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González-Martínez S, Riestra-Fernández M, Martínez-Morillo E, Avello-Llano N, Delgado-Álvarez E, Menéndez-Torre EL. Nutritional Iodine Status in Pregnant Women from Health Area IV in Asturias (Spain): Iodised Salt Is Enough. Nutrients 2021; 13:nu13061816. [PMID: 34071767 PMCID: PMC8228027 DOI: 10.3390/nu13061816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Iodine deficiency during pregnancy may have adverse effects on the neurodevelopment of the foetus. Recent studies of pregnant women in Asturias (Spain) indicate that nutritional iodine levels are sufficient. The objective of this study was to confirm the appropriate nutritional iodine status and to analyse the influence of the ingestion of iodine on maternal urinary iodine concentration (UIC) and thyroid function. Methods: An observational study was carried out between May and June 2017 on women in the first trimester of pregnancy from Health Area IV in Asturias. The women completed a questionnaire related to their consumption of iodine and samples were taken to analyse UIC and thyroid function. Results: Three hundred and eighteen pregnant women were involved. Of these, 51.10% used iodised salt, 48.90% consumed ≥ 2 servings of dairy products daily and 87.08% took iodine supplements. The median UIC was 171.5 μg/L (116–265 μg/L) and 60.41% of women had UIC ≥ 150 μg/L. Multivariate logistic regression analysis demonstrated that iodised salt had a protective effect on UIC < 150 μg/L (odds ratio (OR) 0.404 (0.237–0.683), p = 0.001), but not iodine supplements (OR 0.512 (0.240–1.085), p = 0.080). The average level of thyroid stimulating hormone (TSH) was 2.26 ± 0.94 mIU/L; 68.40% of pregnant women taking iodine supplements had TSH < 2.5 mIU/L compared to 30.00% of those who were not taking supplements (p = 0.031). Conclusions: The pregnant women in our health area are maintaining appropriate nutritional iodine levels. The consumption of iodised salt protects against iodine deficiency; thus, iodine supplements should be taken on an individualised basis.
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Affiliation(s)
- Silvia González-Martínez
- Endocrinology and Nutrition Service, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (E.D.-Á.); (E.L.M.-T.)
- Endocrinology, Nutrition, Diabetes and Obesity Research Group (ENDO), Health Research Institute of Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Correspondence:
| | - María Riestra-Fernández
- Endocrinology, Nutrition, Diabetes and Obesity Research Group (ENDO), Health Research Institute of Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Endocrinology and Nutrition Service, Hospital Universitario de Cabueñes, 33203 Gijón, Spain
| | - Eduardo Martínez-Morillo
- Clinical Biochemistry Service, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (E.M.-M.); (N.A.-L.)
| | - Noelia Avello-Llano
- Clinical Biochemistry Service, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (E.M.-M.); (N.A.-L.)
| | - Elías Delgado-Álvarez
- Endocrinology and Nutrition Service, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (E.D.-Á.); (E.L.M.-T.)
- Endocrinology, Nutrition, Diabetes and Obesity Research Group (ENDO), Health Research Institute of Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Faculty of Medicine, University of Oviedo, 33011 Oviedo, Spain
| | - Edelmiro Luis Menéndez-Torre
- Endocrinology and Nutrition Service, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (E.D.-Á.); (E.L.M.-T.)
- Endocrinology, Nutrition, Diabetes and Obesity Research Group (ENDO), Health Research Institute of Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Faculty of Medicine, University of Oviedo, 33011 Oviedo, Spain
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Impact of Dietary Habit, Iodine Supplementation and Smoking Habit on Urinary Iodine Concentration During Pregnancy in a Catalonia Population. Nutrients 2020; 12:nu12092656. [PMID: 32878172 PMCID: PMC7551663 DOI: 10.3390/nu12092656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/19/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The nutritional status of women during pregnancy can have a considerable effect on maternal and fetal health, and on the perinatal outcome. Aim: to assess the changes occurring in dietary iodine intake, potassium iodide supplementation, and smoking habit, and the impact of these changes on the urinary iodine concentration (UIC) during pregnancy in a population of women in Catalonia (Spain). (2) Methods: Between 2009–2011, an observational study included a cohort of women whose pregnancies were monitored in the public health system in the Central and North Metropolitan areas of Catalonia. Women received individual educational counseling, a dietary questionnaire was completed, and a urine sample was collected for iodine determination at each trimester visit. (3) Results: 633 (67.9%) women answered the questionnaire at all 3 visits. The percentage of women with a desirable UIC (≥150 μg/L) increased from the first to the second trimester and remained stable in the third (57.3%, 68.9%, 68%; p < 0.001). Analysis of the relationship between UIC ≥ 150 μg/L and the women’s dietary habits showed that the percentage with UIC ≥ 150 μg/L increased with greater consumption of milk in the first trimester, and the same was true for iodized salt use in all three trimesters and iodine supplementation in all three. (4) Conclusion: During pregnancy, increased intake of milk, iodized salt, and iodine supplements were associated with an increase in the UIC.
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Ollero MD, Martínez JP, Pineda J, Toni M, Espada M, Anda E. Change over time in the iodine nutritional status of pregnant women from the Pamplona healthcare region. ACTA ACUST UNITED AC 2020; 67:643-649. [PMID: 32327369 DOI: 10.1016/j.endinu.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/30/2019] [Accepted: 12/11/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Adequate iodine intake is essential during pregnancy. A previous study of pregnant women from the Pamplona healthcare region showed mild iodine deficiency (mean urinary iodine level, 125 mcg/L). This study was intended to ascertain the iodine intake of pregnant women in our region and to analyze the change over time in their iodine nutritional status. METHODS An observational study of 400 women in their first trimester of pregnancy. An iodine intake questionnaire was administered. To assess iodine status, urinary iodine concentration (UIC) was measured in a simple urine sample, and serum thyroglobulin levels were determined. In addition, thyroid volume was measured by cervical ultrasound examination. RESULTS Iodized salt was used by 70.5% of all participants (55.3% since the pre-gestational period) and 98.5% of them received iodine-containing supplements (mean dose, 202.6±30.1 mcg/day). Mean urinary iodine concentration was 242 mcg/L (138.5-415.5 mcg/L) and the mean serum thyroglobulin level was 12.3 mcg/L (8.3-9 mcg/L). Iodized salt intake was associated with higher UICs and lower thyroid volume. No differences were found in any of the tested parameters regarding the intake of dairy products, fish, or eggs. CONCLUSIONS Iodine intake by pregnant women in Pamplona has increased due to a greater use of iodized salt and to higher doses of iodine supplements. As a result of this, an adequate iodine status has been achieved in the last decade.
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Affiliation(s)
- M Dolores Ollero
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona (Navarra), España; Instituto de Investigación Sanitaria de Navarra (IdisNa), Pamplona (Navarra), España.
| | - Juan Pablo Martínez
- Sección de Endocrinología, Hospital García Orcoyen, Estella (Navarra), España
| | - Javier Pineda
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona (Navarra), España; Instituto de Investigación Sanitaria de Navarra (IdisNa), Pamplona (Navarra), España
| | - Marta Toni
- Instituto de Investigación Sanitaria de Navarra (IdisNa), Pamplona (Navarra), España; Sección de Endocrinología, Hospital García Orcoyen, Estella (Navarra), España
| | - Mercedes Espada
- Unidad de Química Clínica, Laboratorio de Salud Pública del Gobierno Vasco, Derio, España
| | - Emma Anda
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona (Navarra), España; Instituto de Investigación Sanitaria de Navarra (IdisNa), Pamplona (Navarra), España
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Verhagen NJE, Gowachirapant S, Winichagoon P, Andersson M, Melse-Boonstra A, Zimmermann MB. Iodine Supplementation in Mildly Iodine-Deficient Pregnant Women Does Not Improve Maternal Thyroid Function or Child Development: A Secondary Analysis of a Randomized Controlled Trial. Front Endocrinol (Lausanne) 2020; 11:572984. [PMID: 33123091 PMCID: PMC7573140 DOI: 10.3389/fendo.2020.572984] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/31/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Iodine deficiency during pregnancy may be associated with lower offspring IQ, but there are few data on the safety and efficacy of maternal iodine supplementation on child development. In a previously reported multi-center randomized trial conducted in Thailand and India, we assessed the effect of iodine supplementation in mildly iodine-deficient pregnant women on offspring development. In this secondary analysis of that trial, we report data only from the Thai pregnant women in the study, who were more iodine deficient at entry. Methods: Pregnant women in Bangkok, Thailand, were randomized to receive daily 200 μg oral iodine or placebo until delivery. We assessed thyroid size and thyroid function during pregnancy and cognitive and motor development at ages 1, 2, and 5.7 years. The trial was registered at www.clinicaltrials.gov/NCT00791466. Findings: Women (n = 514) entered the trial between November 2008 and March 2011 at a mean ± SD gestational age of 11 ± 2.8 weeks; their median (IQR) UIC was 112 (75, 170) μg/L. Mean compliance with supplementation was 88%. We assessed 397 mothers in the 3rd trimester, 231 infants at age 2 y, and 157 children at mean age 5.7 y. During pregnancy, there was a slightly greater decrease in free and total thyroxine concentrations in the iodine group (p < 0.05). At age 2 years, the iodine group had borderline lower scores for combined fine and gross motor function (p = 0.05), but there were no other significant differences in development. At 5.7 years, there were no significant group differences in child development. Conclusion: Daily iodine supplementation in mildly iodine deficient pregnant women was associated with small negative effects on maternal thyroxine concentrations, but did not affect child development. The safety and efficacy of iodine supplementation in mildly-iodine deficient pregnant women needs to be evaluated further in large randomized controlled trials.
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Affiliation(s)
- Nicole J. E. Verhagen
- Division of Human Nutrition, Wageningen University and Research, Wageningen, Netherlands
| | | | | | - Maria Andersson
- Division of Gastroenterology and Nutrition, Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - Alida Melse-Boonstra
- Division of Human Nutrition, Wageningen University and Research, Wageningen, Netherlands
| | - Michael B. Zimmermann
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- *Correspondence: Michael B. Zimmermann
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Vila L, Lucas A, Donnay S, de la Vieja A, Wengrovicz S, Santiago P, Bandrés O, Velasco I, Garcia-Fuentes E, Ares S, Moreno Navarro JC, Espada M, Muñoz A, Galofré JC, Puig-Domingo M. Iodine nutrition status in Spain Needs for the future. ACTA ACUST UNITED AC 2019; 67:61-69. [PMID: 30962160 DOI: 10.1016/j.endinu.2019.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
Although iodine nutrition in Spain has improved in recent years, the problem is not completely resolved. It is necessary that health institutions establish measures to ensure an adequate iodine nutrition of the population, especially among the highest risk groups (children and adolescents, women of childbearing age, pregnant women and nursing mothers). A low salt intake should be advised, but it should be iodized. It is also imperative that food control agencies establish effective control over adequate iodization of salt. Indicators on iodine nutrition should be included in future health surveys. The EUthyroid study and the Krakow Declaration on iodine nutrition provide an opportunity to set up a pan-European plan for the prevention of iodine deficiency that should be considered and used by health authorities.
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Affiliation(s)
- Lluís Vila
- Servicio de Endocrinología y Nutrición, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, España; Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición.
| | - Anna Lucas
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Servicio de Endocrinología y Nutrición, Hospital Germans Trias i Pujol, Badalona, España
| | - Sergio Donnay
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Servicio de Endocrinología y Nutrición, Fundación Hospital Alcorcón, Madrid, España
| | - Antonio de la Vieja
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Unidad de Tumores Endocrinos. 53.03.020. Instituto de Salud Carlos III-UFIEC, Madrid, España
| | - Silvia Wengrovicz
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Instituto Catalán de Endocrinología, Clínica Tres Torres, Barcelona, España
| | - Piedad Santiago
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Jaén, Jaén, España
| | - Orosia Bandrés
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Sección de Endocrinología y Nutrición, Hospital Royo Villanova, Zaragoza, España
| | - Inés Velasco
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Servicio de Obstetricia y Ginecología, Hospital Riotinto, Riotinto, Huelva, España
| | - Eduardo Garcia-Fuentes
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Unidad de Gestión Clínica de Aparato Digestivo/Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Málaga, España
| | - Susana Ares
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España
| | - José Carlos Moreno Navarro
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Laboratorio de Tiroides Molecular, INGEMM-Instituto de Medicina y Genética Molecular, Hospital Universitario de La Paz, Madrid, España
| | - Mercedes Espada
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Unidad de Bioquímica Clínica, Laboratorio de Salud Pública de Bilbao, Gobierno Vasco, Parque Tecnológico de Bizkaia, Derio, España
| | - Antonio Muñoz
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Centro de Atención Primaria de la Seu d'Urgell, Lleida, España
| | - Juan Carlos Galofré
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Departamento de Endocrinología Clínica, Universidad de Navarra, Pamplona, España
| | - Manel Puig-Domingo
- Grupo Nutrición de Yodo. Área de conocimiento de la Tiroides-Sociedad Española de Endocrinología y Nutrición; Servicio de Endocrinología y Nutrición, Hospital Germans Trias i Pujol, Institut de Recerca Germans Trias i Pujol (IGTP), Badalona, España
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Donnay Candil S, Oleaga Alday A, Álvarez-García E. Valores de referencia de TSH en población gestante española. ¿Podemos unificar criterios? ENDOCRINOL DIAB NUTR 2019; 66:124-131. [DOI: 10.1016/j.endinu.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/15/2018] [Accepted: 09/25/2018] [Indexed: 10/27/2022]
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Arrizabalaga JJ, Jalón M, Espada M, Cañas M, Arena JM, Vila L. Estado de nutrición de yodo y prevalencia de concentraciones anormales de TSH en la población escolar de 6-7 años de la comunidad autónoma del País Vasco. ENDOCRINOL DIAB NUTR 2018; 65:247-254. [DOI: 10.1016/j.endinu.2018.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/01/2018] [Accepted: 02/06/2018] [Indexed: 11/29/2022]
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Mioto VCB, Monteiro ACDCNG, de Camargo RYA, Borel AR, Catarino RM, Kobayashi S, Chammas MC, Marui S. High prevalence of iodine deficiency in pregnant women living in adequate iodine area. Endocr Connect 2018; 7:762-767. [PMID: 29700098 PMCID: PMC5958744 DOI: 10.1530/ec-18-0131] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/26/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Iodine deficiency during pregnancy is associated with obstetric and neonatal adverse outcomes. Serum thyroglobulin (sTg) and thyroid volume (TV) are optional tools to urinary iodine concentration (UIC) for defining iodine status. This cross-sectional study aims to evaluate the iodine status of pregnant women living in iodine-adequate area by spot UIC and correlation with sTg, TV and thyroid function. METHODS Two hundred and seventy-three pregnant women were evaluated at three trimesters. All had no previous thyroid disease, no iodine supplementation and negative thyroperoxidase and thyroglobulin antibodies. Thyroid function and sTg were measured using electrochemiluminescence immunoassays. TV was determined by ultrasonography; UIC was determined using a modified Sandell-Kolthoff method. RESULTS Median UIC was 146 µg/L, being 52% iodine deficient and only 4% excessive. TSH values were 1.50 ± 0.92, 1.50 ± 0.92 and 1.91 ± 0.96 mIU/L, respectively, in each trimester (P = 0.001). sTg did not change significantly during trimesters with median 11.2 ng/mL and only 3.3% had above 40 ng/mL. Mean TV was 9.3 ± 3.4 mL, which positively correlated with body mass index, but not with sTg. Only 4.5% presented with goitre.When pregnant women were categorized as iodine deficient (UIC < 150 µg/L), adequate (≥150 and <250 µg/L) and excessive (≥250 µg/L), sTg, thyroid hormones and TV at each trimester showed no statistical differences. CONCLUSIONS Iodine deficiency was detected frequently in pregnant women living in iodine-adequate area. sTg concentration and TV did not correlate to UIC. Our observation also demonstrated that the Brazilian salt-iodization programme prevents deficiency, but does not maintain iodine status within adequate and recommended ranges for pregnant women.
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Affiliation(s)
- Verônica Carneiro Borges Mioto
- Thyroid UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas HCFMUSP-Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | - Rosalinda Yossie Asato de Camargo
- Thyroid UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas HCFMUSP-Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Andréia Rodrigues Borel
- Clinic of the Paraisópolis Community Einstein ProjectJewish School of Health Sciences Albert Einstein, Sao Paulo, Sao Paulo, Brazil
| | - Regina Maria Catarino
- Hematology and BiochemistryCenter of Pathology, Adolfo Lutz Institute, Sao Paulo, Sao Paulo, Brazil
| | - Sergio Kobayashi
- Ultrasound UnitDepartment of Radiology, Hospital das Clinicas HCFMUSP-Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Maria Cristina Chammas
- Ultrasound UnitDepartment of Radiology, Hospital das Clinicas HCFMUSP-Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Suemi Marui
- Thyroid UnitDivision of Endocrinology and Metabolism, Hospital das Clinicas HCFMUSP-Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
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Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid 2017; 27:315-389. [PMID: 28056690 DOI: 10.1089/thy.2016.0457] [Citation(s) in RCA: 1303] [Impact Index Per Article: 186.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.
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Affiliation(s)
- Erik K Alexander
- 1 Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Elizabeth N Pearce
- 2 Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine , Boston, Massachusetts
| | - Gregory A Brent
- 3 Department of Medicine, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA , Los Angeles, California
| | - Rosalind S Brown
- 4 Division of Endocrinology, Boston Children's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Herbert Chen
- 5 Department of Surgery, University of Alabama at Birmingham , Birmingham, Alabama
| | - Chrysoula Dosiou
- 6 Division of Endocrinology, Stanford University School of Medicine , Stanford, California
| | - William A Grobman
- 7 Department of Obstetrics and Gynecology, Northwestern University , Chicago, Illinois
| | - Peter Laurberg
- 8 Departments of Endocrinology & Clinical Medicine, Aalborg University Hospital , Aalborg, Denmark
| | - John H Lazarus
- 9 Institute of Molecular Medicine, Cardiff University , Cardiff, United Kingdom
| | - Susan J Mandel
- 10 Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Robin P Peeters
- 11 Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Scott Sullivan
- 12 Department of Obstetrics and Gynecology, Medical University of South Carolina , Charleston, South Carolina
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