g., slow growth rates, low hormone levels, and delayed sexual maturity) are shared with spontaneously mutated, long-lived dwarf mice. Although some youthful traits likely evolved as adaptations to subterranean habitats (e.g., thermolability), the nature of these intrinsic pedomorphic features may also contribute to their prolonged youthfulness, longevity, and healthspan.
Collapse
Affiliation(s)
| | | | - Patrick A. Gibney
- Calico Life Sciences LLC, South San Francisco, California
- Department of Food Science, College of Agriculture and Life Sciences, Stocking Hall, Cornell University, Ithaca, New York
| | - Vikram Narayan
- Calico Life Sciences LLC, South San Francisco, California
| | - Kelly M. Grimes
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Megan Smith
- Calico Life Sciences LLC, South San Francisco, California
| | - Tzuhua D. Lin
- Calico Life Sciences LLC, South San Francisco, California
| | - Holly M. Brown-Borg
- Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| |
Collapse
|
116
|
Jha AB, Warkentin TD. Biofortification of Pulse Crops: Status and Future Perspectives. PLANTS (BASEL, SWITZERLAND) 2020; 9:E73. [PMID: 31935879 PMCID: PMC7020478 DOI: 10.3390/plants9010073] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 01/08/2023]
Abstract
Biofortification through plant breeding is a sustainable approach to improve the nutritional profile of food crops. The majority of the world's population depends on staple food crops; however, most are low in key micronutrients. Biofortification to improve the nutritional profile of pulse crops has increased importance in many breeding programs in the past decade. The key micronutrients targeted have been iron, zinc, selenium, iodine, carotenoids, and folates. In recent years, several biofortified pulse crops including common beans and lentils have been released by HarvestPlus with global partners in developing countries, which has helped in overcoming micronutrient deficiency in the target population. This review will focus on recent research advances and future strategies for the biofortification of pulse crops.
Collapse
Affiliation(s)
| | - Thomas D. Warkentin
- Crop Development Centre/Department of Plant Sciences, University of Saskatchewan, 51 Campus Drive, Saskatoon, SK S7N 5A8, Canada;
| |
Collapse
|
117
|
Prom-u-thai C, Rashid A, Ram H, Zou C, Guilherme LRG, Corguinha APB, Guo S, Kaur C, Naeem A, Yamuangmorn S, Ashraf MY, Sohu VS, Zhang Y, Martins FAD, Jumrus S, Tutus Y, Yazici MA, Cakmak I. Simultaneous Biofortification of Rice With Zinc, Iodine, Iron and Selenium Through Foliar Treatment of a Micronutrient Cocktail in Five Countries. FRONTIERS IN PLANT SCIENCE 2020; 11:589835. [PMID: 33304367 PMCID: PMC7691665 DOI: 10.3389/fpls.2020.589835] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/15/2020] [Indexed: 05/20/2023]
Abstract
Widespread malnutrition of zinc (Zn), iodine (I), iron (Fe) and selenium (Se), known as hidden hunger, represents a predominant cause of several health complications in human populations where rice (Oryza sativa L.) is the major staple food. Therefore, increasing concentrations of these micronutrients in rice grain represents a sustainable solution to hidden hunger. This study aimed at enhancing concentration of Zn, I, Fe and Se in rice grains by agronomic biofortification. We evaluated effects of foliar application of Zn, I, Fe and Se on grain yield and grain concentration of these micronutrients in rice grown at 21 field sites during 2015 to 2017 in Brazil, China, India, Pakistan and Thailand. Experimental treatments were: (i) local control (LC); (ii) foliar Zn; (iii) foliar I; and (iv) foliar micronutrient cocktail (i.e., Zn + I + Fe + Se). Foliar-applied Zn, I, Fe or Se did not affect rice grain yield. However, brown rice Zn increased with foliar Zn and micronutrient cocktail treatments at all except three field sites. On average, brown rice Zn increased from 21.4 mg kg-1 to 28.1 mg kg-1 with the application of Zn alone and to 26.8 mg kg-1 with the micronutrient cocktail solution. Brown rice I showed particular enhancements and increased from 11 μg kg-1 to 204 μg kg-1 with the application of I alone and to 181 μg kg-1 with the cocktail. Grain Se also responded very positively to foliar spray of micronutrients and increased from 95 to 380 μg kg-1. By contrast, grain Fe was increased by the same cocktail spray at only two sites. There was no relationship between soil extractable concentrations of these micronutrients with their grain concentrations. The results demonstrate that irrespective of the rice cultivars used and the diverse soil conditions existing in five major rice-producing countries, the foliar application of the micronutrient cocktail solution was highly effective in increasing grain Zn, I and Se. Adoption of this agronomic practice in the target countries would contribute significantly to the daily micronutrient intake and alleviation of micronutrient malnutrition in human populations.
Collapse
Affiliation(s)
- Chanakan Prom-u-thai
- Agronomy Division, Department of Plant and Soil Sciences, Faculty of Agriculture, Chiang Mai University, Chiang Mai, Thailand
| | - Abdul Rashid
- Pakistan Academy of Sciences, Islamabad, Pakistan
| | - Hari Ram
- Department of Plant Breeding & Genetics, Punjab Agricultural University, Ludhiana, India
| | - Chunqin Zou
- Center for Resources, Environment and Food Security, China Agricultural University, Beijing, China
| | | | | | - Shiwei Guo
- College of Resources and Environment, Nanjing Agricultural University, Nanjing, China
| | - Charanjeet Kaur
- Punjab Agricultural University Regional Research Station, Gurdaspur, India
| | - Asif Naeem
- Soil and Environmental Sciences Division, Nuclear Institute for Agriculture and Biology, Faisalabad, Pakistan
| | - Supapohn Yamuangmorn
- Agronomy Division, Department of Plant and Soil Sciences, Faculty of Agriculture, Chiang Mai University, Chiang Mai, Thailand
| | - Muhammad Yasin Ashraf
- Soil and Environmental Sciences Division, Nuclear Institute for Agriculture and Biology, Faisalabad, Pakistan
| | - Virinder Singh Sohu
- Department of Plant Breeding & Genetics, Punjab Agricultural University, Ludhiana, India
| | - Yueqiang Zhang
- College of Resources and Environment, Southwest University, Chongqing, China
| | | | - Suchada Jumrus
- Agronomy Division, Department of Plant and Soil Sciences, Faculty of Agriculture, Chiang Mai University, Chiang Mai, Thailand
| | - Yusuf Tutus
- Faculty of Engineering and Natural Sciences, Sabancı University, Istanbul, Turkey
| | | | - Ismail Cakmak
- Faculty of Engineering and Natural Sciences, Sabancı University, Istanbul, Turkey
- *Correspondence: Ismail Cakmak,
| |
Collapse
|
118
|
Toloza FJK, Motahari H, Maraka S. Consequences of Severe Iodine Deficiency in Pregnancy: Evidence in Humans. Front Endocrinol (Lausanne) 2020; 11:409. [PMID: 32636808 PMCID: PMC7318882 DOI: 10.3389/fendo.2020.00409] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
Iodine is a necessary micronutrient for the production of thyroid hormones and normal human development. Despite the significant worldwide strategies for the prevention and control of iodine deficiency, it is still a prevalent public health issue, especially in pregnant women. Severe iodine deficiency during pregnancy and neonatal period is associated with many major and irreversible adverse effects, including an increased risk of pregnancy loss and infant mortality, neonatal hypothyroidism, cretinism, and neuropsychomotor retardation. We will review the impact of severe iodine deficiency on maternofetal, neonatal, and offspring outcomes. We will also discuss its epidemiology, classification of iodine deficiency severity, and current recommendations to prevent iodine deficiency in childbearing age and pregnant women.
Collapse
Affiliation(s)
- Freddy J. K. Toloza
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Knowledge and Evaluation Research Unit in Endocrinology (KER-Endo), Rochester, MN, United States
| | - Hooman Motahari
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Knowledge and Evaluation Research Unit in Endocrinology (KER-Endo), Rochester, MN, United States
- Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
- *Correspondence: Spyridoula Maraka
| |
Collapse
|
119
|
Schiller T, Agmon A, Ostrovsky V, Shefer G, Knobler H, Zornitzki T. Moderate Iodine Deficiency Is Common in Pregnancy but Does Not Alter Maternal and Neonatal Thyroid Function Tests. Front Endocrinol (Lausanne) 2020; 11:523319. [PMID: 33362709 PMCID: PMC7759626 DOI: 10.3389/fendo.2020.523319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 11/11/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION An Israeli national survey found that 85% of pregnant women had urinary iodine content (UIC) levels below the adequacy range (<150 µg/L). Widespread desalinated water usage and no national fortification plan are possible causes. Studies assessing relationships between iodine status and maternal and neonatal thyroid function provided varying results. Our aims were to determine whether iodine deficiency was associated with altered maternal or neonatal thyroid function and the factors leading to iodine deficiency. METHODS A cross-sectional study including 100 healthy women without prior thyroid disease, in their first trimester of a singleton pregnancy were recruited from an HMO clinic in central Israel. The women were followed from their first trimester. All women completed a 24-h dietary recall and life habits questionnaires. We tested for UIC, maternal and neonatal thyroid function, maternal autoantibodies, and neonatal outcomes. RESULTS Median UIC in our cohort was 49 µg/L [25%-75% interquartile range (IQR) 16-91.5 µg/L], with 84% below adequacy range. No correlation was found between iodine deficiency and maternal or neonatal thyroid function which remained within normal ranges. Antibody status did not differ, but thyroglobulin levels were significantly higher in iodine insufficient subjects. UIC was higher in women consuming an iodine containing supplement. There was no association between UIC and dietary iodine content or water source. CONCLUSIONS Moderate iodine deficiency is common in our healthy pregnant women population. Our data imply that moderate iodine deficiency in pregnancy seem sufficient to maintain normal maternal and neonatal thyroid function.
Collapse
Affiliation(s)
- Tal Schiller
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hebrew University Medical School, Rehovot, Israel
| | - Arnon Agmon
- Clalit Health Services, Lev Tel Aviv Women’s Health Center, Tel Aviv, Israel
| | - Viviana Ostrovsky
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hebrew University Medical School, Rehovot, Israel
| | - Gabi Shefer
- Tel Aviv Sourasky Medical Center, Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv, Israel
| | - Hilla Knobler
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hebrew University Medical School, Rehovot, Israel
| | - Taiba Zornitzki
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hebrew University Medical School, Rehovot, Israel
- *Correspondence: Taiba Zornitzki,
| |
Collapse
|
120
|
Ultrasound Measurements of Fetal Thyroid: Reference Ranges from a Cohort of Low-Risk Pregnant Women. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9524378. [PMID: 31930141 PMCID: PMC6942710 DOI: 10.1155/2019/9524378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/03/2019] [Indexed: 11/18/2022]
Abstract
Background Adequate thyroid function is essential for normal growth and development of the fetus. Sonographic recognition of alterations in fetal thyroid dimensions may be the first sign of thyroid dysfunction, permitting early diagnosis and intervention. The main goal of this study was to build curves with reference values for ultrasound measurements of the fetal thyroid from 14 to 40 weeks of gestation. Methods This is a prospective longitudinal study of 90 Brazilian pregnant women, complementary to a cohort multicentre study named “WHO multicentre study for the development of growth standards from fetal life to childhood: the fetal component.” Pregnant women without any pre-existing conditions that might affect fetal growth received antenatal care from the first trimester until childbirth, undergoing serial ultrasound evaluations of the fetus, including the thyroid. Longitudinal, anteroposterior, and transverse diameters of both thyroid lobes were measured in the fetus. Fetal thyroid lobe volume was also estimated. By quantile regression analysis, reference curves of measurements were fitted according to the gestational age. Results A reference standard of thyroid growth was defined during pregnancy by fitting curves of its measurements. Reference values for the 10th, 50th, and 90th centiles of fetal thyroid measurements (longitudinal, anteroposterior, transverse diameters, and lobe volume) were defined, from 14 to 40 weeks of gestation. Conclusion We provided a reference curve of optimal thyroid development in a low-risk population that can be used as a standard of comparison to diagnose deviations from the norm. In addition, we demonstrated an alternative and simplified method for early recognition of thyroid morphological alterations by an individualized technique to evaluate the thyroid lobes.
Collapse
|
121
|
Goris JM, Temple VJ, Sumbis J, Zomerdijk N, Codling K. Iodine status of non-pregnant women and availability of food vehicles for fortification with iodine in a remote community in Gulf province, Papua New Guinea. PLoS One 2019; 14:e0224229. [PMID: 31730622 PMCID: PMC6858069 DOI: 10.1371/journal.pone.0224229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/08/2019] [Indexed: 12/03/2022] Open
Abstract
Adequate iodine status of women of childbearing age is essential for optimal growth and development of their offspring. The objectives of the current study were to assess the iodine status of non-pregnant women, availability and use of commercial salt, extent to which it is iodised, and availability of other industrially processed foods suitable for fortification with iodine. This prospective cross-sectional study was carried out in 2018 in a remote area in Gulf province, Papua New Guinea. Multistage cluster sampling was used to randomly select 300 women visiting local markets. Of these, 284 met study criteria of being non-pregnant and non-lactating. Single urine samples were collected from each of them. Discretionary salt intake was assessed; salt samples were collected from a sub-sample of randomly selected households. A semi-structured, pre-tested questionnaire to assess use and availability of commercial salt and other processed foods was modified and used. Salt was available on the interview day in 51.6% of households. Mean iodine content in household salt samples was 37.8 ± 11.8 ppm. Iodine content was below 30.0 ppm in 13.1% and below 15.0 ppm in 3.3% of salt samples. Mean iodine content of salt available at markets was 39.6 ± 0.52 ppm. Mean discretionary intake of salt per capita per day was 3.9 ± 1.21 g. Median UIC was 34.0 μg/L (95% CI, 30.0-38.0 ppm), indicating moderate iodine deficiency. For women with salt in the household, median UIC was 39.5 μg/L (95% CI, 32.0-47.0 μg/L), compared to median UIC of 29.0 μg/L (95% CI, 28.0-32.0 μg/L) for those without salt. This community has low consumption of iodised salt, likely due to limited access. Investigation of other industrially processed foods indicated salt is the most widely consumed processed food in this remote community, although 39.8% of households did use salty flavourings.
Collapse
Affiliation(s)
| | - Victor J. Temple
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Joan Sumbis
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Nienke Zomerdijk
- School of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Karen Codling
- Iodine Global Network—Southeast Asia and the Pacific, Bangkok, Thailand
| |
Collapse
|
122
|
McMullan P, Hamill L, Doolan K, Hunter A, McCance D, Patterson C, Smyth P, Woodside JV, Mullan K. Iodine deficiency among pregnant women living in Northern Ireland. Clin Endocrinol (Oxf) 2019; 91:639-645. [PMID: 31325189 DOI: 10.1111/cen.14065] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/24/2019] [Accepted: 07/17/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Mild iodine deficiency has re-emerged among school girls in the UK. We wished to study a contemporaneous pregnant population because a relationship between maternal iodine deficiency and offspring cognitive scores has recently been reported. The WHO has set a median population urinary iodine concentration (UIC) of ≥100 and ≥150 µg/L to define adequacy outside of and during pregnancy, respectively. Iodine creatinine ratio (ICR) is also used to correct for dilution effects (sufficiency ≥150 µg/g creatinine in pregnancy). DESIGN AND METHODS A total of 241 women were followed across trimesters (T) into the postpartum period (PPP) along with 80 offspring with spot urine sampling and food frequency questionnaires. RESULTS Median UIC was 73 µg/L in the 1st T (ICR 102 µg/g creatinine) despite 55% taking iodine-containing supplements. Median UICs were 94, 117 and 90 µg/L in the 2nd T, 3rd T and PPP, respectively. Corresponding ICRs were 120, 126 and 60 µg/g creatinine. ICR was associated with volume of milk consumed throughout pregnancy. Median UIC among the offspring was 148 µg/L, with no difference between the breast- and formula-fed babies. CONCLUSIONS Pregnant women living in Northern Ireland may be at risk of iodine deficiency across pregnancy and into the PPP while the offspring are iodine sufficient. This is the first study of its kind in the UK with data for pregnant women and their offspring. The UK does not provide an iodine fortification programme nor offer routine iodine dietary advice in pregnancy and this requires consideration by public health agencies.
Collapse
Affiliation(s)
- Paul McMullan
- Regional Centre for Endocrinology and Diabetes Royal Victoria Hospital Belfast, Belfast, UK
| | | | | | | | - David McCance
- Regional Centre for Endocrinology and Diabetes Royal Victoria Hospital Belfast, Belfast, UK
| | | | | | | | - Karen Mullan
- Regional Centre for Endocrinology and Diabetes Royal Victoria Hospital Belfast, Belfast, UK
| |
Collapse
|
123
|
Næss S, Aakre I, Kjellevold M, Dahl L, Nerhus I, Midtbø LK, Markhus MW. Validation and reproducibility of a new iodine specific food frequency questionnaire for assessing iodine intake in Norwegian pregnant women. Nutr J 2019; 18:62. [PMID: 31665021 PMCID: PMC6821006 DOI: 10.1186/s12937-019-0489-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/28/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Iodized salt is not mandatory in Norway, and the permitted level of iodine in table salt is low (5 μg/g). Thus, milk and dairy products, fish and eggs are the main dietary sources of iodine in Norway. Mild-to-moderate iodine deficiency in pregnant women has been described in several European countries, including Norway. There are few validated tools available to assess iodine intake in an efficient manner. The aim of the current study was to assess the validity and reproducibility of a new iodine-specific food frequency questionnaire (I-FFQ) in Norwegian pregnant women. METHODS An I-FFQ consisting of a total of 60 food items and the use of supplements was developed to assess iodine intake and was administrated to 137 pregnant women at gestational week 18-19. Reference methods were a structured 6-days iodine specific food diary, urinary iodine concentration (UIC) (pooled sample of spot UIC from six consecutive days), and thyroid function tests. Correlation analyses, Cohen's weighted kappa, Bland-Altman plots, and linear regression analyses were used to assess validity. Reproducibility of the I-FFQ was assessed in a subgroup (n = 47) at gestational week 35-36. RESULTS There was a strong correlation between estimated iodine intake from the I-FFQ and food diary (r = 0.62, P < 0.001) and an acceptable correlation between the I-FFQ and UIC (r = 0.21, P = 0.018). There was no significant association between the I-FFQ and thyroid function tests. The I-FFQ estimated higher iodine intake compared to the food diary with a mean absolute difference 33 μg/day. The limits of agreement from the Bland-Altman plots were large, however few participants fell outside the limits of agreement (5.2-6.5%). There was no difference between the estimated iodine intake from the I-FFQ assessed at gestational week 18-19, and gestational week 35-36 (P = 0.866), and there was a strong correlation between the two time points (r = 0.63, P < 0.001). CONCLUSION In summary, this study suggests that the I-FFQ can be used as a valid tool to estimate and rank iodine intake among Norwegian pregnant women. We further suggest that this I-FFQ may also be valid in other populations with similarly dietary patterns and where salt is not iodized. TRIAL REGISTRATION The study is registered in ClinicalTrials.gov (NCT02610959).
Collapse
Affiliation(s)
- Synnøve Næss
- Institute of Marine Research (IMR), 5817 Bergen, Norway
| | - Inger Aakre
- Institute of Marine Research (IMR), 5817 Bergen, Norway
| | | | - Lisbeth Dahl
- Institute of Marine Research (IMR), 5817 Bergen, Norway
| | - Ive Nerhus
- Institute of Marine Research (IMR), 5817 Bergen, Norway
| | | | | |
Collapse
|
124
|
The Joint Role of Thyroid Function and Iodine Status on Risk of Preterm Birth and Small for Gestational Age: A Population-Based Nested Case-Control Study of Finnish Women. Nutrients 2019; 11:nu11112573. [PMID: 31731400 PMCID: PMC6893669 DOI: 10.3390/nu11112573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/17/2022] Open
Abstract
Normal maternal thyroid function during pregnancy is essential for fetal development and depends upon an adequate supply of iodine. Little is known about how iodine status is associated with preterm birth and small for gestational age (SGA) in mildly iodine insufficient populations. Our objective was to evaluate associations of early pregnancy serum iodine, thyroglobulin (Tg), and thyroid-stimulating hormone (TSH) with odds of preterm birth and SGA in a prospective, population-based, nested case-control study from all births in Finland (2012–2013). Cases of preterm birth (n = 208) and SGA (n = 209) were randomly chosen from among all singleton births. Controls were randomly chosen from among singleton births that were not preterm (n = 242) or SGA (n = 241) infants during the same time period. Women provided blood samples at 10–14 weeks’ gestation for serum iodide, Tg and TSH measurement. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for preterm birth and SGA. Each log-unit increase in serum iodide was associated with higher odds of preterm birth (adjusted OR = 1.19, 95% CI = 1.02–1.40), but was not associated with SGA (adjusted OR = 1.01, 95% CI = 0.86–1.18). Tg was not associated with preterm birth (OR per 1 log-unit increase = 0.87, 95% CI = 0.73–1.05), but was inversely associated with SGA (OR per log-unit increase = 0.78, 95% CI = 0.65–0.94). Neither high nor low TSH (versus normal) were associated with either outcome. These findings suggest that among Finnish women, iodine status is not related to SGA, but higher serum iodide may be positively associated with preterm birth.
Collapse
|
125
|
Manousou S, Andersson M, Eggertsen R, Hunziker S, Hulthén L, Nyström HF. Iodine deficiency in pregnant women in Sweden: a national cross-sectional study. Eur J Nutr 2019; 59:2535-2545. [PMID: 31616973 PMCID: PMC7413865 DOI: 10.1007/s00394-019-02102-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/26/2019] [Indexed: 01/20/2023]
Abstract
Purpose Voluntary salt iodization at 50 mg/kg salt ensures adequate iodine nutrition in Swedish school-aged children, but iodine status in pregnant women is uncertain. Methods We conducted a cross-sectional national study of 743 pregnant women, at median gestational age of 23 weeks (IQR 9, 38), recruited from maternal health care centers. We measured: urinary iodine concentration (UIC) and urinary creatinine concentration in spot urine samples; thyroglobulin (Tg), thyroid-stimulating hormone (TSH), and total thyroxine (tT4) on dried blood spots (DBS); and thyreoperoxidase antibodies in serum samples. Data on dietary supplement use were obtained, and women were classified as supplement users (consuming multivitamins containing ≥ 150 µg iodine/day) and non-supplement users (no supplements or < 150 µg iodine/day from supplements). Results Overall median UIC [bootstrapped 95% confidence interval (CI)] was 101 µg/L (95, 108; n = 737): 149 µg/L (132, 164) in supplement users (n = 253) and 85 µg/L (79, 92) in non-supplement users (n = 440) (p < 0.001). Overall geometric mean DBS-Tg (95% CI) was 22.1 μg/L (20.8, 23.5; n = 675) and the prevalence of elevated DBS-Tg was 19%. DBS-Tg was lower in supplement users (n = 229) than in non-supplement users (n = 405) (19.1 vs 24.4 μg/L, p < 0.001). DBS-TSH, DBS-tT4, and S-TPOab positivity did not differ between the two groups. Conclusions Pregnant women in Sweden have inadequate iodine nutrition. Women not taking iodine supplements containing ≥ 150 µg iodine/day are affected by mild iodine deficiency and are at higher risk for increased thyroid activity, while maintaining euthyroidism. Iodine intake should be improved in women both before and after conception by promotion of iodized salt instead of non-iodized salt. We urge regular monitoring of iodine status in the general Swedish population, as well as in risk groups.
Collapse
Affiliation(s)
- Sofia Manousou
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. .,Frölunda Specialist Hospital, Marconigatan 31, 42144, Västra Frölunda, Sweden.
| | - Maria Andersson
- Division of Gastroenterology and Nutrition, University Children's Hospital Zurich, Eleonore Foundation, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Iodine Global Network, Ottawa, ON, Canada
| | - Robert Eggertsen
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Mölnlycke Health Care Centre, Ekdalavägen 2, 43530, Mölnlycke, Sweden
| | - Sandra Hunziker
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland
| | - Lena Hulthén
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 13, 40530, Gothenburg, Sweden
| | - Helena Filipsson Nyström
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Endocrinology, Sahlgrenska University Hospital, Gröna Stråket 8, 41345, Gothenburg, Sweden
| |
Collapse
|
126
|
Zhang H, Wu M, Yang L, Wu J, Hu Y, Han J, Gu Y, Li X, Wang H, Ma L, Yang X. Evaluation of median urinary iodine concentration cut-off for defining iodine deficiency in pregnant women after a long term USI in China. Nutr Metab (Lond) 2019; 16:62. [PMID: 31516542 PMCID: PMC6734293 DOI: 10.1186/s12986-019-0381-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/12/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The WHO/UNICEF/ICCIDD define iodine deficiency during pregnancy as median urinary iodine concentration (MUIC) ≤ 150 μg/L. China implemented universal salt iodization (USI) in 1995, and recent surveillance showed nationwide elimination of iodine deficiency disorders (IDD). Data from 2014 showed that the MUIC in 19,500 pregnant women was 154.6 μg/L and 145 μg/L in 9000 pregnant women in 2015. However, symptoms of iodine deficiency were absent. Our study sought to evaluate whether MUIC below 150 μg/L affects thyroid function of Chinese pregnant women and their newborns in Chinese context. METHODS We screened 103 women with normal thyroid function and MUIC lower than 150 μg/L during week 6 of pregnancy at Peking Union Medical College Hospital. Patient demographics and dietary salt intake were recorded. Subjects were followed at 12, 24, and 32 gestational weeks. At each visit, a 3-day dietary record, drinking water samples, and edible salt samples were collected and analyzed for total dietary iodine intake. Additionally, 24-h urine iodine and creatinine were measured. Blood tests assessed thyroid function in both mothers and newborns. RESULTS Of 103 pregnant women enrolled, 79 completed all follow-up visits. Most subjects maintained normal thyroid function throughout pregnancy. However, 19 had thyroid dysfunction based on thyroid stimulating hormone and free thyroxine levels. The median serum iodine was 71 μg/L (95% CI: 44, 109). The median thyroglobulin was < 13 μg/L. values above this level indicate iodine deficiency in pregnant women. The median dietary iodine intake during pregnancy, derived from the 3-day record and measures of water and salt, was 231.17 μg/d. Assuming 90% urinary iodine excretion (UIE), 200.11 μg/d UIE means the 222.34 μg iodine loss per day, suggesting that subjects had a positive iodine balance throughout pregnancy. All neonatal blood samples showed TSH levels lower than 10 mIU/L, indicating normal thyroid function. No significant difference was found among gestational weeks for urinary iodine, and the MUIC in subjects who completed 3 follow-up visits was 107.41 μg/L. CONCLUSION Twenty years after implementing USI, expectant Chinese mothers with MUIC of 107.4 μg/L, less than the WHO's 150 μg/L benchmark, maintained thyroid function in both themselves and their newborn babies.
Collapse
Affiliation(s)
- Huidi Zhang
- The Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xicheng District Beijing, China
| | - Meng Wu
- Shaanxi Provincial Centre for Disease Control and Prevention, No.3, jiandong street, Xi’an, Shaanxi China
| | - Lichen Yang
- The Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xicheng District Beijing, China
| | - Jinghuan Wu
- The Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xicheng District Beijing, China
| | - Yichun Hu
- The Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xicheng District Beijing, China
| | - Jianhua Han
- The Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academic Medical Science and Peking Union College, No.1 Shuaifuyuan Wangfujing, Dongcheng District Beijing, China
| | - Yunyou Gu
- The National IDD Reference Laboratory, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xicheng District Beijing, China
| | - Xiuwei Li
- The National IDD Reference Laboratory, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xicheng District Beijing, China
| | - Haiyan Wang
- The National IDD Reference Laboratory, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xicheng District Beijing, China
| | - Liangkun Ma
- Department of Obstetrics-gynecology, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing, Dongcheng District Beijing, China
| | - Xiaoguang Yang
- The Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nan Wei Road, Xicheng District Beijing, China
| |
Collapse
|
127
|
Hay I, Hynes KL, Burgess JR. Mild-to-Moderate Gestational Iodine Deficiency Processing Disorder. Nutrients 2019; 11:E1974. [PMID: 31443337 PMCID: PMC6770179 DOI: 10.3390/nu11091974] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/12/2019] [Accepted: 08/15/2019] [Indexed: 12/28/2022] Open
Abstract
This synopsis paper aims to identify if a common pattern of learning and social difficulties can be conceptualized across recent longitudinal studies investigating the influence of mild-to-moderate gestational iodine deficiency (GID) on offspring's optimal cognitive and psycho-social development. The main studies investigated are: The Southampton Women's Study (SWS)-United Kingdom; the Avon Longitudinal Study of Parents and Children (ALSPAC)-United Kingdom; the Gestational Iodine Cohort Longitudinal Study-Tasmania, Australia, and the Danish National Birth Cohort Case-Control Study-Denmark. In contrast to severe GID where there is a global negative impact on neurodevelopment, mild-to-moderate intrauterine iodine deficiency has subtler, but nonetheless important, permanent cognitive and psycho-social consequences on the offspring. This paper links the results from each study and maintains that mild-to-moderate GID is associated with a disorder that is characterized by speed of neural transmitting difficulties that are typically associated with working memory capacity difficulties and attention and response inhibition. The authors maintain that this disorder is better identified as Gestational Iodine Deficiency Processing Disorder (GIDPD), rather than, what to date has often been identified as 'suboptimal development'. The Autistic Spectrum Disorder (ASD), Attention Deficit, Hyperactivity Disorder (ADHD), language and literacy disorders (learning disabilities and dyslexia) are the main manifestations associated with GIDPD. GIDPD is identified on IQ measures, but selectively and mainly on verbal reasoning IQ subtests, with individuals with GIDPD still operating within the 'normal' full-scale IQ range. Greater consideration needs to be given by public health professionals, policy makers and educators about the important and preventable consequences of GID. Specifically, more emphasis should be placed on adequate iodine intake in women prior to pregnancy, as well as during pregnancy and when lactating. Secondly, researchers and others need to further extend, refine and clarify whether GIDPD, as a nosological (medical classification) entity, is a valid disorder and concept for consideration.
Collapse
Affiliation(s)
- Ian Hay
- Faculty of Education, University of Tasmania, Launceston 7250, Australia.
| | - Kristen L Hynes
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7001, Australia
| | - John R Burgess
- Department of Endocrinology, Royal Hobart Hospital, Hobart 7001, Australia
- School of Medicine, University of Tasmania, Hobart 7000, Australia
| |
Collapse
|
128
|
Wang X, Liu C, Zhang M, Han Y, Aase H, Villanger GD, Myhre O, Donkelaar AV, Martin RV, Baines EA, Chen R, Kan H, Xia Y. Evaluation of Maternal Exposure to PM 2.5 and Its Components on Maternal and Neonatal Thyroid Function and Birth Weight: A Cohort Study. Thyroid 2019; 29:1147-1157. [PMID: 31298631 DOI: 10.1089/thy.2018.0780] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Particulate matter (PM) air pollution is an environmental risk to public health. The prevalence of thyroid disease during pregnancy has increased rapidly in recent decades, but the available data on the relationships among air pollution, thyroid function, and birth outcomes in pregnant women, particularly in China, are scarce. We aimed to evaluate the association between maternal exposure to PM2.5 and its components and maternal and neonatal thyroid function and to investigate whether thyroid function acts as a mediator between air pollution and birth weight. Methods: In this prospective birth cohort study, the levels of maternal exposure to PM2.5 and its components during the first trimester were assessed in 433 pregnant women in Nanjing, China, enrolled during 2014-2015. We evaluated the levels of maternal exposure to PM2.5 and its six main constituents-organic matter (OM), black carbon (BC), sulfate (SO42-), nitrate (NO3-), ammonium (NH4+), and soil dust-using the V4.CH.02 product of the Dalhousie University Atmospheric Composition Analysis Group. The maternal serum-free thyroxine (fT4), thyrotropin (TSH), and thyroid peroxidase antibody (TPOAb) levels during the second trimester were measured through electrochemiluminescent microparticle immunoassays. The neonatal TSH levels were detected using an AutoDELFIA Neonatal TSH kit within 72 hours after birth, and the birth weight Z-score of each newborn was estimated. Results: Higher exposure to maternal PM2.5 and some components (BC and NH4+) decreased the maternal fT4 level (p < 0.05), and the birth weight Z-score was decreased (p < 0.05) by higher exposure to maternal PM2.5 and some components (OM, BC, NO3-, and NH4+). A mediation analysis clarified that the maternal fT4 levels explained 15.9%, 18.4%, and 20.9% of the associations of maternal PM2.5, BC, and NH4+ exposure with the birth weight Z-score, respectively (p < 0.05). After additional sensitivity analyses including only nonpreterm participants (n = 418) and non-TPOAb-positive participants (n = 415), the models remained stable. Conclusions: Our results suggest an inverse association between maternal exposure to PM2.5 and its components and the maternal fT4 levels. Maternal fT4 might act as a mediator between exposure to PM2.5 and its components and birth weight.
Collapse
Affiliation(s)
- Xu Wang
- 1State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- 2Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Cong Liu
- 3Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Mingzhi Zhang
- 1State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- 2Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yingying Han
- 1State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- 2Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Heidi Aase
- 4Department of Child Development and Norwegian Institute of Public Health, Oslo, Norway
| | - Gro Dehli Villanger
- 4Department of Child Development and Norwegian Institute of Public Health, Oslo, Norway
| | - Oddvar Myhre
- 5Department of Toxicology and Risk Assessment, Norwegian Institute of Public Health, Oslo, Norway
| | - Aaron van Donkelaar
- 6Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - Randall V Martin
- 6Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
- 7Harvard-Smithsonian Center for Astrophysics, Cambridge, Massachusetts
| | - Erica Anne Baines
- 8Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Renjie Chen
- 3Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Haidong Kan
- 3Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, School of Public Health, Fudan University, Shanghai, China
| | - Yankai Xia
- 1State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- 2Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| |
Collapse
|
129
|
Mullan K, Hamill L, Doolan K, Young I, Smyth P, Flynn A, Walton J, Meharg AA, Carey M, McKernan C, Bell M, Black N, Graham U, McCance D, McHugh C, McMullan P, McQuaid S, O'Loughlin A, Tuthill A, Bath SC, Rayman M, Woodside JV. Iodine status of teenage girls on the island of Ireland. Eur J Nutr 2019; 59:1859-1867. [PMID: 31321499 DOI: 10.1007/s00394-019-02037-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/29/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Karen Mullan
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, Ireland.
| | | | | | | | | | | | | | | | | | | | | | | | - Una Graham
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, Ireland
| | - David McCance
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, Ireland
| | | | - Paul McMullan
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, Ireland
| | | | | | | | | | | | | |
Collapse
|
130
|
Birthweight and risk of thyroid cancer and its histological types: A large cohort study. Cancer Epidemiol 2019; 62:101564. [PMID: 31325768 DOI: 10.1016/j.canep.2019.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/05/2019] [Accepted: 07/07/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aetiology of thyroid cancer is poorly understood, but it is possible that this malignancy has origins early in life. It is, however, currently unknown if birthweight, as an indicator of prenatal growth, is related to thyroid cancer risk. OBJECTIVE To investigate if birthweight is associated with the later risk of thyroid cancer and its histological types. METHODS 246,141 children (120,505 girls, 125,636 boys) from the Copenhagen School Health Records Register, born 1936-1989, were prospectively followed in the Danish Cancer Registry. Cox regressions were used to estimate hazards ratios (HR) and 95% confidence intervals (CI). RESULTS During follow up, 241 individuals (172 women, 69 men) were diagnosed with thyroid cancer (162 papillary, 53 follicular). Birthweight was significantly and positively associated with risk of thyroid cancer overall (HR = 1.30 [95% CI: 1.03-1.64] per kilogram). There were no sex differences in the associations. Birthweight was positively and significantly associated with follicular thyroid cancer (HR = 1.74 [95% CI: 1.07-2.82] per kilogram), and although there was an indication of a positive association, it did not reach statistical significance for the more common papillary type (HR = 1.20 [95% CI: 0.90-1.59] per kilogram). CONCLUSION A heavier weight at birth is associated with an elevated risk of total and follicular thyroid cancer, which underscores that prenatal exposures may be important in thyroid cancer aetiology.
Collapse
|
131
|
Chen Y, Chen W, Du C, Fan L, Wang W, Gao M, Zhang Y, Cui T, Hao Y, Pearce EN, Wang C, Zhang W. Iodine Nutrition and Thyroid Function in Pregnant Women Exposed to Different Iodine Sources. Biol Trace Elem Res 2019; 190:52-59. [PMID: 30280309 DOI: 10.1007/s12011-018-1530-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/19/2018] [Indexed: 10/28/2022]
Abstract
Pregnant women are more vulnerable to iodine deficiency and iodine excess. The study aimed to assess the changes in iodine nutrition and thyroid function of pregnant women exposed to different iodine sources resulting in various iodine intakes during pregnancy. From 2016 to 2017, 2004 healthy pregnant women aged 20-35 years from Shandong and Tianjin, China, were enrolled. Urinary iodine concentration (UIC), drinking water iodine content (WIC), thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroid hormone (FT4), thyroglobulin (Tg), serum thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) were measured. Pregnant women in both Shandong and Tianjin were iodine sufficient, but the median UIC in pregnant women was significantly higher in Shandong (244 μg/L) than that in Tianjin (159 μg/L). No differences were found in UIC over the course of gestation in Shandong. In Tianjin, the UIC decreased during 13-24 weeks and stabilized thereafter. Compared with Tianjin, TSH levels were higher and FT3 and FT4 levels were lower in Shandong. Both FT3 and FT4 significantly decreased during pregnancy in Shandong and Tianjin. TSH and Tg increased over the course of gestation in both Shandong and Tianjin. The iodine status of pregnant women in Tianjin and Shandong were sufficient, but different changing patterns in UIC and thyroid function during pregnancy were presented. More attention should be focused on iodine nutrition of pregnant women, even in iodine-sufficient areas.
Collapse
Affiliation(s)
- Yanting Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, #22 Qixiangtai Street, Heping District, Tianjin, 300070, China
| | - Wen Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, #22 Qixiangtai Street, Heping District, Tianjin, 300070, China
| | - Cong Du
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, #22 Qixiangtai Street, Heping District, Tianjin, 300070, China
| | - Lili Fan
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, #22 Qixiangtai Street, Heping District, Tianjin, 300070, China
| | - Wei Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, #22 Qixiangtai Street, Heping District, Tianjin, 300070, China
| | - Min Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, #22 Qixiangtai Street, Heping District, Tianjin, 300070, China
| | - Yixin Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, #22 Qixiangtai Street, Heping District, Tianjin, 300070, China
| | - Tingkai Cui
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, #22 Qixiangtai Street, Heping District, Tianjin, 300070, China
| | - Yunmeng Hao
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, #22 Qixiangtai Street, Heping District, Tianjin, 300070, China
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, USA
| | - Chongdan Wang
- Department of Obstetrics, Tanggu Maternity Hospital, Tianjin, China
| | - Wanqi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, #22 Qixiangtai Street, Heping District, Tianjin, 300070, China.
| |
Collapse
|
132
|
van der Reijden OL, Galetti V, Bürki S, Zeder C, Krzystek A, Haldimann M, Berard J, Zimmermann MB, Herter-Aeberli I. Iodine bioavailability from cow milk: a randomized, crossover balance study in healthy iodine-replete adults. Am J Clin Nutr 2019; 110:102-110. [PMID: 31788697 DOI: 10.1093/ajcn/nqz092] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/19/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Milk and dairy products are considered important dietary sources of iodine in many countries. However, to our knowledge, iodine bioavailability from milk has not been directly measured in humans. OBJECTIVE The aim of this study was to compare iodine bioavailability in iodine-replete adults from: 1) cow milk containing a high concentration of native iodine; 2) milk containing a low concentration of native iodine, with the addition of potassium iodide (KI) to assess a potential matrix effect; and 3) an aqueous solution of KI as a comparator; with all 3 containing equal amounts of total iodine (263 µg/250 mL). We also speciated iodine in milk. DESIGN We conducted a 3-wk, randomized, crossover balance study in adults (n = 12) consuming directly analyzed, standardized diets. During the 3 test conditions - high intrinsic iodine milk (IIM), extrinsically added iodine in milk (EIM), and aqueous iodine solution (AIS) - subjects collected 24-h urine over 3 d and consumed the test drink on the second day, with 3- or 4-d wash-out periods prior to each treatment. Iodine absorption was calculated as the ratio of urinary iodine excretion (UIE) to total iodine intake. Milk iodine speciation was performed using ion chromatography-mass spectrometry. RESULTS Iodine intake from the standardized diet was 195 ± 6 µg/d for males and 107 ± 6 µg/d for females; the test drinks provided an additional 263 µg. Eleven subjects completed the protocol. There was a linear relation between iodine intake and UIE (β = 0.89, SE = 0.04, P < 0.001). There were no significant differences in UIE among the 3 conditions (P = 0.24). Median (range) fractional iodine absorption across the 3 conditions was 91 (51-145), 72 (48-95), and 98 (51-143)% on days 1, 2, and 3, respectively, with day 2 significantly lower compared with days 1 and 3 (P < 0.001). In milk, 80-93% of the total iodine was inorganic iodide. CONCLUSION Nearly all of the iodine in cow milk is iodide and although fractional iodine absorption from milk decreases with increasing dose, its bioavailability is high. The trial was registered at clinicaltrials.gov as NCT03590431.
Collapse
Affiliation(s)
- Olivia L van der Reijden
- ETH Zurich, Institute of Food, Nutrition and Health, Laboratory of Human Nutrition, Zurich, Switzerland
| | - Valeria Galetti
- ETH Zurich, Institute of Food, Nutrition and Health, Laboratory of Human Nutrition, Zurich, Switzerland
| | - Sarah Bürki
- ETH Zurich, Institute of Food, Nutrition and Health, Laboratory of Human Nutrition, Zurich, Switzerland
| | - Christophe Zeder
- ETH Zurich, Institute of Food, Nutrition and Health, Laboratory of Human Nutrition, Zurich, Switzerland
| | - Adam Krzystek
- ETH Zurich, Institute of Food, Nutrition and Health, Laboratory of Human Nutrition, Zurich, Switzerland
| | - Max Haldimann
- Federal Food Safety and Veterinary Office, Division of Risk Assessment, Bern, Switzerland
| | - Joel Berard
- ETH Zurich, AgroVet-Strickhof, Lindau, Switzerland
| | - Michael B Zimmermann
- ETH Zurich, Institute of Food, Nutrition and Health, Laboratory of Human Nutrition, Zurich, Switzerland
| | - Isabelle Herter-Aeberli
- ETH Zurich, Institute of Food, Nutrition and Health, Laboratory of Human Nutrition, Zurich, Switzerland
| |
Collapse
|
133
|
Waugh DT. Fluoride Exposure Induces Inhibition of Sodium/Iodide Symporter (NIS) Contributing to Impaired Iodine Absorption and Iodine Deficiency: Molecular Mechanisms of Inhibition and Implications for Public Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1086. [PMID: 30917615 PMCID: PMC6466022 DOI: 10.3390/ijerph16061086] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 12/24/2022]
Abstract
The sodium iodide symporter (NIS) is the plasma membrane glycoprotein that mediates active iodide transport in the thyroid and other tissues, such as the salivary, gastric mucosa, rectal mucosa, bronchial mucosa, placenta and mammary glands. In the thyroid, NIS mediates the uptake and accumulation of iodine and its activity is crucial for the development of the central nervous system and disease prevention. Since the discovery of NIS in 1996, research has further shown that NIS functionality and iodine transport is dependent on the activity of the sodium potassium activated adenosine 5'-triphosphatase pump (Na+, K+-ATPase). In this article, I review the molecular mechanisms by which F inhibits NIS expression and functionality which in turn contributes to impaired iodide absorption, diminished iodide-concentrating ability and iodine deficiency disorders. I discuss how NIS expression and activity is inhibited by thyroglobulin (Tg), tumour necrosis factor alpha (TNF-α), transforming growth factor beta 1 (TGF-β1), interleukin 6 (IL-6) and Interleukin 1 beta (IL-1β), interferon-γ (IFN-γ), insulin like growth factor 1 (IGF-1) and phosphoinositide 3-kinase (PI3K) and how fluoride upregulates expression and activity of these biomarkers. I further describe the crucial role of prolactin and megalin in regulation of NIS expression and iodine homeostasis and the effect of fluoride in down regulating prolactin and megalin expression. Among many other issues, I discuss the potential conflict between public health policies such as water fluoridation and its contribution to iodine deficiency, neurodevelopmental and pathological disorders. Further studies are warranted to examine these associations.
Collapse
Affiliation(s)
- Declan Timothy Waugh
- EnviroManagement Services, 11 Riverview, Doherty's Rd, Bandon, Co. Cork, P72 YF10, Ireland.
| |
Collapse
|
134
|
Farebrother J, Zimmermann MB, Andersson M. Excess iodine intake: sources, assessment, and effects on thyroid function. Ann N Y Acad Sci 2019; 1446:44-65. [PMID: 30891786 DOI: 10.1111/nyas.14041] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/30/2019] [Accepted: 02/02/2019] [Indexed: 12/15/2022]
Abstract
Iodine is essential for thyroid hormone synthesis. High iodine intakes are well tolerated by most healthy individuals, but in some people, excess iodine intakes may precipitate hyperthyroidism, hypothyroidism, goiter, and/or thyroid autoimmunity. Individuals with preexisting thyroid disease or those previously exposed to iodine deficiency may be more susceptible to thyroid disorders due to an increase in iodine intake, in some cases at intakes only slightly above physiological needs. Thyroid dysfunction due to excess iodine intake is usually mild and transient, but iodine-induced hyperthyroidism can be life-threatening in some individuals. At the population level, excess iodine intakes may arise from consumption of overiodized salt, drinking water, animal milk rich in iodine, certain seaweeds, iodine-containing dietary supplements, and from a combination of these sources. The median urinary iodine concentration (UIC) of a population reflects the total iodine intake from all sources and can accurately identify populations with excessive iodine intakes. Our review describes the association between excess iodine intake and thyroid function. We outline potential sources of excess iodine intake and the physiological responses and consequences of excess iodine intakes. We provide guidance on choice of biomarkers to assess iodine intake, with an emphasis on the UIC and thyroglobulin.
Collapse
Affiliation(s)
- Jessica Farebrother
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland.,Department of Women and Children's Health, King's College London, London, UK
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland.,Iodine Global Network, Ottawa, Ontario, Canada
| | - Maria Andersson
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland.,Iodine Global Network, Ottawa, Ontario, Canada.,Division of Gastroenterology and Nutrition, University Children's Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
135
|
McMullan P, Hunter A, McCance D, Woodside JV, Mullan K. Knowledge about iodine requirements during pregnancy and breastfeeding among pregnant women living in Northern Ireland. BMC Nutr 2019; 5:24. [PMID: 32153937 PMCID: PMC7050819 DOI: 10.1186/s40795-019-0285-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/25/2019] [Indexed: 01/15/2023] Open
Abstract
Background Iodine is an essential micronutrient important for foetal nerve and brain development, especially in the early stages of pregnancy. The re-emergence of mild to moderate iodine deficiency has recently been reported in the United Kingdom (UK). The level of knowledge amongst pregnant women regarding iodine nutrition is poorly understood. The aim of this study was to determine the level of knowledge about iodine nutrition during pregnancy among pregnant women living in Northern Ireland (NI). Methods A cross-sectional study in pregnant women was carried out in Royal Jubilee Maternity Hospital Belfast, from March to June 2015. Two hundred pregnant women were provided with a short questionnaire on iodine knowledge during routine clinic visits and comparisons were made across trimester and parity. Results Only 20% of women were aware of the potentially increased iodine requirements during pregnancy and breast feeding; 45% were unable to identify any foods they thought would be iodine rich. The three main sources of dietary iodine in the UK are fish, dairy and eggs and 30, 9 and 15% correctly identified these as good sources respectively. When asked about whether they felt they had been given sufficient advice about folic acid and iodine in pregnancy, 90% felt this was so for folic acid, but only 5% for iodine. Conclusions This study suggests that iodine knowledge among pregnant women living in NI is poor. In the absence of any iodine fortification programme, women in the UK may be vulnerable to iodine deficiency in pregnancy. At present they are poorly equipped to make positive dietary changes to meet their increasing iodine requirements during pregnancy and breastfeeding. Public health strategies should be considered to target this population group.
Collapse
Affiliation(s)
- Paul McMullan
- 1Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, UK
| | | | - David McCance
- 1Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, UK
| | - Jayne V Woodside
- 2Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Karen Mullan
- 1Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, UK
| |
Collapse
|
136
|
Variation of iodine status during pregnancy and its associations with thyroid function in women from Rio de Janeiro, Brazil. Public Health Nutr 2019; 22:1232-1240. [PMID: 30846017 DOI: 10.1017/s1368980019000399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess iodine status and its effects on maternal thyroid function throughout pregnancy. DESIGN In the present prospective cohort study, three urinary samples were requested for urinary iodine concentration (UIC) determinations in both the first and third gestational trimesters. Serum thyrotropin (TSH) and free thyroxine (FT4) were analysed in both trimesters and thyroid antibodies were assessed once. SETTING Rio de Janeiro, Brazil.ParticipantsFirst-trimester pregnant women (n 243), of whom 100 were re-evaluated during the third trimester. RESULTS Iodine sufficiency was found in the studied population (median UIC=216·7 µg/l). The first- and third-trimester median UIC was 221·0 and 208·0 µg/l, respectively. TSH levels (mean (sd)) were higher in the third trimester (1·08 (0·67) v. 1·67 (0·86) mIU/l; P<0·001), while FT4 levels decreased significantly (1·18 (0·16) v. 0·88 (0·12) ng/dl; P<0·001), regardless the presence of iodine deficiency (UIC<150 µg/l) or circulating thyroid antibodies. UIC correlated (β; 95% CI) independently and negatively with age (-0·43; -0·71, -0·17) and positively with multiparity (0·15; 0·02, 0·28) and BMI (0·25; 0·00, 0·50). Furthermore, median UIC per pregnant woman tended to correlate positively with TSH (0·07; -0·01, 0·14). Women with median UIC≥250 µg/l and at least one sample ≥500 µg/l throughout pregnancy had a higher risk of subclinical hypothyroidism (OR=6·6; 95% CI 1·2, 37·4). CONCLUSIONS In this cohort with adequate iodine status during pregnancy, excessive UIC was associated with an increased risk of subclinical hypothyroidism.
Collapse
|
137
|
Effectiveness of increased salt iodine concentration on iodine status: trend analysis of cross-sectional national studies in Switzerland. Eur J Nutr 2019; 59:581-593. [PMID: 30843107 DOI: 10.1007/s00394-019-01927-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/06/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE Despite longstanding voluntary salt iodisation in Switzerland, data suggest inadequate iodine intake in vulnerable population groups. In response, the salt iodine concentration was increased from 20 to 25 mg/kg and we assessed the impact on iodine status. METHODS We conducted a cross-sectional national study in school-age children (n = 731), women of reproductive age (n = 353) and pregnant women (n = 363). We measured urinary iodine concentration (UIC) and urinary sodium concentration (UNaC) in spot urine samples. The current median UIC was compared with national data from 1999, 2004 and 2009. We measured TSH, total T4 and thyroglobulin (Tg) on dried blood spot samples collected in women. RESULTS The median UIC (bootstrapped 95% CI) was 137 µg/L (131, 143 µg/L) in school children, 88 µg/L (72, 103 µg/L) in women of reproductive age and 140 µg/L (124, 159 µg/L) in pregnant women. Compared to 2009, the median UIC increased modestly in school children (P < 0.001), but did not significantly change in pregnant women (P = 0.417). Estimated sodium intake exceeded the recommendations in all population groups. The prevalence of thyroid disorders in women was low, but Tg was elevated in 13% of the pregnant women. CONCLUSION Iodine intake is overall adequate in Swiss school-age children, but only borderline sufficient in pregnant and non-pregnant women, despite high salt intakes and satisfactory household coverage with iodized salt. Our findings suggest increasing the concentration of iodine in salt may not improve iodine intakes in women if iodised salt is not widely used in processed foods. REGISTRATION This trial was registered at clinicaltrials.gov as NCT02312466.
Collapse
|
138
|
Parisi F, di Bartolo I, Savasi VM, Cetin I. Micronutrient supplementation in pregnancy: Who, what and how much? Obstet Med 2019; 12:5-13. [PMID: 30891086 PMCID: PMC6416688 DOI: 10.1177/1753495x18769213] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/05/2018] [Indexed: 12/22/2022] Open
Abstract
Pregnancy represents a period of major physiological and metabolic change, aiming to ensure proper fetal growth and development, as well as maternal preservation. This review focuses on maternal nutrition, and particularly on micronutrient deficiencies and supplementation during pregnancy. Nutrient deficiencies and consequences in pregnant women are presented, with an overview of current recommendations for dietary supplementation in pregnancy, even considering the risk of micronutrient overload. Appropriate universal supplementation and prophylaxis/treatment of nutritional needs currently appear to be the most cost-effective goal in low-income countries, thus ensuring adequate intake of key elements including folate, iron, calcium, vitamin D and A. In high-income countries, a proper nutritional assessment and counselling should be mandatory in obstetric care in order to normalize pregestational body mass index, choose a healthy dietary pattern and evaluate the risk of deficiencies.
Collapse
Affiliation(s)
- F Parisi
- Center for Fetal Research Giorgio Pardi, Department
of Biomedical and Clinical Sciences, Università degli Studi di Milano, Hospital
Luigi Sacco, Unit of Obstetrics and Gynecology, Milan, Italy
| | - I di Bartolo
- Center for Fetal Research Giorgio Pardi, Department
of Biomedical and Clinical Sciences, Università degli Studi di Milano, Hospital
Luigi Sacco, Unit of Obstetrics and Gynecology, Milan, Italy
| | - VM Savasi
- Center for Fetal Research Giorgio Pardi, Department
of Biomedical and Clinical Sciences, Università degli Studi di Milano, Hospital
Luigi Sacco, Unit of Obstetrics and Gynecology, Milan, Italy
| | - I Cetin
- Center for Fetal Research Giorgio Pardi, Department
of Biomedical and Clinical Sciences, Università degli Studi di Milano, Hospital
Luigi Sacco, Unit of Obstetrics and Gynecology, Milan, Italy
| |
Collapse
|
139
|
Lebsir D, Guemri J, Kereselidze D, Grison S, Benderitter M, Pech A, Cohen D, Benadjaoud MA, Lestaevel P, Souidi M. Repeated potassium iodide exposure during pregnancy impairs progeny's brain development. Neuroscience 2019; 406:606-616. [PMID: 30797025 DOI: 10.1016/j.neuroscience.2019.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 01/29/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Abstract
Protracted radioiodine release may require repeated intake of potassium iodide (KI) to protect thyroid gland. It is well established that iodine excess inhibits transiently the thyroid function. As developing fetus depends on maternal thyroid hormones (TH) supply, more knowledge is needed about the plausible effects that repeated KI intake can cause in this sensitive population, especially that even subtle variation of maternal thyroid function may have persistent consequences on progeny brain processing. The aim of this study is to assess the consequences of repeated intake of KI during pregnancy on the progeny's thyroid function and brain development. To do so pregnant Wistar rats received KI over eight days, and then thirty days after the weaning, male progeny was subjected to behavior test. Pituitary and thyroid hormones level, anti-thyroid antibodies level, organs morphology, gene expression and global DNA methylation were assessed. Thirty days after the weaning, KI-exposed male progeny showed an uncommon hormonal status, characterized by a decrease of both thyroid-stimulating hormone (-28%) and free thyroxine (-7%) levels. Motor coordination was altered in KI-exposed male progeny. At the cerebellar level, we observed a decrease of mRNA expression of DCX (-42%) and RC3 (-85%); on the other hand, at the cortical level, mRNA expression of MBP (+71%), MOBP (+90%) and Kcna1 (+42%) was increased. To conclude, repeated KI prophylaxis is not adequate during pregnancy since it led to long-term irreversible neurotoxicity in the male progeny.
Collapse
Affiliation(s)
- Dalila Lebsir
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE, SESANE, 92262 Fontenay-aux-Roses, France
| | - Julien Guemri
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE, SESANE, 92262 Fontenay-aux-Roses, France
| | - Dimitri Kereselidze
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE, SESANE, 92262 Fontenay-aux-Roses, France
| | - Stephane Grison
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE, SESANE, 92262 Fontenay-aux-Roses, France
| | - Marc Benderitter
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE, SERAMED, 92262 Fontenay-aux-Roses, France
| | - Annick Pech
- Pharmacie centrale des armées, Direction des Approvisionnement en produits de Santé des Armées, 45000 Orléans, France
| | - David Cohen
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE, SESANE, 92262 Fontenay-aux-Roses, France
| | - Mohamed Amine Benadjaoud
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE, SERAMED, 92262 Fontenay-aux-Roses, France
| | - Philippe Lestaevel
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE, SESANE, 92262 Fontenay-aux-Roses, France
| | - Maâmar Souidi
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-SANTE, SERAMED, 92262 Fontenay-aux-Roses, France.
| |
Collapse
|
140
|
Bell GA, Männistö T, Liu A, Kannan K, Yeung EH, Kim UJ, Suvanto E, Surcel HM, Gissler M, Mills JL. The joint role of thyroid function and iodine concentration on gestational diabetes risk in a population-based study. Acta Obstet Gynecol Scand 2019; 98:500-506. [PMID: 30580457 DOI: 10.1111/aogs.13523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 12/11/2018] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Iodine is essential for thyroid function, and iodine deficiency during pregnancy is common in Europe and the USA. However, no published studies have examined the role of iodine deficiency in the relation between thyroid function and gestational diabetes mellitus (GDM). MATERIAL AND METHODS We conducted a population-based, nested case-control study within the Finnish Maternity Cohort using pregnancy and perinatal outcome data from the Finnish Maternal Birth Register. We randomly selected 224 GDM cases with singleton pregnancies and 224 controls without GDM from all singleton births occurring in Finland during 2012-2013. Blood was drawn at 10-14 weeks' gestation and analyzed for serum iodide, thyroglobulin, and thyroid-stimulating hormone (TSH) concentrations. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) of GDM. RESULTS Very high thyroglobulin concentration (>95% percentile; >83 μg/L) was not associated with significantly altered odds of GDM compared to those with normal levels (OR 0.41; 95% CI: 0.12, 1.38). High concentrations of TSH were also not associated with increased odds of GDM compared to normal levels of TSH (OR 0.45; 95% CI: 0.06, 3.18). Women in the lowest 5th percentile (<1.58 ng/mL) of iodine did not have increased odds of GDM compared to those with iodide in the highest quartile (OR 0.39; 95% CI: 0.11, 1.35). CONCLUSIONS Low levels of iodide and thyroid function in early pregnancy are not associated with increased risk of GDM in this mildly iodine-deficient population.
Collapse
Affiliation(s)
- Griffith A Bell
- Division of Intramural Population Health Research, National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Tuija Männistö
- Northern Finland Laboratory Center NordLab, Oulu University and Oulu University Hospital, Oulu, Finland
| | - Aiyi Liu
- Division of Intramural Population Health Research, National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Edwina H Yeung
- Division of Intramural Population Health Research, National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Un-Jung Kim
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Eila Suvanto
- Northern Finland Laboratory Center NordLab, Oulu University and Oulu University Hospital, Oulu, Finland
| | - Heljä-Marja Surcel
- Biobank Borealis of Northern Finland, Oulu University Hospital, Oulu, Finland.,Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Mika Gissler
- National Institute of Health and Welfare, Helsinki, Finland.,Karolinska Institute, Stockholm, Sweden
| | - James L Mills
- Division of Intramural Population Health Research, National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| |
Collapse
|
141
|
Croce L, Di Dalmazi G, Orsolini F, Virili C, Brigante G, Gianetti E, Moleti M, Napolitano G, Tonacchera M, Rotondi M. Graves' Disease and the Post-partum Period: An Intriguing Relationship. Front Endocrinol (Lausanne) 2019; 10:853. [PMID: 31920967 PMCID: PMC6914725 DOI: 10.3389/fendo.2019.00853] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/21/2019] [Indexed: 11/29/2022] Open
Abstract
The post-partum period is an immunologically peculiar period in a woman's life. Indeed, most of the pregnancy-related immune changes gradually revert in the 12 months following delivery. Although the post-partum period has long been identified as a period of aggravation of autoimmune thyroid diseases, most of the currently available studies took into account the relationship between post-partum and autoimmune thyroiditis. More recently, the potential repercussions of the post-partum period on Graves' disease were also taken into account. The present mini review will briefly overview the most recent advances in our knowledge of the immunology of the post-partum period in relation with the potential repercussions on the clinical course of Graves' disease. Moreover, some peculiar aspects of post-partum Graves' disease in terms of clinical and biochemical presentation, diagnostic challenges, and specific therapeutic considerations also taking into account the recommendation of the latest clinical guidelines on the management of thyroid diseases in pregnancy will be overviewed.
Collapse
Affiliation(s)
- Laura Croce
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
- PHD course in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Giulia Di Dalmazi
- Unit of Endocrinology, Department of Medicine and Sciences of Aging, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Francesca Orsolini
- Endocrinology Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Camilla Virili
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Giulia Brigante
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Gianetti
- Endocrinology Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mariacarla Moleti
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giorgio Napolitano
- Unit of Endocrinology, Department of Medicine and Sciences of Aging, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Massimo Tonacchera
- Endocrinology Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- *Correspondence: Mario Rotondi
| |
Collapse
|
142
|
Patel A, Lee SY, Stagnaro-Green A, MacKay D, Wong AW, Pearce EN. Iodine Content of the Best-Selling United States Adult and Prenatal Multivitamin Preparations. Thyroid 2019; 29:124-127. [PMID: 30266075 DOI: 10.1089/thy.2018.0386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Iodine is essential for thyroid hormone production and fetal development. Even mild maternal iodine deficiency in gestation may be associated with impaired child neurodevelopment. Iodine requirements increase during pregnancy and lactation. Supplements containing 150 μg/day are recommended by the American Thyroid Association for all U.S. women who are pregnant, lactating, or planning pregnancy. The contribution of multivitamin supplements as an iodine source for pregnant and nonpregnant US adults has not been well studied. This study aimed to understand better the contribution of the top-selling adult multivitamins (AMV) and prenatal multivitamins (PMV) to iodine nutrition in the United States. METHODS Product names, dollar sales, unit and volume sales, and recommended daily intakes of the top-selling 99 AMV and 60 PMV from July 2016 to July 2017 were obtained from Information Resources, Inc. Iodine content and source were determined from product labels. After excluding private-label brands and unavailable product labels, a final sample of 89 AMV and 59 PMV was analyzed. RESULTS Of the 89 AMV, 74.2% contained iodine. The median (range) iodine content of AMV was 150 μg (38-150 μg) per daily serving. Over the study period, 8,924,371,955 AMV doses were sold, of which 84.8% contained iodine. Thirty-four (57.6%) of the 59 PMV contained iodine, with a median (range) iodine content of 150 μg (25-290 μg) per daily serving. Over the study period, 466,927,559 PMV doses were sold, of which 76.8% contained iodine. All iodine-containing AMV used potassium iodine as an iodine source. Of iodine-containing PMV, 73.5% used potassium iodide, 23.5% kelp, and 2.9% inactivated Saccharomyces cerevisiae as an iodine source. CONCLUSIONS During the one-year study period, a higher proportion of AMV doses than PMV doses contained iodine. Some PMV but no AMV included sources of iodine known to be highly variable. The median iodine content of the top-selling AMV and PMV was at the recommended 150 μg daily intake, but the range remains wide. Twenty-four percent of PMV doses sold did not contain iodine. More effort is needed to ensure adequate iodine content in prenatal vitamins for women who are pregnant, lactating, or planning pregnancy.
Collapse
Affiliation(s)
- Aneesh Patel
- 1 Boston University School of Medicine, Boston, Massachusetts
| | - Sun Y Lee
- 2 Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Alex Stagnaro-Green
- 3 Department of Medicine, Obstetrics, and Gynecology and Medical Education, University of Illinois College of Medicine at Rockford, Rockford, Illinois
| | | | | | - Elizabeth N Pearce
- 2 Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| |
Collapse
|
143
|
Assessing the impact of oral iodine supplementation on whole body iodine store, thyroid autoimmunity and serum biochemistry profile in women of childbearing age. JOURNAL OF NUTRITION & INTERMEDIARY METABOLISM 2018. [DOI: 10.1016/j.jnim.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
144
|
Teasdale S, Morton A. Changes in biochemical tests in pregnancy and their clinical significance. Obstet Med 2018; 11:160-170. [PMID: 30574177 PMCID: PMC6295771 DOI: 10.1177/1753495x18766170] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/22/2018] [Indexed: 12/11/2022] Open
Abstract
Interpretation of laboratory investigations relies on reference intervals. Physiological changes in pregnancy may result in significant changes in normal values for many biochemical assays, and as such results may be misinterpreted as abnormal or mask a pathological state. The aims of this review are as follows: 1. To review the major physiological changes in biochemical tests in normal pregnancy. 2. To outline where these physiological changes are important in interpreting laboratory investigations in pregnancy. 3. To document the most common causes of abnormalities in biochemical tests in pregnancy, as well as important pregnancy-specific causes.
Collapse
Affiliation(s)
- Stephanie Teasdale
- Queensland Diabetes and Endocrine Centre, Mater Misericordiae Hospital, Brisbane, Australia
| | - Adam Morton
- Queensland Diabetes and Endocrine Centre, Mater Misericordiae Hospital, Brisbane, Australia
| |
Collapse
|
145
|
Mullan K, Patterson C, Doolan K, Cundick J, Hamill L, McKeeman G, McMullan P, Smyth P, Young I, Woodside JV. Neonatal TSH levels in Northern Ireland from 2003 to 2014 as a measure of population iodine status. Clin Endocrinol (Oxf) 2018; 89:849-855. [PMID: 30184261 DOI: 10.1111/cen.13849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/01/2018] [Accepted: 09/01/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The re-emergence of iodine deficiency in the UK has recently been reported in a large cohort of teenage girls including from Northern Ireland (NI) using the gold standard spot urinary iodine concentration. We wished to explore and confirm this by analysing neonatal thyroid-stimulating hormone (nTSH) levels in the NI population. DESIGN We analysed the nTSH heel prick tests results from the NI national screening database between 2003 and 2014. The WHO proposes a definition for population iodine sufficiency at <3% of the population with nTSH results >5 mIU/L. METHODS Anonymized results from 288 491 nTSH tests were retrieved, and prevalence rates of results at increasing cut-offs including >2 mIU/L and >5 mIU/L calculated. We also assessed for possible seasonal variation in nTSH results. RESULTS An overall population prevalence of 0.49% with TSH >5 mIU/L was found, indicating population iodine sufficiency with no year attaining a prevalence >3%. The prevalence of nTSH >2 mIU/L decreased to 4.1% in 2007 and subsequently increased to 9.8% in 2014. Modest seasonal variation was also detected, with higher levels among April/May births. CONCLUSIONS The neonatal TSH database suggests iodine sufficiency in the NI population. However, the rising frequency of results >2 mIU/L may indicate an emerging mild iodine deficiency. This is one of the largest and longest studies of its kind in the UK and the first carried out in NI. The summer months may be a time of increased risk of iodine deficiency in our pregnant women whose requirements are increased and who are not currently targeted by any iodine fortification programme in the UK.
Collapse
Affiliation(s)
- Karen Mullan
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, UK
| | - Chris Patterson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Katy Doolan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Jennifer Cundick
- Regional Biochemistry Laboratory, Royal Victoria Hospital Belfast, Belfast, UK
| | - Lesley Hamill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Gareth McKeeman
- Regional Biochemistry Laboratory, Royal Victoria Hospital Belfast, Belfast, UK
| | - Paul McMullan
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital Belfast, Belfast, UK
| | | | - Ian Young
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Jayne V Woodside
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| |
Collapse
|
146
|
Salek T, Dhaifalah I, Langova D, Havalova J. The prevalence of maternal hypothyroidism in first trimester screening from 11 to 14 weeks of gestation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 163:265-268. [PMID: 30401989 DOI: 10.5507/bp.2018.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 10/02/2018] [Indexed: 11/23/2022] Open
Abstract
AIM The aim of this study was to determine the prevalence of maternal hypothyroidism in the first trimester from 11 to 14 weeks of gestation according to the American Thyroid Association (ATA) guidelines from 2017 and to compare the rates for singleton and twin pregnancies. METHODS A total of 4965 consecutive Caucasian singleton pregnancies and 109 Caucasian twin pregnancies were included in the investigation. Patients with a history of thyroid gland disorder were excluded. Subclinical maternal hypothyroidism was defined as a thyroid stimulating hormone (TSH) concentration above the 97.5th percentile and free thyroxine (fT4) within the range of a reference population of women at 11-14 weeks of gestation. Overt maternal hypothyroidism was defined as a TSH concentration above the 97.5th percentile and an fT4 below the 2.5th percentile of the reference population.TSH, fT4, and anti thyroid peroxidase antibody (TPOAb) were measured by immunochemiluminescent assays on an 16200 Abbott Architect analyzer. RESULTS The prevalence of hypothyroidism for twin pregnancies was no higher than that for singleton pregnancies; 6.42% (7/109) vs. 5.32% (264/4965), respectively; P=0.61. All twin pregnancies were subclinical. Singleton hypothyroid pregnancies included 4.91% (244 cases) of subclinical and 0.41% (20 cases) of overt hypothyroidism. The prevalence of TPOAb positive hypothyroid women for twin pregnancies and singleton pregnancies was 71% (5/7) vs. 52% (137/264 cases), respectively but the differences were not statistically significant; P=0.31. CONCLUSION Each first trimester screening center should establish its TSH and fT4 reference ranges. Our center had higher upper reference limits of TSH than that of the universally fixed limit of 2.5 mU/L, which led to a lower measured prevalence of maternal hypothyroidism. A large number of hypothyroid women were TPOAb positive.
Collapse
Affiliation(s)
- Tomas Salek
- Department of Clinical Biochemistry and Pharmacology, Tomas Bata Hospital in Zlin a. s., Havlickovo nabrezi 600, 76275 Zlin, Czech Republic.,Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava - Zabreh, Czech Republic
| | - Ishraq Dhaifalah
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava - Zabreh, Czech Republic.,Department of Obstetrics and Gynecology, Tomas Bata Hospital in Zlin a. s., Havlickovo nabrezi 600, 76275 Zlin, Czech Republic.,FETMED (Fetmed Fetal Medicine Center and Genetics), Olomouc and Ostrava, Czech Republic
| | - Dagmar Langova
- Internal Medicine Clinic, Tomas Bata Hospital in Zlin a. s., Havlickovo nabrezi 600, 76275 Zlin, Czech Republic
| | - Jana Havalova
- Department of Obstetrics and Gynecology, Tomas Bata Hospital in Zlin a. s., Havlickovo nabrezi 600, 76275 Zlin, Czech Republic
| |
Collapse
|
147
|
Puchkova LV, Babich PS, Zatulovskaia YA, Ilyechova EY, Di Sole F. Copper Metabolism of Newborns Is Adapted to Milk Ceruloplasmin as a Nutritive Source of Copper: Overview of the Current Data. Nutrients 2018; 10:E1591. [PMID: 30380720 PMCID: PMC6266612 DOI: 10.3390/nu10111591] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/17/2018] [Accepted: 10/26/2018] [Indexed: 12/19/2022] Open
Abstract
Copper, which can potentially be a highly toxic agent, is an essential nutrient due to its role as a cofactor for cuproenzymes and its participation in signaling pathways. In mammals, the liver is a central organ that controls copper turnover throughout the body, including copper absorption, distribution, and excretion. In ontogenesis, there are two types of copper metabolism, embryonic and adult, which maintain the balance of copper in each of these periods of life, respectively. In the liver cells, these types of metabolism are characterized by the specific expression patterns and activity levels of the genes encoding ceruloplasmin, which is the main extracellular ferroxidase and copper transporter, and the proteins mediating ceruloplasmin metalation. In newborns, the molecular genetic mechanisms responsible for copper homeostasis and the ontogenetic switch from embryonic to adult copper metabolism are highly adapted to milk ceruloplasmin as a dietary source of copper. In the mammary gland cells, the level of ceruloplasmin gene expression and the alternative splicing of its pre-mRNA govern the amount of ceruloplasmin in the milk, and thus, the amount of copper absorbed by a newborn is controlled. In newborns, the absorption, distribution, and accumulation of copper are adapted to milk ceruloplasmin. If newborns are not breast-fed in the early stages of postnatal development, they do not have this natural control ensuring alimentary copper balance in the body. Although there is still much to be learned about the neonatal consequences of having an imbalance of copper in the mother/newborn system, the time to pay attention to this problem has arrived because the neonatal misbalance of copper may provoke the development of copper-related disorders.
Collapse
Affiliation(s)
- Ludmila V Puchkova
- Laboratory of Trace Elements Metabolism, ITMO University, Kronverksky av., 49, 197101 St.-Petersburg, Russia.
- Department of Molecular Genetics, Research Institute of Experimental Medicine, Acad. Pavlov str., 12, 197376 St.-Petersburg, Russia.
- Department of Biophysics, Peter the Great St. Petersburg Polytechnic University, Politekhnicheskaya str., 29, 195251 St.-Petersburg, Russia.
| | - Polina S Babich
- Department of Zoology, Herzen State Pedagogical University of Russia, Kazanskaya str., 6, 191186 St.-Petersburg, Russia.
| | - Yulia A Zatulovskaia
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Ekaterina Y Ilyechova
- Laboratory of Trace Elements Metabolism, ITMO University, Kronverksky av., 49, 197101 St.-Petersburg, Russia.
| | - Francesca Di Sole
- Department of Physiology and Pharmacology, Des Moines University, Des Moines, IA 50312, USA.
| |
Collapse
|
148
|
Mejia LA, Kuo WY, Beltran-Velazquez F. Provision of micronutrients in coexisting public health programs and risk of excessive intake: regulatory considerations. Ann N Y Acad Sci 2018; 1446:66-80. [PMID: 30346034 PMCID: PMC6618271 DOI: 10.1111/nyas.13972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/28/2018] [Accepted: 09/06/2018] [Indexed: 12/01/2022]
Abstract
Countries around the world have been implementing public health interventions to provide vitamins and minerals. There is a concern that the cumulative micronutrient contribution of coexisting programs, when targeting the same population, may exceed their safe levels of intake, thus potentially challenging the primum non nocere principle. We assessed the regulatory framework of such interventions and determined qualitatively whether there were provisions in the regulations that called for coordination among programs to ensure their innocuousness. Country cases from various WHO regions were selected for the study: (1) the Americas: Chile, Costa Rica, and Guatemala; (2) Africa: Malawi, Uganda, and Zambia; (3) South Asia: Bangladesh; and (4) the Western Pacific Region: China and the Philippines. We did not identify any provisions in the existing regulations requiring coordination mechanisms among interventions. However, in some countries, governments have established national micronutrient fortification commissions or alliances aimed to foster interprogram coordination. Their focus, however, has been mostly on the efficacy of the programs and less on their safety. A regulatory framework for coexisting micronutrient interventions should be comprehensive, accounting for all micronutrient sources and including regulatory provisions for coordination among programs.
Collapse
Affiliation(s)
- Luis A Mejia
- Department of Food Science and Human Nutrition, College of Agricultural, Consumer and Environmental Sciences, University of Illinois, Urbana-Champaign, Illinois
| | - Wan-Yuan Kuo
- Department of Food Science and Human Nutrition, College of Agricultural, Consumer and Environmental Sciences, University of Illinois, Urbana-Champaign, Illinois.,Department of Health and Human Development, Montana State University, Bozeman, Montana
| | - Filiberto Beltran-Velazquez
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| |
Collapse
|
149
|
Takele WW, Alemayehu M, Derso T, Tariku A. Two-thirds of pregnant women attending antenatal care clinic at the University of Gondar Hospital are found with subclinical iodine deficiency, 2017. BMC Res Notes 2018; 11:738. [PMID: 30333053 PMCID: PMC6192361 DOI: 10.1186/s13104-018-3829-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/09/2018] [Indexed: 11/21/2022] Open
Abstract
Objective This study was aimed at determining the magnitude of prenatal iodine deficiency and its determinants among women attending antenatal care clinic at the University of Gondar Specialized Referral Hospital, Northwest Ethiopia. A cross-sectional study was conducted from March 13 to April 25/2017. Precisely, 378 pregnant women were included in the study selected via systematic random sampling technique. Urinary Iodine concentration was determined through spectrophotometer using Sandell-Kolthoff reaction. Iodine deficiency was defined as women having urinary iodine concentration of < 150 µg/L. Moreover, stool examination was done. Results Subclinical iodine deficiency among pregnant women was 60.5% (95% CI 55%, 65.5%). The Median iodine concentration was 137 μg/L (IQR 80 μg/L). Being governmental employee [AOR = 0.42 (95% CI 0.1 = 20, 0.87)], cabbage consumption of twice or more times per week [AOR = 2.35 (95% CI 1.44, 3.82)], not consuming maize in the last 1 week [AOR = 0.29 (95% CI 0.18, 0.48)], poor household wealth status [AOR = 2.7 (95% CI 1.24, 5.89)], and second trimester of pregnancy [AOR = 2.43 (95% CI 1.37, 4.32)] were significantly associated with iodine deficiency. Prenatal iodine deficiency was high, which deemed a mild public Health problem. Therefore, improving household income, and nutrition education to minimize maize and cabbage consumption are recommended.
Collapse
Affiliation(s)
- Wubet Worku Takele
- Department of Community Health Nursing, School of Nursing College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Mekuriaw Alemayehu
- Department of Environmental Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Terefe Derso
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Tariku
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
150
|
Abel MH, Korevaar TI, Erlund I, Villanger GD, Caspersen IH, Arohonka P, Alexander J, Meltzer HM, Brantsæter AL. Iodine Intake is Associated with Thyroid Function in Mild to Moderately Iodine Deficient Pregnant Women. Thyroid 2018; 28:1359-1371. [PMID: 30132420 PMCID: PMC6157349 DOI: 10.1089/thy.2018.0305] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Studies indicate that mild to moderate iodine deficiency in pregnancy may have a long-term negative impact on child neurodevelopment. These effects are likely mediated via changes in maternal thyroid function, since iodine is essential for the production of thyroid hormones. However, the impact of iodine availability on thyroid function during pregnancy and on thyroid function reference ranges are understudied. The aim of this study was to investigate the association between iodine intake and thyroid function during pregnancy. DESIGN In a population-based pregnancy cohort including 2910 pregnant women participating in The Norwegian Mother and Child Cohort Study, we explored cross sectional associations of maternal iodine intake measured (1) by a food frequency questionnaire and (2) as iodine concentration in a spot urine sample, with plasma thyroid hormones and antibodies. RESULTS Biological samples were collected in mean gestational week 18.5 (standard deviation 1.3) and diet was assessed in gestational week 22. Median iodine intake from food was 121 μg/day (interquartile range 90, 160), and 40% reported use of iodine-containing supplements in pregnancy. Median urinary iodine concentration (UIC) was 59 μg/L among those who did not use supplements and 98 μg/L in the women reporting current use at the time of sampling, indicating mild to moderate iodine deficiency in both groups. Iodine intake as measured by the food frequency questionnaire was not associated with the outcome measures, while UIC was inversely associated with FT3 (p = 0.002) and FT4 (p < 0.001). Introduction of an iodine-containing supplement after gestational week 12 was associated with indications of lower thyroid hormone production (lower FT4, p = 0.027, and nonsignificantly lower FT3, p = 0.17). The 2.5th and 97.5th percentiles of TSH, FT4, and FT3 were not significantly different by groups defined by calculated iodine intake or by UIC. CONCLUSION The results indicate that mild to moderate iodine deficiency affect thyroid function in pregnancy. However, the differences were small, suggesting that normal reference ranges can be determined based on data also from mildly iodine deficient populations, but this needs to be further studied. Introducing an iodine-containing supplement might temporarily inhibit thyroid hormone production and/or release.
Collapse
Affiliation(s)
- Marianne Hope Abel
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
- Department of Nutrition, Tine SA, Oslo, Norway
| | - Tim I.M. Korevaar
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Iris Erlund
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Gro Dehli Villanger
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ida Henriette Caspersen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Petra Arohonka
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Jan Alexander
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Helle Margrete Meltzer
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Lise Brantsæter
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|