Current iodine nutrition status in Poland (2017): is the Polish model of obligatory iodine prophylaxis able to eliminate iodine deficiency in the population?

AbstractObjective:The monitoring of the populations’ iodine status is an essential part of successful programmes of iodine deficiency elimination. The current study aimed at the evaluation of current iodine nutrition in school children, pregnant and lactating women as a marker of the effectiveness and sustainability of mandatory iodine prophylaxis in Poland.Design:The following iodine nutrition indicators were used: urinary iodine concentration (UIC) (all participants) and serum thyroglobulin (pregnant and lactating women).Setting:The study was conducted in 2017 within the National Health Programme in five regions of Poland.Participants:The research included 300 pregnant women, 100 lactating women and 1000 school children (aged 6–12 years).Results:In pregnant women, median UIC was 111·6 µg/l; there was no significant difference in median UIC according to the region of residence. In 8 % of pregnant women, thyroglobulin level was >40 ng/ml (median thyroglobulin 13·3 ng/ml). In lactating women, median UIC was 68·0 µg/l. A significant inter-regional difference was noted (P = 0·0143). In 18 % of breastfeeding women, thyroglobulin level was >40 ng/ml (median thyroglobulin 18·5 ng/ml). According to the WHO criteria, the investigated sample of pregnant and lactating women was iodine-deficient. Median UIC in school children was 119·8 µg/l (with significant inter-regional variation; P = 0·0000), which is consistent with iodine sufficiency. Ninety-four children (9·4 %) had UIC < 50 µg/l.Conclusions:Mandatory iodisation of household salt in Poland has led to a sustainable optimisation of iodine status in the general population. However, it has failed to assure adequate iodine nutrition during pregnancy and lactation.

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Insufficient iodine nutrition status and the risk of pre-eclampsia: a systemic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-043505 ◽

2021 ◽

Vol 11 (2) ◽

pp. e043505

Author(s):

Charles Bitamazire Businge ◽

Anthony Usenbo ◽

Benjamin Longo-Mbenza ◽

AP Kengne

Keyword(s):

Pregnant Women ◽

Iodine Deficiency ◽

Meta Analysis ◽

Random Effect Model ◽

Urinary Iodine ◽

Systemic Review ◽

Nutrition Status ◽

Urinary Iodine Concentration ◽

Iodine Nutrition ◽

Significant Difference

BackgroundAlthough subclinical hypothyroidism in pregnancy is one of the established risk factors for pre-eclampsia, the link between iodine deficiency, the main cause of hypothyroidism, and pre-eclampsia remains uncertain. We conducted a systematic review to determine the iodine nutrition status of pregnant women with and without pre-eclampsia and the risk of pre-eclampsia due to iodine deficiency.MethodsMEDLINE, EMBASE, Google Scholar, Scopus and Africa-Wide Information were searched up to 30th June 2020. Random-effect model meta-analysis was used to pool mean difference in urinary iodine concentration (UIC) between pre-eclamptic and normotensive controls and pool ORs and incidence rates of pre-eclampsia among women with UIC <150 µg/L.ResultsFive eligible studies were included in the meta-analysis. There was a significant difference in the pooled mean UIC of 254 pre-eclamptic women and 210 normotensive controls enrolled in three eligible case–control studies (mean UIC 164.4 µg/L (95% CI 45.1 to 283.6, p<0.01, I2 >50)). The overall proportions of pre-eclampsia among women with UIC <150 µg/L and UIC >150 µg/L in two cross-sectional studies were 203/214 and 67/247, respectively, with a pooled OR of 0.01 (95% CI 0 to 4.23, p=0.14, I2 >50) for pre-eclampsia among women with UIC >150 µg/L. The overall incidence of pre-eclampsia among women with UIC <150 µg/L and UIC >150 µg/L in two cohort studies was 6/1411 and 3/2478, respectively, with a pooled risk ratio of 2.85 (95% CI 0.42 to 20.05, p=0.09, I2 <25).ConclusionAlthough pre-eclamptic women seem to have lower UIC than normotensive pregnant women, the available data are insufficient to provide a conclusive answer on association of iodine deficiency with pre-eclampsia risk.PROSPERO registration numberCRD42018099427.

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Iodine deficiency in pregnant women in Sweden: a national cross-sectional study

European Journal of Nutrition ◽

10.1007/s00394-019-02102-5 ◽

2019 ◽

Vol 59 (6) ◽

pp. 2535-2545 ◽

Cited By ~ 4

Author(s):

Sofia Manousou ◽

Maria Andersson ◽

Robert Eggertsen ◽

Sandra Hunziker ◽

Lena Hulthén ◽

...

Keyword(s):

Pregnant Women ◽

Iodine Deficiency ◽

Geometric Mean ◽

Iodized Salt ◽

National Study ◽

Urinary Iodine Concentration ◽

Iodine Nutrition ◽

Cross Sectional ◽

Iodine Status ◽

Supplement Use

Abstract Purpose Voluntary salt iodization at 50 mg/kg salt ensures adequate iodine nutrition in Swedish school-aged children, but iodine status in pregnant women is uncertain. Methods We conducted a cross-sectional national study of 743 pregnant women, at median gestational age of 23 weeks (IQR 9, 38), recruited from maternal health care centers. We measured: urinary iodine concentration (UIC) and urinary creatinine concentration in spot urine samples; thyroglobulin (Tg), thyroid-stimulating hormone (TSH), and total thyroxine (tT4) on dried blood spots (DBS); and thyreoperoxidase antibodies in serum samples. Data on dietary supplement use were obtained, and women were classified as supplement users (consuming multivitamins containing ≥ 150 µg iodine/day) and non-supplement users (no supplements or < 150 µg iodine/day from supplements). Results Overall median UIC [bootstrapped 95% confidence interval (CI)] was 101 µg/L (95, 108; n = 737): 149 µg/L (132, 164) in supplement users (n = 253) and 85 µg/L (79, 92) in non-supplement users (n = 440) (p < 0.001). Overall geometric mean DBS-Tg (95% CI) was 22.1 μg/L (20.8, 23.5; n = 675) and the prevalence of elevated DBS-Tg was 19%. DBS-Tg was lower in supplement users (n = 229) than in non-supplement users (n = 405) (19.1 vs 24.4 μg/L, p < 0.001). DBS-TSH, DBS-tT4, and S-TPOab positivity did not differ between the two groups. Conclusions Pregnant women in Sweden have inadequate iodine nutrition. Women not taking iodine supplements containing ≥ 150 µg iodine/day are affected by mild iodine deficiency and are at higher risk for increased thyroid activity, while maintaining euthyroidism. Iodine intake should be improved in women both before and after conception by promotion of iodized salt instead of non-iodized salt. We urge regular monitoring of iodine status in the general Swedish population, as well as in risk groups.

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IODINE STATUS OF PREGNANT WOMEN RESIDING IN URBAN SLUMS IN DELHI

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i7.25002 ◽

2018 ◽

Vol 11 (7) ◽

pp. 506

Author(s):

Spriha Rao ◽

Gurudayal Singh Toteja ◽

Neena Bhatia ◽

Supriya Dwivedi ◽

Zaozianlungliu Gonmei ◽

...

Keyword(s):

Pregnant Women ◽

Urinary Iodine ◽

Urban Slums ◽

Iodized Salt ◽

Nutrition Status ◽

Urinary Iodine Concentration ◽

Iodine Nutrition ◽

Cross Sectional ◽

Iodine Status ◽

Salt Iodine

Objectives: The present study was carried out to determine the iodine nutrition status among pregnant women in slums of West Delhi.Methods: A community-based cross-sectional study was carried out among the third-trimester pregnant women residing in urban slums of West Delhi. Urinary iodine concentration was estimated using ammonium persulfate method, and salt iodine was estimated using iodometric titration.Results: Of the total 180 pregnant women, 70.6% were consuming adequately iodized salt (iodine levels ≥15 ppm). Median urinary iodine level for the pregnant women was 147.5 μg/L indicating iodine deficiency among this group. A total of 51.1% of women had urinary iodine levels <150 μg/L.Conclusion: Pregnant women belonging to slum community from Delhi have a suboptimal iodine status. Further, the proportion of women consuming iodized salt is less than the national average indicating the need to educate these women about the importance of iodine during pregnancy.

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Iodised salt contribution to iodine nutrition status of pregnant and lactating women

British Journal Of Nutrition ◽

10.1017/s0007114515001543 ◽

2015 ◽

Vol 114 (1) ◽

pp. 126-133 ◽

Cited By ~ 5

Author(s):

Haihong Zhang ◽

Shengmin Lv ◽

Zhenguo Mu ◽

Weihong Li ◽

Xia Zhang ◽

...

Keyword(s):

Pregnant Women ◽

Rural Areas ◽

Salt Intake ◽

Urinary Iodine ◽

Iodine Content ◽

Nutrition Status ◽

Iodine Nutrition ◽

Lactating Women ◽

Iodised Salt ◽

The Impact

Sufficient iodine intake by pregnant and lactating women is crucial to their offspring's cognitive development. The aim of the present study was to explore the impact of iodised salt intake on the iodine status of pregnant and lactating women. Thirty towns were selected from 211 towns in the rural areas of Shijiazhuang city using probability proportionate to size sampling in this cross-sectional survey. In each selected town, forty pregnant women and forty lactating women were randomly selected to contribute urine samples to determine iodine content. The median urinary iodine content (UIC) of 1200 pregnant women in all was 146 (interquartile range (IQR) 88–239) μg/l. The median UIC in the first, second and third trimesters were 166 (IQR 92–276) μg/l, 145 (IQR 83–248) μg/l and 134 (IQR 79–221) μg/l, respectively. The median UIC in the first trimester was significantly higher than that in the third trimester (P= 0·04). The median UIC of 1200 lactating women in all was 120 (IQR 66–195) μg/l. Their median UIC in every 4-week block was higher than the WHO criteria except in weeks 25–28 and weeks 33–36 of lactation. Pregnant women's median UIC did not correlate with median salt iodine (MSI) (P= 0·402); however, there was a linear correlation between MSI and the lactating women's median UIC (P= 0·007). Iodised salt failed to provide adequate iodine to pregnant women possibly due to limited intake of iodised salt during pregnancy, though it was found to provide adequate iodine to lactating women in the rural areas of Shijiazhuang city.

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Thyroglobulin as a marker of iodine nutrition status in the general population

Acta Endocrinologica ◽

10.1530/eje-09-0262 ◽

2009 ◽

Vol 161 (3) ◽

pp. 475-481 ◽

Cited By ~ 58

Author(s):

Pernille Vejbjerg ◽

Nils Knudsen ◽

Hans Perrild ◽

Peter Laurberg ◽

Allan Carlé ◽

...

Keyword(s):

Iodine Deficiency ◽

Age Groups ◽

Urinary Iodine ◽

Thyroid Volume ◽

Nutrition Status ◽

Iodine Nutrition ◽

Serum Thyroglobulin ◽

Cross Sectional ◽

Iodine Status ◽

Reference Limit

ObjectiveThe iodine status of a population is traditionally evaluated by either urinary iodine (UI) excretion or by some measure of thyroid volume and the prevalence of goitre. In this prospective study of a mandatory iodization programme, we aimed to evaluate serum thyroglobulin (Tg) as a marker of iodine status in the population.MethodsTwo identical cross-sectional studies were performed before (1997–1998,n=4649) and after (2004–2005,n=3570) the initiation of the Danish iodization programme in two areas with mild and moderate iodine deficiency. Serum Tg was measured from blood samples. Thyroid volume was measured by ultrasonography.ResultsBefore iodization, the median serum Tg was considerably higher in moderate than in mild iodine deficiency. Iodization led to a lower serum Tg in all examined age groups. The marked pre-iodization difference in Tg level between the regions was eliminated. The prevalence of Tg above the suggested reference limit (40 μg/l) decreased from 11.3 to 3.7% (P<0.0001). Using bootstrapping, we demonstrated a higher efficacy of Tg than of thyroid volume to show a difference between pre- and post-iodization values.ConclusionWe found serum Tg to be a suitable marker of iodine nutrition status in the population. The results may suggest that the Danish iodization programme has led to a sufficient iodine intake, even if the median UI excretion is still marginally low according to WHO criteria.

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The results of neonatal TSH screening do not agree with indicators of the optimal iodine status of pregnant women in the Republic of Georgia

Clinical and experimental thyroidology ◽

10.14341/ket9777 ◽

2018 ◽

Vol 14 (2) ◽

pp. 81-85 ◽

Cited By ~ 3

Author(s):

Nelli Barnabishvilli ◽

Gregory A. Gerasimov ◽

Teimuraz Azikuri

Keyword(s):

Iodine Deficiency ◽

Endemic Goiter ◽

Thyroid Stimulating Hormone ◽

Capital City ◽

Iodine Nutrition ◽

Iodine Status ◽

Significant Difference ◽

High Prevalence ◽

The Republic ◽

Tsh Levels

Background. Georgia historically was a country with moderate to severe iodine deficiency and high prevalence of endemic goiter. A representative countrywide iodine survey conducted in Georgia in 2017 confirmed optimal iodine nutrition of the population with median UIC 298 mcg/L in SAC and 211 mcg/L in PW. Aim. The aim of this study was to assess status of iodine nutrition of population in Georgia. Methods. The assesement based on the proportion of neonatal Thyroid-Stimulating Hormone (TSH) levels >5mIU/L from 2009 to 2015 and compare these data with the results of direct assessment of iodine status made during the 2017 national survey. Results. From 2009 to 2015 the proportion of newborns with TSH >20 mIU/L decreased threefold: from 0.45 to 0.15%. This trend was observed in all regions of the country with significant difference between the capital city and Western in Eastern parts of the country. There has been also significant reduction of the prevalence of TSH >5 mIU/L in Georgia from 4.46% in 2009 to 3.5% in 2015. However, only in Tbilisi the frequency of elevated TSH was below 3% – the cutoff level for adequate iodine nutrition. In other regions (Western and Eastern Georgia) prevalence of TSH >5 mIU/L was 3.8% and 4.4% respectively that could be falsely interpreted as mild iodine deficiency. Conclusions. Although neonatal TSH is useful to detect moderate to severe iodine deficiency, it should be cautiously recommended for the evaluation of iodine status in iodine sufficient to mildly iodine deficient regions.

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Assessment of Iodine Status among Pregnant Women and Neonates Using Neonatal Thyrotropin (TSH) in Mainland China after the Introduction of New Revised Universal Salt Iodisation (USI) in 2012: A Re-Emergence of Iodine Deficiency?

International Journal of Endocrinology ◽

10.1155/2019/3618169 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Hang Zhou ◽

Zheng Feei Ma ◽

Yiming Lu ◽

Binyu Pan ◽

Jian Shao ◽

...

Keyword(s):

Birth Weight ◽

Pregnant Women ◽

Iodine Deficiency ◽

Mainland China ◽

Cross Sectional Study ◽

Thyroid Status ◽

Iodine Nutrition ◽

Cross Sectional ◽

Normal Reference Range ◽

Iodine Status

Iodine deficiency during pregnancy can cause iodine deficiency disorders (IDD). However, it is unclear about iodine and thyroid status of Chinese pregnant women and neonates after the implementation of the revised universal salt iodisation (USI) level in 2012. Therefore, the aim of the cross-sectional study was to determine iodine nutrition and thyroid status among pregnant women and their neonates in China after the implementation of USI. Medical records of pregnant women and neonates in Northern Jiangsu People’s Hospital between January 2016 and December 2017 were reviewed and included. We included 3060 mother-and-newborn pairs in the study. Mean age of participants was 28.2 ± 4.1 years. TSH, FT3, and FT4 of participants were within normal reference range. The overall mean neonatal TSH, birth weight, and prevalence of low birth weight (LBW) were 4.86 ± 2.06 mIU/L, 3358 ± 455 g, and 3.2%, respectively. The prevalence of neonatal TSH values >5 mIU/L was 29.3%, suggesting iodine deficiency in the region. In conclusion, our results indicated iodine deficiency in the region, according to the neonatal TSH cutoff recommended by WHO/UNICEF/IGD. More efforts are urgently required to improve iodine status of pregnant women in the region in order to prevent a re-emergence of iodine deficiency.

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Iodine status and its determinants in subpopulation of pregnant women in rural Central India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180191 ◽

2018 ◽

Vol 7 (2) ◽

pp. 665

Author(s):

Surekha A. Tayade ◽

Shakuntala Chhabra

Keyword(s):

Family History ◽

High Risk ◽

Pregnant Women ◽

Iodine Deficiency ◽

Tertiary Care ◽

Central India ◽

Iodized Salt ◽

High Risk Population ◽

Iodine Status ◽

Rich Food

Background: There is an increased demand for iodine and thyroid hormones, in pregnancy starting from the early weeks of pregnancy suggesting that there may be a need for additional supplements of iodine in high risk population to prevent iodine deficiency and its associated disorders. Hence this study was undertaken to determine the iodine status and its determinants in a subpopulation of pregnant women from a rural area of Central India.Methods: A hospital based, cross-sectional, observational study was carried out among pregnant women seeking antenatal care at Kasturba Hospital of MGIMS, Sewagram, a rural tertiary care institute in central India. Information was collected about demographic variables, use of iodized salt, iodine rich food and goitrogens as part of diet and other determinants. Spot urine samples were obtained, and assessment of urine iodine concentration was done by using Sandell-Kolthoff reaction.Results: Among 250 pregnant women of first trimester, iodine deficiency (ID) was present in 11.8 %, of which 59.25% had mild deficiency, 33.33% moderate deficiency and 7.4% severe deficiency. More women with iodine deficiency were of higher age, had less formal education and belonged to lower middle and lower economic class. Higher number of women with iodine deficiency had family history of thyroid disorders compared to iodine sufficient (18.51% versus 5.58%), more iodine deficient commonly had goitrogens (cabbage, cauliflower, radish, sweet potato, soya etc) as part of their meals (77.77% versus 68.60%), lesser women with ID ate iodine rich food (fish, milk yoghurt, bread) (18.51% versus 68.60%) and fewer of them used iodized salt during food preparation (25.92% versus 69.95%) compared to iodine sufficient, with a significant difference.Conclusions: Iodine deficiency is prevalent in pregnant women in this geographic region of central India. Age, low socioeconomic status, lack of education, family history, low intake of iodized salt and iodine rich food and more consumption of goitrogenic food as part of diet are risk factors. Appropriate health education, promoting use of iodized salt, quality assurance of universal salt iodization by household survey and screening in high risk group is suggested.

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Iodine deficiency in pregnant women living in the South East of the UK: the influence of diet and nutritional supplements on iodine status

British Journal Of Nutrition ◽

10.1017/s0007114513004030 ◽

2014 ◽

Vol 111 (9) ◽

pp. 1622-1631 ◽

Cited By ~ 60

Author(s):

Sarah C. Bath ◽

Alan Walter ◽

Andrew Taylor ◽

John Wright ◽

Margaret P. Rayman

Keyword(s):

Pregnant Women ◽

Iodine Deficiency ◽

Urinary Iodine ◽

World Health ◽

The South ◽

Childbearing Age ◽

Iodine Status ◽

Supplement Use ◽

Iodine Excretion ◽

The Uk

Iodine is a key component of the thyroid hormones which are crucial for brain development. Adequate intake of iodine in pregnancy is important as in utero deficiency may have lifelong consequences for the offspring. Data on the iodine status of UK pregnant women are sparse, and there are no such data for pregnant women in the South East of the UK. A total of 100 pregnant women were recruited to a cross-sectional study carried out at the Royal Surrey County Hospital, Guildford, at their first-trimester visit for an ultrasound scan. The participants provided a spot-urine sample (for the measurement of urinary iodine concentration (UIC) and creatinine concentration) and 24 h iodine excretion was estimated from the urinary iodine:creatinine ratio. Women completed a general questionnaire and a FFQ. The median UIC (85·3 μg/l) indicated that the group was iodine deficient by World Health Organisation criteria. The median values of the iodine:creatinine ratio (122·9 μg/g) and of the estimated 24 h iodine excretion (151·2 μg/d) were also suggestive of iodine deficiency. UIC was significantly higher in women taking an iodine-containing prenatal supplement (n 42) than in those not taking such a supplement (P< 0·001). In the adjusted analyses, milk intake, maternal age and iodine-containing prenatal supplement use were positively associated with the estimated 24 h urinary iodine excretion. Our finding of iodine deficiency in these women gives cause for concern. We suggest that women of childbearing age and pregnant women should be given advice on how to improve their iodine status through dietary means. A national survey of iodine status in UK pregnant women is required.

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