1
|
Li S, Wang C, Cheng Y, Li J, Zhang H, Jin Q, Meng Q, Wu W, Wang T, Liu D, Meng X, Guo W, Zhang W. Iodine Metabolism in Urine and Breast Milk among Lactating Women with Adequate Iodine. J Nutr 2024; 154:2006-2013. [PMID: 38718924 DOI: 10.1016/j.tjnut.2024.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/24/2024] [Accepted: 04/19/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND In lactating women, iodine metabolism is regulated and maintained by the kidneys and mammary glands. Limited research exists on how iodine absorbed by lactating women is distributed between the kidneys and breasts. OBJECTIVES This study aimed to accurately evaluate the total iodine intake (TII), urinary iodine excretion (UIE), and breast milk iodine excretion (BMIE) in lactating women and explore the relationship between TII and total iodine excretion (TIE). METHODS A 7-d iodine metabolism study was conducted on 41 lactating women with a mean age of 30 y in Yuncheng and Gaoqing, China, from December 2021 to August 2023. TII and TIE were calculated by measuring the iodine content in food, water, 24-h urine, feces, and breast milk. The urinary iodine excretion rate (UIER), breast milk iodine excretion rate (BMIER), and partitioning of iodine excretion between urine and breast milk were determined. RESULTS Iodine metabolism studies were performed for 285 d. The median TII and TIE values were 255 and 263 μg/d, respectively. With an increase in TII, UIER, and BMIER, the UIE and BMIE to TII ratio exhibited a downward trend. The median UIER, BMIER, and proportion of iodine excreted in urine and breast milk were 51.5%, 38.5%, 52%, and 37%, respectively. When the TII was <120 μg/d, the BMIER decreased with the increase of the TII (β: -0.90; 95% confidence interval: -1.08, -0.72). CONCLUSIONS When maternal iodine intake is low, the proportion in breast milk increases, ensuring sufficient iodine nutrition for infants. In addition, the UIE of lactating women with adequate iodine concentrations is higher than their BMIE. This study was registered at clinicaltrials.gov as NCT04492657.
Collapse
Affiliation(s)
- Shaohan Li
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Chunxi Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yuangui Cheng
- Department of General Surgery, Gaoqing County People's Hospital, Gaoqing, China
| | - Junjing Li
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hexi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Qi Jin
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Qi Meng
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wen Wu
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ting Wang
- Department of Obstetrics, Yuncheng County People's Hospital, Yuncheng, China
| | - Denghai Liu
- Department of Clinical Laboratory, Yuncheng County People's Hospital, Yuncheng, China
| | - Xianglu Meng
- Department of Clinical Laboratory, Yuncheng County People's Hospital, Yuncheng, China
| | - Wenxing Guo
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China.
| | - Wanqi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China; Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| |
Collapse
|
2
|
Sohn SY, Inoue K, Rhee CM, Leung AM. Risks of Iodine Excess. Endocr Rev 2024:bnae019. [PMID: 38870258 DOI: 10.1210/endrev/bnae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 06/15/2024]
Abstract
Iodine is a micronutrient that is required for thyroid hormone synthesis. The iodide cycle in thyroid hormone synthesis consists of a series of transport, oxidation, organification, and binding/coupling steps in thyroid follicular cells. Common sources of iodine include the consumption of an iodine-rich diet or iodine fortified foods, the administration of amiodarone, iodine-containing supplements, or iodinated contrast media, and other miscellaneous sources. Methods to assess population iodine status include the measurement of urinary iodine concentrations, blood thyroglobulin levels, prevalence of elevated neonatal TSH levels, and thyroid volume. Although excessive iodine intake or exposure is generally well tolerated, an acute iodine load may result in thyroid dysfunction (hypothyroidism or hyperthyroidism) in certain susceptible individuals due to the failure to escape from the Wolff-Chaikoff effect and to the Jod-Basedow phenomenon, respectively. In this review, we discuss the associations between excessive iodine intake or exposure, with particular focus on iodinated contrast media as a common source of excess iodine in healthcare settings, and risks of incident thyroid dysfunction. We also summarize the risks of iodine excess in vulnerable populations and review current guidelines regarding the screening and monitoring of iodinated contrast-induced thyroid dysfunction. Finally, we discuss the long-term potential nonthyroidal health risks associated with iodine excess and suggest the need for more data to define safe upper limits for iodine intake, particularly in high-risk populations.
Collapse
Affiliation(s)
- Seo Young Sohn
- Division of Endocrinology, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Hakubi Center, Kyoto University, Kyoto, Japan
| | - Connie M Rhee
- Division of Nephrology, Department of Medicine, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Division of Nephrology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| |
Collapse
|
3
|
Li S, Guo W, Jin Q, Meng Q, Yang R, Zhang H, Fu M, Wang T, Liu D, Meng X, Zhang W. Salivary iodine concentration in pregnant women and its association with iodine status and thyroid function. Eur J Nutr 2024; 63:1139-1149. [PMID: 38355932 DOI: 10.1007/s00394-024-03332-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE There have been no reports on the application of salivary iodine concentration (SIC) in evaluating iodine nutrition in pregnant women. This study aimed to clarify the relationship between SIC and indicators of iodine nutritional status and thyroid function during pregnancy, to investigate whether salivary iodine can be applied to the evaluation of iodine nutritional status in pregnant women, and to provide a reference basis for establishing a normal range of salivary iodine values during pregnancy. METHODS Pregnant women were enrolled in the Department of Obstetrics, the people's hospital of Yuncheng Country, Shandong Province, from July 2021 to December 2022, using random cluster sampling. Saliva, urine, and blood samples were collected from pregnant women to assess iodine nutritional status, and venous blood was collected to determine thyroid function. RESULTS A total of 609 pregnant women were included in this study. The median spot urinary iodine concentration (SUIC) was 261 μg/L. The median SIC was 297 μg/L. SIC was positively correlated with SUIC (r = 0.46, P < 0.0001), 24-h UIC (r = 0.30, P < 0.0001), 24-h urinary iodine excretion (24-h UIE) (r = 0.41, P < 0.0001), and estimated iodine intake (EII) (r = 0.52, P < 0.0001). After adjusting for confounders, there was a weak correlation between SIC and serum total iodine and serum non-protein-bound iodine (P = 0.02, P = 0.04, respectively). Pregnant women with a SIC < 176 μg/L had a higher risk of insufficient iodine status (OR = 2.07, 95% CI 1.35-3.19) and thyroid dysfunction (OR = 2.71, 95% CI 1.18-6.21) compared to those with higher SIC. Those having SIC > 529 μg/L were more likely to have excessive iodine status (OR = 2.82, 95% CI 1.81-4.38) and thyroid dysfunction (OR = 3.04, 95% CI 1.36-6.78) than those with lower SIC values. CONCLUSION SIC is associated with urinary iodine concentration and thyroid function in pregnant women. SIC < 176 μg/L was associated with an increased risk for iodine deficiency and hypothyroxinemia, while SIC > 529 μg/L was related to excess and thyrotoxicosis. SIC can be used as a reference indicator for evaluating the iodine nutrition status of pregnant women, but it needs further investigation and verification. TRIAL REGISTRATION NCT04492657(Aug 9, 2022).
Collapse
Affiliation(s)
- Shaohan Li
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Wenxing Guo
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Qi Jin
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Qi Meng
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Rui Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Hexi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Min Fu
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Ting Wang
- Department of Obstetrics, Yuncheng County People's Hospital, Yuncheng, 274700, China
| | - Denghai Liu
- Department of Clinical Laboratory, Yuncheng County People's Hospital, Yuncheng, 274700, China
| | - Xianglu Meng
- Department of Clinical Laboratory, Yuncheng County People's Hospital, Yuncheng, 274700, China
| | - Wanqi Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, 300052, China.
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, 300070, China.
- Tianjin Key Laboratory of Hormones and Development (Ministry of Health), Tianjin, 300384, China.
| |
Collapse
|
4
|
Fan L, Bu Y, Chen S, Wang S, Zhang W, He Y, Sun D. Iodine nutritional status and its associations with thyroid function of pregnant women and neonatal TSH. Front Endocrinol (Lausanne) 2024; 15:1394306. [PMID: 38883600 PMCID: PMC11176414 DOI: 10.3389/fendo.2024.1394306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Iodine serves as a crucial precursor for the synthesis of thyroid hormones and plays an import role in both pregnant women and their offspring. The relationships between iodine nutritional status and maternal thyroid function and neonatal outcomes remain inconclusive in areas with adequate iodine nutrition. This study aims to investigate their correlations. Methods Blood, morning urine and 24-hour urine were collected from the pregnant women to measure thyroid functions, serum iodine concentration (SIC), morning urine iodine concentration (UIC) and 24-hour urine iodine excretion (24-hour UIE). Indicators of their offspring's neonatal indexes were recorded. Results A total of 559 pregnant women were enrolled in this study. The iodine indicators including Tg, 24-hour UIE and morning UIC were significantly different among the euthyroid pregnant women and those with different thyroid disorders. The levels of FT3, FT4, and SIC exhibited a gradual decline and the concentration of TSH exhibited a gradual increase trend throughout the progression of pregnancy in euthyroid pregnant women. There were no significant differences in neonatal outcomes and neonatal TSH values among euthyroid pregnant women and thyroid disorders pregnant women. SIC had a significant impact on maternal FT4 levels throughout all three trimesters, with varying degrees of importance observed in each trimester. TSH level emerged as the primary determinant of FT4 during the first trimester, while SIC exerted a predominant influence on FT4 levels in the second and third trimesters. The prevalence of thyroid disorders in pregnant women was the lowest when the SIC of pregnant women was probable in the range of 60~70 μg/L, 24-hours UIE was in the range of 250~450 μg, and Tg was in the range of 9~21 μg/L. Maternal TSH exhibited a notable influence on neonatal TSH levels, particularly at the 50th and 75th quantiles. Among the iodine nutritional indicators, SIC and morning UIC demonstrated higher AUC values for abnormal FT4 and TSH, respectively. Discussion The iodine nutrition status of pregnant women exerts an impact on their thyroid function and prevalence of thyroid disorders, and neonatal TSH was affected by maternal TSH. SIC may be a better indicator for iodine nutritional assessment than other indexes.
Collapse
Affiliation(s)
- Lijun Fan
- Endemic Disease Control Center, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
- National Health Commission, Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology (23618504), Harbin, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, China
| | - Ye Bu
- The Fourth Affiliation Hospital, Harbin Medical University, Harbin, China
| | - Shiqi Chen
- Endemic Disease Control Center, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Sihan Wang
- Endemic Disease Control Center, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Wei Zhang
- Endemic Disease Control Center, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Yan He
- Endemic Disease Control Center, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Dianjun Sun
- Endemic Disease Control Center, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
- National Health Commission, Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology (23618504), Harbin, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, China
| |
Collapse
|
5
|
Candido AC, Vieira AA, de Souza Ferreira E, Moreira TR, do Carmo Castro Franceschini S, Cotta RMM. Prevalence of Excessive Iodine Intake in Pregnancy and Its Health Consequences: Systematic Review and Meta-analysis. Biol Trace Elem Res 2023; 201:2784-2794. [PMID: 36018544 DOI: 10.1007/s12011-022-03401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/22/2022] [Indexed: 11/02/2022]
Abstract
The objective was to estimate the prevalence of excessive iodine intake in pregnant women and to investigate the consequences for maternal-fetal health. The systematic review was based on PRISMA. The search was conducted in September 2021 in LILACS, PubMed/MEDLINE, Science Direct, and SCOPUS databases. Observational studies that assessed excessive nutritional iodine status in pregnancy diagnosed by urinary iodine concentration and associated it with biomarkers of thyroid health function were included. Study selection, data extraction, and risk of biased evaluation were performed independently. Meta-analysis was calculated using a fixed and random effect model, and heterogeneity was assessed by the chi-square test. Meta-regressions were performed to identify the causes of heterogeneity using the Knapp and Hartung test. Nine studies were included in the systematic review, and eight in the meta-analysis. The prevalence of excessive iodine intake in 10,736 pregnant women in different regions of the world was 52%. The main implications for pregnant women were hypothyroxinemia, hypothyroidism, and hyperthyroidism. For the newborn, macrosomia and thyroid dysfunction. In addition, drinking water with high iodine intake contributed to excessive iodine intake. Therefore, the prevalence of iodine excess was 52%, with high heterogeneity among studies, explained by trimester of gestation and FT4 level; therefore, the farther the trimester of gestation and the lower the FT4, the higher the prevalence of iodine excess. PROSPERO Registration: CRD420206467 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206467 ).
Collapse
Affiliation(s)
- Aline Carare Candido
- Department of Nutrition and Health, Ed. Centro de Ciências Biológicas II, Universidade Federal de Viçosa, Peter Henry Rolfs Avenue, w/o. Campus Universitário, Viçosa, Minas Gerais, 36570.900, Brazil.
| | - Almir Antônio Vieira
- Department of Agricultural Engineering, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Emily de Souza Ferreira
- Department of Nutrition and Health, Ed. Centro de Ciências Biológicas II, Universidade Federal de Viçosa, Peter Henry Rolfs Avenue, w/o. Campus Universitário, Viçosa, Minas Gerais, 36570.900, Brazil
| | - Tiago Ricardo Moreira
- Department of Medicine and Nursing, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | | | | |
Collapse
|
6
|
Wu W, Guo W, Zhang N, Gao M, Zhang K, Pearce EN, Li S, Ren Z, Yang Y, Wang C, Zhang W. Adverse Effects on the Thyroid of Chinese Pregnant Women Exposed to Long-Term Iodine Excess: Optimal and Safe Tolerable Upper Intake Levels of Iodine. Nutrients 2023; 15:nu15071635. [PMID: 37049475 PMCID: PMC10097226 DOI: 10.3390/nu15071635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
Ensuring optimal iodine nutrition in pregnant women is a global public health concern. However, there is no direct data on safe tolerable upper intake levels (ULs) for pregnant women. A cross-sectional study was performed to determine the ULs of pregnant women. A total of 744 pregnant women were enrolled in this study. The median (IQR) urinary iodine concentration (UIC) in pregnant women was 150.2 (87.6, 268.0) μg/L, and the urinary iodine excretion (UIE) over 24 h was 204.2 (116.0, 387.0) μg/day. Compared with those with a UIE figure of between 150–250 μg/day, the reference group, the prevalence of thyroid dysfunction was 5.7 times higher (95%CI: 1.7, 19.2) in pregnant women with a UIE figure of between 450–550 μg/day, and 3.9 times higher (95%CI: 1.5, 10.3) in pregnant women with a UIE figure of ≥550 μg/day. Compared with an estimated iodine intake (EII) of between 100–200 μg/day, the reference group, the prevalence of thyroid dysfunction was 4.3 times higher (95%CI: 1.3, 14.4) in pregnant women with a UIE figure of between 500–600 μg/day, and 3.6 times higher (95%CI: 1.5, 8.9) in pregnant women with UIE of ≥600 μg/day. In general, our cross-sectional study found that excessive iodine intake during pregnancy appears to directly increase the risk of thyroid dysfunction. Avoiding chronic iodine intakes of 500 μg/day or higher or having a UIE figure of ≥450 μg/day is recommended for pregnant women in China.
Collapse
|
7
|
González Martínez S, Prieto García B, Escudero Gomis AI, Delgado Álvarez E, Menéndez Torre EL. Neonatal TSH as a marker of iodine nutrition status. Effect of maternal ioduria and thyroid function on neonatal TSH. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 97:375-382. [PMID: 36241542 DOI: 10.1016/j.anpede.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/12/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Neonatal thyroid stimulating hormone (nTSH) is a marker of iodine nutrition status in the population. The WHO considers a prevalence of less than 3% of nTSH levels greater than 5 mIU/L in samples obtained within 72h from birth indicative of iodine sufficiency. The aim of this study was to determine the prevalence of nTSH levels greater than 5 mIU/L in an iodine-sufficient population and its association with maternal, neonatal and obstetric factors. MATERIALS AND METHODS A total of 243 pregnant women were recruited between May and June 2017 in our health area. A questionnaire of iodine intake was administered, in addition to determination of ioduria, thyroid function and autoimmunity in the first trimester of gestation. We analysed nTSH levels in samples collected between 48 and 72h post birth and other obstetric and neonatal factors. RESULTS The mean nTSH level (standard deviation) was 2.43 (1.68 mIU/L), with 7.8% of neonates having levels greater than 5 mIU/L. The highest nTSH levels corresponded to neonates of mothers with insufficient ioduria (P = 0.021) or TSH levels greater than 2.5 mIU/L, in both the case of negative (P = 0.049) and positive (P = 0.006) thyroid autoimmunity results. Maternal ioduria less than 150 μg/L was a risk factor for nTSH levels greater than 5 mIU/L (3.70 [1.06-14.60]; P = 0.046), while a neonatal weight of 2500 g or greater was a protective factor (0.14 [0.02-1.00]; P = 0.038). CONCLUSIONS The prevalence of nTSH levels greater than 5 mIU/L in our health area was high based on the WHO recommendations. Maternal iodine deficiency was associated with a higher risk of nTSH levels greater than 5 mIU/L. Given that nTSH is currently measured before 72h post birth, we need new cut-off points to keep on using nTSH as a marker of iodine nutritional status.
Collapse
Affiliation(s)
- Silvia González Martínez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Spain; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain.
| | - Belén Prieto García
- Servicio de Bioquímica Clínica, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Elías Delgado Álvarez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Spain; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Edelmiro Luis Menéndez Torre
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Spain; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain
| |
Collapse
|
8
|
TSH neonatal como marcador del estado de nutrición de yodo. Influencia de la yoduria y la función tiroidea maternas sobre la TSH neonatal. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
9
|
Wassie MM, Smithers LG, Zhou SJ. Association Between Newborn Thyroid-Stimulating-Hormone Concentration and Neurodevelopment and Growth: a Systematic Review. Biol Trace Elem Res 2022; 200:473-487. [PMID: 33686634 DOI: 10.1007/s12011-021-02665-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/02/2021] [Indexed: 10/22/2022]
Abstract
Iodine nutrition during pregnancy can affect newborn thyroid-stimulating-hormone concentration (TSH). Associations of newborn TSH with the neurodevelopment and growth of children are inconsistent. The aim of the study was to systematically review the literature on the associations between newborn TSH and childhood neurodevelopment and growth. Databases including PubMed, Scopus, CINAHL, Embase, PsycINFO, WHO, and Iodine Global Network were searched for eligible studies. Seventeen studies were included. Neurodevelopment was assessed using different tools in children aged 1-12 years of age. The associations between newborn TSH and cognitive development were negative in studies from iodine deficient populations, while a null association was found in studies from iodine sufficient populations. A null association between TSH and psychomotor development was observed regardless of iodine status of the study populations. There was no evidence of an association between newborn TSH and child anthropometry, but evidence of negative association was found between newborn TSH and birthweight. Although the associations between newborn TSH and neurodevelopment may differ based on the iodine status of populations, most of the included studies did not adjust for the key confounders and had a small sample size. Quality data-linkage studies that utilize newborn TSH data from newborn screening with adequate adjustment for potential confounders are warranted to better understand the relationship between newborn TSH and neurodevelopment and growth in children. CRD42020152878.
Collapse
Affiliation(s)
- Molla Mesele Wassie
- Department of Food and Nutrition, School of Agriculture Food and Wine, The University of Adelaide, PMB1, Glen Osmond, 5064, SA, Australia
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lisa Gaye Smithers
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia
| | - Shao Jia Zhou
- Department of Food and Nutrition, School of Agriculture Food and Wine, The University of Adelaide, PMB1, Glen Osmond, 5064, SA, Australia.
- Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia.
| |
Collapse
|
10
|
Associations between newborn thyroid-stimulating hormone concentration and neurodevelopment and growth of children at 18 months. Br J Nutr 2021; 126:1478-1488. [PMID: 33494842 DOI: 10.1017/s0007114521000325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The study aimed to assess the associations between newborn thyroid-stimulating hormone (TSH) concentration, a marker of iodine nutrition in early life, and childhood neurodevelopment and growth using data collected from two pregnancy studies, one in a borderline iodine-deficient setting (DHA to Optimize Mother Infant Outcome (DOMInO) Study) and one in an iodine-sufficient setting (Pregnancy Iodine and Neurodevelopment in Kids (PINK) Study). TSH data were obtained from routine newborn screening. Neurodevelopment was assessed at 18 months using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III). Weight, height and head circumference were measured at 18 months. In total, 1467 children were included in the analysis. Comparing the highest with the lowest TSH quartile, the mean differences (MD) in the Bayley-III scores ranged from -2·0 (95 % CI -4·7, 0·7) to -2·2 (95 % CI -5·8, 1·3) points in DOMInO and 1·0 (95 % CI -1·6, 3·6) to 2·0 (95 % CI -0·4, 4·4) points in PINK in the cognitive, language and motor scales; the MD in the anthropometric z scores ranged from -0·01 (95 % CI -0·5, 0·5) to -0·5 (95 % CI -0·9, -0·1) in both studies. A 1 mIU/l increase in TSH was associated with -0·3 (95 % CI -0·9, 0·2) point and 0·2 (95 % CI -0·3, 0·7) point changes in the mean cognitive score in the DOMInO and PINK, respectively. A null association between TSH and growth was also observed in both studies. Longitudinal studies that utilise newborn TSH data and examine neurodevelopmental outcomes at later ages are warranted, as neurodevelopmental assessments in older children are more predictive of later achievement.
Collapse
|
11
|
Ferreira JL, Gomes M, Príncipe RM. Controversial Screening for Thyroid Dysfunction in Preconception and Pregnancy: An Evidence-Based Review. J Family Reprod Health 2021; 14:234-241. [PMID: 34054992 PMCID: PMC8144488 DOI: 10.18502/jfrh.v14i4.5204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To evaluate the recommendations on the most adequate screening method (universal or selective) for thyroid dysfunction. Although thyroid dysfunction is a common disorder in fertile women and untreated cases may have negative maternal, fetal and neonatal outcomes, its screening in preconception and early pregnancy is controversial. Materials and methods: An evidence-based review was conducted to identify publications since 2017 of American Thyroid Association (ATA) guidelines, according to the following Population, Intervention, Comparison, Outcomes and Study (PICOS): women in preconception or pregnancy without thyroid disease who underwent universal or selective screening for thyroid dysfunction. Study selection obeyed the PRISMA criteria. Results: We included 15 of 325 publications. The 2017 ATA guidelines recommend selective screening in both preconception and pregnancy. The only two reviews on preconception recommended universal screening. For pregnancy, nine articles suggested universal screening, while a prospective study advocated selective screening. The main benefits advocated for universal screening were easy and low-cost tests; absence of missed diagnosis; safe and inexpensive treatment and its potential in preventing negative outcomes. Iodine deficiency is a decisive indication, but it was not evaluated in all clinical studies. Screening harms and knowledge gaps were the main arguments against universal screening. There are very few cost-effectiveness studies. Conclusion: We recommend universal screening for thyroid dysfunction in early pregnancy, which is a distinct point of view from 2017 ATA guidelines (weak recommendation, low-quality evidence). It is not possible to make a formal recommendation for preconception (insufficient evidence). We strongly suggest an individualized analysis by each country.
Collapse
Affiliation(s)
- Joana Lima Ferreira
- Department of Endocrinology, Pedro Hispano Hospital, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Mafalda Gomes
- Department of Family Medicine, Family Health Unit of Mar, Greater Porto IV Health Centers Grouping,Póvoa de Varzim, Portugal
| | - Rosa Maria Príncipe
- Department of Endocrinology, Pedro Hispano Hospital, Matosinhos Local Health Unit, Matosinhos, Portugal
| |
Collapse
|
12
|
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
|
13
|
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
|
14
|
Fan P, Luo ZC, Tang N, Wang W, Liu Z, Zhang J, Ouyang F. Advanced Maternal Age, Mode of Delivery, and Thyroid Hormone Levels in Chinese Newborns. Front Endocrinol (Lausanne) 2019; 10:913. [PMID: 31998241 PMCID: PMC6966407 DOI: 10.3389/fendo.2019.00913] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022] Open
Abstract
Objective: Thyroid hormones are essential for fetal growth and neurodevelopment, however, data on cord blood thyroid hormones are sparse in China where maternal age at childbearing is increasing in recent decades. We aimed to assess cord blood levels of free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) in full-term Chinese newborns, and examine potential related perinatal factors. Methods: This study included 922 mother-newborn pairs from a prospective birth cohort enrolled in 2012-2013, Shanghai, China. Cord serum concentrations of FT3, FT4, TSH, and TPOAb were measured in newborns. Results: Newborns born via cesarean section had higher cord serum FT3 (mean ± SD: 1.90 ± 1.16 pmol/L) and lower cord serum TSH (5.15 ± 2.60 mIU/L) than those born via vaginal delivery (FT3: 1.62 ± 0.93 pmol/L; TSH: 9.27 ± 6.76 mIU/L). In cesarean section deliveries, the concentration of cord serum FT3 was 0.15 (95%CI: -0.03, 0.33; p = 0.10) pmol/L lower in infants of mothers aged 30-34 years, and 0.57 (95%CI: 0.22, 0.92; p = 0.002) pmol/L lower in infants of mothers ≥35 years compared to infants of mothers <30 years. Large-for-gestational-age (birth weight >90th percentile) was associated with higher TSH (p = 0.02). Similar results were also found in vaginal deliveries. Conclusions: In this Chinese term birth cohort, newborns born via cesarean section had higher cord serum FT3 and lower TSH than those born via vaginal delivery. Advanced maternal age was associated with lower fetal FT3. Further research is needed to understand whether this association may mediate the adverse impact of advanced maternal age on neurodevelopment in early life.
Collapse
Affiliation(s)
- Pianpian Fan
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhong-Cheng Luo
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Obstetrics and Gynecology, Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ning Tang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiye Wang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiwei Liu
- Department of Neonatology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fengxiu Ouyang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Fengxiu Ouyang ;
| |
Collapse
|
15
|
Nazeri P, Tahmasebinejad Z, Mehrabi Y, Hedayati M, Mirmiran P, Azizi F. Lactating Mothers and Infants Residing in an Area with an Effective Salt Iodization Program Have No Need for Iodine Supplements: Results from a Double-Blind, Placebo-Controlled, Randomized Controlled Trial. Thyroid 2018; 28:1547-1558. [PMID: 30272528 DOI: 10.1089/thy.2018.0153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The necessity of iodine supplementation in lactating mothers residing in countries with sustained salt iodization programs for iodine sufficiency of breast-fed infants remains unclear. The aims of this study were to investigate the effect of iodine supplementation on iodine status and growth parameters of lactating mothers and breast-fed infants and to compare these data with that of formula-feeding mothers and their infants during the first year of infancy. METHODS In this multicenter, double-blinded, randomized clinical trial conducted in four healthcare centers in Tehran (Iran), healthy lactating mothers and their term newborns aged 3-5 days were randomly assigned to treatment groups: placebo, 150 μg/day iodine, or 300 μg/day iodine. They were followed up for 12 months. Formula-fed infants aged 30-45 days and their mothers were randomly selected from the same centers. The primary outcomes were maternal and infant urinary iodine concentrations (UICs), breast-milk iodine concentrations (BMICs), and infant growth parameters, measured at 1, 2, 4, 6, 9, and 12 months during routine health visits. The formula-fed group was assessed at 2, 4, 6, 9, and 12 months of age. Analysis was by per protocol principle using mixed-effects models. RESULTS Mother-newborn pairs (n = 180) in treatment groups and partially/exclusively formula-feeding mother-infant pairs (n = 60) participated between October 2014 and January 2016. Median baseline UICs in the treatment groups were 84 μg/L (interquartile range [IQR] 41-143 μg/L) in mothers and 208 μg/L (IQR 91-310 μg/L) in their infants. The values in the formula-fed group were 76 μg/L (IQR 40-144 μg/L) in mothers and 121 μg/L (IQR 66-243 μg/L) in infants. The 300 μg/day iodine group showed significantly higher UICs and BMICs than did the other treatment groups; infant UICs in the 150 μg/day iodine, placebo, and formula-fed groups were similar. Infants in all groups showed iodine sufficiency (median UIC ≥100 μg/L) throughout the study period. Anthropometric measurements were similar between the treatment and formula-fed groups over the study period, except at the last follow-up visit at 12 months. CONCLUSION Supplementation of breast-feeding mothers with either 300 or 150 μg/day iodine improved their iodine status. However, the iodine status of infants in all groups studied indicated iodine sufficiency during the first year of infancy, demonstrating that in countries with effective salt iodization program, iodine supplementation for lactating mothers is unnecessary.
Collapse
Affiliation(s)
- Pantea Nazeri
- 1 Family Health Institute, Breastfeeding Research Center, Tehran University of Medical Sciences , Tehran, Iran
- 2 Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Zhale Tahmasebinejad
- 2 Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Yadollah Mehrabi
- 3 Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Mehdi Hedayati
- 4 Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Parvin Mirmiran
- 2 Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Fereidoun Azizi
- 5 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| |
Collapse
|
16
|
Lee YA, Cho SW, Sung HK, Kim K, Song YS, Moon SJ, Oh JW, Ju DL, Choi S, Song SH, Cheon GJ, Park YJ, Shin CH, Park SK, Jun JK, Chung JK. Effects of Maternal Iodine Status during Pregnancy and Lactation on Maternal Thyroid Function and Offspring Growth and Development: A Prospective Study Protocol for the Ideal Breast Milk Cohort. Endocrinol Metab (Seoul) 2018; 33:395-402. [PMID: 30229579 PMCID: PMC6145964 DOI: 10.3803/enm.2018.33.3.395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/30/2018] [Accepted: 08/21/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Iodine is an intrinsic element of thyroid hormone, which is essential for childhood growth and development. The Ideal Breast Milk (IBM) cohort study aims to evaluate the effects of maternal iodine status during pregnancy and lactation on maternal thyroid function, offspring growth and development, and offspring thyroid function. METHODS The IBM cohort study recruited pregnant women from Seoul National University Hospital between June 2016 and August 2017, followed by enrollment of their offspring after delivery. For the maternal participants, iodine status is evaluated by urinary iodine concentration (UIC) and dietary records in the third trimester and at 3 to 4 weeks and 12 to 15 months postpartum. For the child participants, cord blood sampling and UIC measurements are performed at birth. At 3 to 4 weeks of age, UIC and breastmilk iodine concentrations are measured. At 12 to 15 months of age, growth and development are assessed and measurements of UIC, a thyroid function test, and ultrasonography are performed. RESULTS A total of 198 pregnant women in their third trimester were recruited. Their mean age was 35.1±3.5 years, and 78 (39.4%) of them were pregnant with twins. Thirty-three (16.7%) of them had a previous history of thyroid disease. CONCLUSION Korea is an iodine-replete area. In particular, lactating women in Korea are commonly exposed to excess iodine due to the traditional practice of consuming brown seaweed soup postpartum. The study of the IBM cohort is expected to contribute to developing guidelines for optimal iodine nutrition in pregnant or lactating women.
Collapse
Affiliation(s)
- Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Kyung Sung
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyungsik Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
| | - Young Shin Song
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sin Je Moon
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Won Oh
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dal Lae Ju
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sooyeon Choi
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Hoon Song
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - June Key Chung
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|
17
|
Nazeri P, Kabir A, Dalili H, Mirmiran P, Azizi F. Breast-Milk Iodine Concentrations and Iodine Levels of Infants According to the Iodine Status of the Country of Residence: A Systematic Review and Meta-Analysis. Thyroid 2018; 28:124-138. [PMID: 29334343 DOI: 10.1089/thy.2017.0403] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Iodine, an essential micronutrient, plays a critical role in normal growth and development, especially during the first two years of life. This systematic review and meta-analysis is among the first to evaluate breast-milk iodine concentrations and infant iodine status in countries characterized by iodine sufficiency or deficiency. METHODS PubMed, Web of Science, Cochrane Library, Google Scholar, and other relevant databases, as well as reference lists of previous reviews, were searched for relevant studies published between 1986 and 2016. Mean or median breast-milk and infant urinary iodine concentrations, along with other relevant data, were extracted from eligible studies. Each study was assessed for quality and risk of bias. RESULTS Of the 496 identified studies, 57 met the criteria for inclusion in the meta-analysis. The mean (confidence interval [CI]) iodine concentrations in maternal colostrum were 152.0 μg/L [CI 106.2-198.7 μg/L] and 57.8 μg/L [CI 41.4-74.1 μg/L] in iodine-sufficient and -deficient countries, respectively, indicating a significant difference between the two iodine statuses. By contrast, the corresponding values in mature milk did not differ significantly between mothers in iodine-sufficient and -deficient countries (71.5 μg/L [CI 51.0-92.0 μg/L] and 28.0 μg/L [CI -13.8 to 69.9 μg/L], respectively]. The weighted urinary iodine levels [CIs] of breast-fed infants in iodine-sufficient countries were significantly higher than those in iodine-deficient countries (164.5 μg/L [CI 116.4-212.7 μg/L] vs. 70.4 μg/L [CI 46.2-94.6 μg/L]). Similarly, a significant difference was observed in the pooled estimates of urinary iodine levels [CIs] among formula-fed infants in iodine-sufficient versus iodine-deficient countries (310.3 μg/L [CI 287.4-342.1 μg/L] vs. 38.3 μg/L [CI 23.4-53.2 μg/L]). CONCLUSION The meta-analysis reveals that in iodine-sufficient countries, the mean iodine concentrations in colostrum and mature breast milk corresponded to iodine sufficiency among infants. The results are thus compatible with the international recommendation that lactating women and infants younger than two years of age who reside in iodine-sufficient countries do not require iodine supplementation.
Collapse
Affiliation(s)
- Pantea Nazeri
- 1 Family Health Institute, Breastfeeding Research Center, Tehran University of Medical Sciences , Tehran, Iran
- 2 Nutrition and Endocrine Research Center, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Ali Kabir
- 3 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences , Tehran, Iran
| | - Hosein Dalili
- 1 Family Health Institute, Breastfeeding Research Center, Tehran University of Medical Sciences , Tehran, Iran
| | - Parvin Mirmiran
- 2 Nutrition and Endocrine Research Center, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Fereidoun Azizi
- 4 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| |
Collapse
|
18
|
Valizadeh M, Nazeri P, Fazli F, Mohammadian F, Kalantari S, Kamali K, Osali H. Application of povidone-iodine at delivery significantly increases maternal urinary iodine but not neonatal thyrotropin in an area with iodine sufficiency. J Pediatr Endocrinol Metab 2017; 30:967-972. [PMID: 28763301 DOI: 10.1515/jpem-2017-0087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 07/03/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of the present study was to investigate the effect of povidone-iodine (PVP-I) application at delivery on maternal urinary iodine concentration (UIC) and neonatal thyrotropin concentration. METHODS In this cross-sectional study, urine samples were collected from each pregnant woman after admission to the hospital and before routine application of the PVP-I for delivery preparation and after delivery at time of screening for congenital hypothyroidism. A heel-prick blood sample was taken from all newborns. RESULTS A total of 394 pregnant women at time of delivery participated in this study. Median (interquartile range [IQR]) maternal UIC values were 120 (105-157) and 253 (126-470) μg/L before and after delivery, respectively (p<0.001). No significant correlations were observed between maternal UIC before and after delivery and neonatal thyrotropin levels. CONCLUSIONS Application of PVP-I significantly increased UIC in postpartum mothers; however, thyrotropin concentration in neonates, whose mothers had adequate UIC, was within the normal range.
Collapse
|
19
|
Sun D, Codling K, Chang S, Zhang S, Shen H, Su X, Chen Z, Scherpbier RW, Yan J. Eliminating Iodine Deficiency in China: Achievements, Challenges and Global Implications. Nutrients 2017; 9:E361. [PMID: 28379180 PMCID: PMC5409700 DOI: 10.3390/nu9040361] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 11/30/2022] Open
Abstract
The prevention of iodine deficiency through salt iodization has been recognized as a global success story, and China stands at the forefront of this achievement with one of the most successful programs in the world. High level political commitment, national mandatory legislation, a state-managed edible salt industry and a complex and highly sophisticated surveillance system have facilitated the success of the program. Challenges have arisen however, including: (i) concern that adequate iodine status in pregnant women cannot be achieved without causing above adequate iodine intakes in children; (ii) declining iodine intake as a result of reductions in salt consumption and increased consumption of processed foods, which may not be made with iodized salt; (iii) the existence of areas with high iodine content in the water; and (iv) declines in household use of iodized salt due to concerns about excess iodine intake and thyroid disease. This article reviews the achievements and challenges of the Chinese Iodine Deficiency Disorders (IDD) Elimination Program and reflects on lessons learned and implications for other national salt iodization programs.
Collapse
Affiliation(s)
- Dianjun Sun
- Centre for Endemic Disease Control, China Chinese Centre for Disease Control and Prevention, Harbin Medical University, 157 Baojian Road, Harbin 150081, China.
| | - Karen Codling
- United Nations Children's Fund, 12 Sanlitun Lu, Beijing 100600, China.
- Iodine Global Network, P.O. Box 51030, 375 des Epinettes, Ottawa, ON K1E 3E6, Canada.
| | - Suying Chang
- United Nations Children's Fund, 12 Sanlitun Lu, Beijing 100600, China.
| | - Shubin Zhang
- Parasitic and Endemic Disease Prevention and Control Division of the National Health and Family Planning Commission of China, 14 Zhichun Road, Beijing 100088, China.
| | - Hongmei Shen
- Centre for Endemic Disease Control, China Chinese Centre for Disease Control and Prevention, Harbin Medical University, 157 Baojian Road, Harbin 150081, China.
| | - Xiaohui Su
- Centre for Endemic Disease Control, China Chinese Centre for Disease Control and Prevention, Harbin Medical University, 157 Baojian Road, Harbin 150081, China.
| | - Zupei Chen
- Iodine Global Network, P.O. Box 51030, 375 des Epinettes, Ottawa, ON K1E 3E6, Canada.
| | - Robert W Scherpbier
- Iodine Global Network, P.O. Box 51030, 375 des Epinettes, Ottawa, ON K1E 3E6, Canada.
| | - Jun Yan
- Parasitic and Endemic Disease Prevention and Control Division of the National Health and Family Planning Commission of China, 14 Zhichun Road, Beijing 100088, China.
| |
Collapse
|
20
|
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: 1312] [Impact Index Per Article: 187.4] [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.
Collapse
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
| |
Collapse
|
21
|
Nazeri P, Mirmiran P, Tahmasebinejad Z, Hedayati M, Delshad H, Azizi F. The Effects of Iodine Fortified Milk on the Iodine Status of Lactating Mothers and Infants in an Area with a Successful Salt Iodization Program: A Randomized Controlled Trial. Nutrients 2017; 9:nu9020180. [PMID: 28241419 PMCID: PMC5331611 DOI: 10.3390/nu9020180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/06/2017] [Accepted: 02/17/2017] [Indexed: 11/20/2022] Open
Abstract
Iodine deficiency during the first two years of life may cause irreversible brain damage and mental retardation. The aim of the present study was to investigate, for the first time, the effect of iodine fortified milk on the iodine status of lactating mothers and their infants. In this multicenter randomized controlled trial, 84 lactating mother-infant pairs from health care centers were randomly selected. After meeting the inclusion criteria, lactating mothers were randomly assigned to two groups: the iodine fortified milk group and the control group (n = 42 each). Maternal and infant urine and breast milk samples were collected at 3–5 (baseline), 7, 10, 14 days, and 1 month postpartum, for a measurement of the iodine concentration. A total of 84 lactating mothers, with a mean age of 28.2 ± 4.5 years, and 84 infants, with a mean age of 4.2 ± 0.7 days, were included in the study. Compared to mothers of the control group, mothers receiving iodine fortified milk had higher urinary (p < 0.001) and breast milk (p < 0.001) iodine concentrations. Urinary iodine levels in infants revealed no significant differences between the two groups. The findings of this study indicate that supplementation with daily iodine fortified milk provides iodine nutrition adequacy among lactating mothers. However, it had no effect on the iodine status of infants, who were previously iodine sufficient.
Collapse
Affiliation(s)
- Pantea Nazeri
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
- Department of Nutrition and Clinical Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, 19395-4741 Tehran, Iran.
| | - Zhale Tahmasebinejad
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
| | - Mehdi Hedayati
- Cellular and Molecular Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
| | - Hossein Delshad
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Iran.
| |
Collapse
|
22
|
Nazeri P, Mirmiran P, Kabir A, Azizi F. Neonatal thyrotropin concentration and iodine nutrition status of mothers: a systematic review and meta-analysis. Am J Clin Nutr 2016; 104:1628-1638. [PMID: 27806973 DOI: 10.3945/ajcn.116.131953] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 09/20/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Low maternal iodine intake disturbs the thyroid function of neonates transiently or permanently. OBJECTIVE To our knowledge, we conducted one of the first systematic reviews and meta-analyses aimed at exploring the association of neonatal thyrotropin concentrations and iodine status of mothers during pregnancy and early postpartum periods. DESIGN Data were collected through literature searches for studies published between 1969 and 2015 with the use of electronic databases. Mean or median maternal urinary iodine and neonatal thyrotropin concentrations, along with other relevant data, were extracted from eligible studies. The quality and risk of bias of each study was assessed. RESULTS A random-effects model was used for the analysis. Of 110 studies identified, 25 trials were shown to be eligible for inclusion in the meta-analysis. Mean (95% CI) thyrotropin concentrations of neonates born to mothers with iodine deficiency were higher than in neonates born to mothers with iodine sufficiency during pregnancy in both heel blood samples [1.79 mIU/L (95% CI: 1.61, 1.97 mIU/L) compared with 1.75 mIU/L (95% CI: 1.68, 1.82 mIU/L), respectively] and cord blood samples [11.91 mIU/L (95% CI: 6.67, 17.14 mIU/L) compared with 6.15 mIU/L (95% CI: 4.30, 8.01 mIU/L), respectively]. There were no significant differences in neonatal thyrotropin concentrations of heel samples between mothers with iodine deficiency and those with sufficiency during the early postpartum period; however, the values of thyrotropin in cord samples of neonates born to mothers with iodine deficiency were significantly higher than in neonates born to mothers with iodine sufficiency [11.62 mIU/L (95% CI: 10.47, 12.77 mIU/L) compared with 7.40 mIU/L (95% CI: 6.21, 8.59 mIU/L)]. CONCLUSION Our findings reveal that, compared with heel blood samples, neonatal thyrotropin in samples collected from the cord are more sensitive to the iodine status of mothers; however, further investigations are required in this regard.
Collapse
Affiliation(s)
| | | | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; and
| |
Collapse
|