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Kryczyk-Kozioł J, Moniak P, Zagrodzki P, Lauterbach R, Huras H, Staśkiewicz M, Krośniak M, Paśko P, Podsiadły R, Dobrowolska-Iwanek J. The Assessment of Iodine Concentrations in Colostrum and Breast Milk Using ICP-MS: The Impact of Delivery Type, Thyroid Function and Gestational Diabetes-A Pilot Study. Foods 2024; 13:2241. [PMID: 39063324 PMCID: PMC11275260 DOI: 10.3390/foods13142241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/09/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Considering the spectrum of benefits of breast milk feeding, determining the essential components of an infant's only food-mother's milk-seems justified, especially in the case of those whose deficiency (e.g., iodine) may result in developmental disorders. The main aim of this study was the determination of the total iodine content of breast milk (including colostrum and mature milk). A secondary objective was to assess the influence of factors such as the type of delivery, hypothyroidism, gestational diabetes or the stage of lactation on this parameter. The study materials were colostrum and milk after 1 (n = 14), 2 and 3 months (n = 8) of lactation with a range of iodine concentrations (µg/L): 195-1648 and 170-842, 174-650 and 273-751, respectively. Iodine was determined using the inductively coupled plasma mass spectrometry (ICP-MS). Multivariate statistical analysis revealed, e.g., that delivery by caesarean section or dose of L-thyroxine taken by women to normalise thyroid hormones, had a significant effect on iodine concentrations in breast milk. Further research aimed at assessing the quality of breast milk should also include determining the factors influencing it.
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Affiliation(s)
- Jadwiga Kryczyk-Kozioł
- Department of Food Chemistry and Nutrition, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland; (J.K.-K.); (P.M.); (P.Z.); (P.P.)
| | - Paulina Moniak
- Department of Food Chemistry and Nutrition, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland; (J.K.-K.); (P.M.); (P.Z.); (P.P.)
| | - Paweł Zagrodzki
- Department of Food Chemistry and Nutrition, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland; (J.K.-K.); (P.M.); (P.Z.); (P.P.)
| | - Ryszard Lauterbach
- Department of Neonatology, Jagiellonian University Hospital, Kopernika 23, 31-501 Kraków, Poland;
| | - Hubert Huras
- Department of Obstetrics and Perinatology, Jagiellonian University Hospital, Kopernika 23, 31-501 Kraków, Poland; (H.H.); (M.S.)
| | - Magdalena Staśkiewicz
- Department of Obstetrics and Perinatology, Jagiellonian University Hospital, Kopernika 23, 31-501 Kraków, Poland; (H.H.); (M.S.)
| | - Mirosław Krośniak
- Department of Food Chemistry and Nutrition, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland; (J.K.-K.); (P.M.); (P.Z.); (P.P.)
| | - Paweł Paśko
- Department of Food Chemistry and Nutrition, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland; (J.K.-K.); (P.M.); (P.Z.); (P.P.)
| | - Robert Podsiadły
- Institute of Physics, Faculty of Natural Sciences, Jan Kochanowski University, Uniwersytecka 7, 25-406 Kielce, Poland;
| | - Justyna Dobrowolska-Iwanek
- Department of Food Chemistry and Nutrition, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland; (J.K.-K.); (P.M.); (P.Z.); (P.P.)
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Nguyen CT. An update: maternal iodine supplementation, thyroid function tests, and child neurodevelopmental outcomes. Curr Opin Endocrinol Diabetes Obes 2023; 30:265-272. [PMID: 37417826 DOI: 10.1097/med.0000000000000824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
PURPOSE OF REVIEW The impact of maternal iodine supplementation (MIS) during pregnancy on thyroid function and child neurodevelopmental outcomes in areas of mild-to-moderate iodine deficiency (MMID) remains unclear. RECENT FINDINGS Despite growing success of salt iodization programs, a 2022 meta-analysis found that 53% of pregnant patients worldwide continue to have insufficient iodine intake during pregnancy. A 2021 randomized controlled trial (RCT) found that MIS in women with mild iodine deficiency led to iodine sufficiency and positive effects on maternal thyroglobulin. A 2021 cohort study of MIS initiated prior to pregnancy was associated with lower thyroid-stimulating hormone (TSH), higher FT3, and FT4. Other cohort studies, however, found that neither salt iodization nor MIS were adequate to meet pregnancy iodine needs. Data have been mixed regarding maternal iodine status and pregnancy outcomes in patients of MMID. Meta-analyses have not shown any clear benefit on infant neurocognitive outcomes with MIS of MMID patients. A 2023 meta-analysis found that the prevalence of excess iodine intake in pregnancy was 52%. SUMMARY MMID continues to exist during pregnancy. Salt iodization alone may be insufficient to ensure adequate iodine status during pregnancy. There is an absence of high-quality data to support routine MIS in areas of MMID. However, patients with specialized diets (vegan, nondairy, no seafood, noniodized salt, and so on) may be at risk for inadequate iodine status in pregnancy. Excess iodine intake can be detrimental to the fetus and should be avoided during pregnancy.
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Affiliation(s)
- Caroline T Nguyen
- Departments of Clinical Medicine, Obstetrics, and Gynecology, Division of Endocrinology, Metabolism, and Diabetes, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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A Scoping Review of Iodine and Fluoride in Pregnancy in Relation to Maternal Thyroid Function and Offspring Neurodevelopment. Adv Nutr 2023; 14:317-338. [PMID: 36796438 DOI: 10.1016/j.advnut.2023.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 02/04/2023] Open
Abstract
Iodine (I), an essential nutrient, is important for thyroid function and therefore growth and development. Fluoride (F), also an essential nutrient, strengthens bones and teeth, and prevents childhood dental caries. Both severe and mild-to-moderate I deficiency and high F exposure during development are associated to decreased intelligence quotient with recent reports associating high levels of F exposure during pregnancy and infancy to low intelligence quotient. Both F and I are halogens, and it has been suggested that F may interfere with the role of I in thyroid function. We provide a scoping review of the literature on I and F exposure dur pregnancy and their individual effects on thyroid function and offspring neurodevelopment. We first discuss I intake and status in pregnancy and the relationship to thyroid function and offspring neurodevelopment. We follow with the F in pregnancy and offspring neurodevelopment. We then review the interaction between I and F on thyroid function. We searched for, and found only one study that assessed both I and F in pregnancy. We conclude more studies are needed.
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González-Martínez S, Martínez-Morillo E, Avello-Llano N, Escudero-Gomis AI, Delgado-Álvarez E, Menéndez-Torre EL. Iodine status in pregnant women in northern Spain. Effect of iodised salt and iodine supplements on thyroid function. ENDOCRINOLOGÍA, DIABETES Y NUTRICIÓN (ENGLISH ED.) 2023; 70:162-170. [PMID: 37030899 DOI: 10.1016/j.endien.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/07/2022] [Indexed: 04/08/2023]
Abstract
INTRODUCTION Iodine deficiency is linked to thyroid dysfunction, particularly in pregnant women. The objective of this study was to ascertain the iodine levels of women in the second trimester of pregnancy, analysing the influence of iodine ingestion on urinary iodine concentration (UIC) and maternal thyroid function. METHODS A prospective observational study of pregnant women from Health Area IV of Asturias (northern Spain) recruited before 13 weeks of gestation between May and June 2017. A questionnaire on iodine intake was completed at the first visit, and urine and serum samples were collected at baseline and again during the second trimester. UIC, thyroid stimulating hormone (TSH) and free thyroxine (FT4) obtained in the second trimester of gestation were analysed and related to iodine intake. Thyroid autoimmunity was also analysed in half of the pregnant women at baseline. RESULTS A total of 241 pregnant women were studied. Of these, 56.7% used iodised salt, 46.7% consumed ≥2 servings of dairy products daily and 88.1% took iodine supplements. Median UIC was 191μg/l (135.3-294μg/l), with 68.1% of the women having UIC ≥150μg/l. Only iodised salt consumption provided protection against iodine deficiency (odds ratio 0.35 [0.20-0.63], p=0.001). In women with no autoimmune thyroid disease (n=88), mean levels of TSH were lower in those that consumed iodised salt than in those that did not (respectively, 2.08±0.89mIU/l vs. 2.56±1.02mIU/l, p=0.025). In women with autoimmune thyroid disease (n=30), mean levels of TSH were higher in those that took iodine supplements than in those that did not (respectively, 2.97±1.25mIU/l vs. 1.16±0.41mIU/l, p=0.002). CONCLUSIONS The pregnant women studied from Health Area IV in Asturias maintain adequate nutritional iodine status in the second trimester of gestation. In our sample, only the consumption of iodised salt was associated with adequate iodine nutrition, without affecting maternal thyroid function. Most of the women used iodine supplements, which was linked to higher levels of TSH in pregnant women with autoimmune thyroid disease.
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Affiliation(s)
- Silvia González-Martínez
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias (HUCA) [Central University Hospital of Asturias], Oviedo, Spain; Endocrinology, Nutrition, Diabetes and Obesity (ENDO) Research Group, Instituto de Investigación Sanitario del Principado de Asturias (ISPA) [Health Research Institute of the Principality of Asturias], Spain.
| | - Eduardo Martínez-Morillo
- Department of Clinical Biochemistry, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Noelia Avello-Llano
- Department of Clinical Biochemistry, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Ana Isabel Escudero-Gomis
- Department of Obstetrics and Gynaecology, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Elías Delgado-Álvarez
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias (HUCA) [Central University Hospital of Asturias], Oviedo, Spain; Endocrinology, Nutrition, Diabetes and Obesity (ENDO) Research Group, Instituto de Investigación Sanitario del Principado de Asturias (ISPA) [Health Research Institute of the Principality of Asturias], Spain; Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Edelmiro Luis Menéndez-Torre
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias (HUCA) [Central University Hospital of Asturias], Oviedo, Spain; Endocrinology, Nutrition, Diabetes and Obesity (ENDO) Research Group, Instituto de Investigación Sanitario del Principado de Asturias (ISPA) [Health Research Institute of the Principality of Asturias], Spain; Faculty of Medicine, University of Oviedo, Oviedo, Spain
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Management of Hyperthyroidism during Pregnancy: A Systematic Literature Review. J Clin Med 2023; 12:jcm12051811. [PMID: 36902600 PMCID: PMC10003540 DOI: 10.3390/jcm12051811] [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: 12/18/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
In pregnancy, several physiological changes affect maternal circulating thyroid hormone levels. The most common causes of hyperthyroidism in pregnancy are Graves' disease and hCG-mediated hyperthyroidism. Therefore, evaluating and managing thyroid dysfunction in women during pregnancy should ensure favorable maternal and fetal outcomes. Currently, there is no consensus regarding an optimal method to treat hyperthyroidism in pregnancy. The term "hyperthyroidism in pregnancy" was searched in the PubMed and Google Scholar databases to identify relevant articles published between 1 January 2010 and 31 December 2021. All of the resulting abstracts that met the inclusion period were evaluated. Antithyroid drugs are the main therapeutic form administered in pregnant women. Treatment initiation aims to achieve a subclinical hyperthyroidism state, and a multidisciplinary approach can facilitate this process. Other treatment options, such as radioactive iodine therapy, are contraindicated during pregnancy, and thyroidectomy should be limited to severe non-responsive thyroid dysfunction pregnant patients. In light of this events, even in the absence of guidelines certifying screening, it is recommended that all pregnant and childbearing women should be screened for thyroid conditions.
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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.
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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
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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
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