Iodine supply of pregnant women in the Czech Republic

Česká verzia

Authors: Radovan Bílek ¹; Nataša Kaňová ¹; Veronika Mindžáková ²; David Neumann ³; Jan Jiskra ⁴; Lydie Ryšavá ⁵; Václav Zamrazil ¹
Authors place of work: Endokrinologický ústav, Praha ¹; Gynekologicko-porodnické oddělené Oblastní nemocnice Mladá Boleslav, a. s. ²; Dětská klinika LF UK a FN Hradec Králové ³; III. interní klinika 1. LF UK a VFN v Praze ⁴; Meziresortní komise pro řešení jodového deficitu při Státním zdravotním ústavu, Praha ⁵
Published in the journal: Vnitř Lék 2016; 62(Suppl 3): 10-16
Category: Original Contributions

Summary

Introduction:
Iodine deficiency is a global public health problem which is particularly noticeable in pregnant or breastfeeding women and their children. Even mild iodine deficiency during pregnancy can lead to damage to the developing brain and thus affecting the fetus intelligence, his cognitive and neurological function, embryogenesis and growth.

Patients:
In the period 2010–2015 was determined by spectrophotometry at the Institute of Endocrinology the basal urinary iodine in 532 pregnant women at the age of 32 ± 5 (18–44) years, which came from Prague, Hradec Kralove and Mlada Boleslav. It was located 349 women in the first trimester, 112 in the second trimester, and 71 women in the third trimester. In the monitoring of pregnant women in the first trimester 218 basal urine samples of women were determined by mass spectrometry with inductively coupled plasma (ICP MS) in The National Institute of Public Health (NIPH). Women came from the 6 areas in the Czech Republic. Development of urinary iodine in the general population in the period 1994–2015 was observed in patients who underwent Institute of Endocrinology and from population studies conducted in 7 regions of the Czech Republic. It performed 52 648 spectrophotometric analysis of urinary iodine in the general population.

Methods:
Urinary iodine was determined by alkali melting of urine samples, followed by spectrophotometric determination of iodine in the form of iodide using the Sandell-Kolthoff reaction in the Institute of Endocrinology or determination was performed by ICP-MS in the laboratory of NIPH.

Results:
On average, only 21.8 % of pregnant women had urinary iodine values determined by spectrophotometry higher than 150 μg/L. The results of iodine nutrition of pregnant women in the first trimester analyzed using ICP-MS are better, but even so, only 50.5 % of pregnant women have urinary iodine higher than 150 μg/L.

Conclusion:
The results of iodine nutrition of pregnant women are alarming, on average, only 30 % of the total of 750 examined women have urinary iodine values greater than 150 μg/L and therefore meet the requirements of the WHO for pregnant women. Our results, however, show that iodine deficiency is not major public health problem in the general population.

Key words:
ICP-MS – pregnant women – Sandell-Kolthoff reaction – urinary iodine

Zdroje

1. Iodine status worldwide. In: de Benoist B, Andersson BM, Egli I et al (eds). WHO Global Database on Iodine Deficiency. Department of Nutrition for Health and Development: Geneva 2004. ISBN 92 4 159200 1. Dostupné z DOI: http://apps.who.int/iris/bitstream/10665/43010/1/9241592001.pdf.

2. Zimmermann MB. The Importance of Adequate Iodine during Pregnancy and Infancy. World Rev Nutr Diet 2016; 115: 118–124. Dostupné z DOI: <http://dx.doi.org/10.1159/000442078>.

3. Alvarez-Pedrerol M, Guxens M, Mendez M et al. Iodine levels and thyroid hormones in healthy pregnant women and birth weight of their offspring. Eur J Endocrinol 2009; 160(3): 423–429. Dostupné z DOI: <http://dx.doi.org/10.1530/EJE-08–0716>.

4. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers. 3rd ed. WHO Press: Geneva 2007. ISBN 978 92 4 159582 7. Dostupné z DOI: http://apps.who.int/iris/bitstream/10665/43781/1/9789241595827_eng.pdf.

5. Bergman A, Heindel JJ, Jobling S et al (eds). [WHO-UNEP]. State of the Science of Endocrine Disrupting Chemicals – 2012. United Nations Environment Programme and the World Health Organization. WHO Press: Geneva 2013. Dostupné z DOI: http://www.unep.org/pdf/WHO_HSE_PHE_IHE_2013.1_eng.pdf.

6. McGrogan A, Seaman HE, Wright JW et al. The incidence of autoimmune thyroid disease: a systematic review of the literature. Clin Endocrinol (Oxf) 2008; 69(5): 687–696. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1365–2265.2008.03338.x>.

7. Lazarus JH. Iodine status in Europe in 2014. Eur Thyroid J 2014; 3(1): 3–6. Dostupné z DOI: <http://dx.doi.org/10.1159/000358873>.

8. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers. 2nd ed. Geneva 2001. Dostupné z DOI: http://apps.who.int/iris/bitstream/10665/61278/1/WHO_NHD_01.1.pdf.

9. Ghirri P, Lunardi S, Boldrini A. Iodine supplementation in the newborn. Nutrients 2014; 6(1): 382–390. Dostupné z DOI: <http://dx.doi.org/10.3390/nu6010382>.

10. The Thyroid Gland. In: De Groot LJ, Jameson JL (eds): Endocrinology Adult and Pediatric: Reproductive Endocrinology. 6th ed. Saunders: 2013. ISBN 978–0323240604.

11. Patel J, Landers K, Li H et al. Thyroid hormones and fetal neurological development. J Endocrinol 2011; 209(1): 1–8. Dostupné z DOI: <http://dx.doi.org/10.1530/JOE-10–0444>.

12. Brucker-Davis F, Panaia-Ferrari P, Gal J et al. Iodine Supplementation throughout Pregnancy Does Not Prevent the Drop in FT4 in the Second and Third Trimesters in Women with Normal Initial Thyroid Function. Eur Thyroid J 2013; 2(3): 187–194. Dostupné z DOI: <http://dx.doi.org/10.1159/000350882>.

13. Glinoer D, de Nayer P, Bourdoux P et al. Regulation of maternal thyroid during pregnancy. J Clin Endocrinol Metab 1990; 71(2): 276–287.

14. Andersen SL, Laurberg P. Iodine Supplementation in Pregnancy and the Dilemma of Ambiguous Recommendations. Eur Thyroid J 2016; 5(1): 35–43. Dostupné z DOI: <http://dx.doi.org/10.1159/000444254>.

15. Stagnaro-Green A, Abalovich M, Alexander E et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011; 21(10): 1081–1125. Dostupné z DOI: <http://dx.doi.org/10.1089/thy.2011.0087>.

16. Zimmermann MB. Assessing iodine status and monitoring progress of iodized salt programs. J Nutr 2004; 134(7): 1673–1677.

17. Delange F, de Benoist B, Pretell E et al. Iodine deficiency in the world: where do we stand at the turn of the century? Thyroid 2001; 11(5): 437–447.

18. Bílek R, Zamrazil V. Thyroglobulin as an indicator of iodine intake. In: Preedy VR, Burrow GN, Watson R (eds). Comprehensive handbook on iodine: Nutritional, Biochemical, Pathological and Therapeutic Aspects. Academic Press: Oxford 2009: 55–64. ISBN 978–0123741356.

19. Bílek R, Cerovská J, Zamrazil V. The relationship between iodine intake and serum thyroglobulin in the general population. Physiol Res 2015; 64(3): 345–353.

20. Bílek R, Čeřovská J. Jod a tyreoidální hormony. Vnitř Lék 2006; 52(10): 881–886.

21. Eltom A, Elnagar B, Elbagir M et al. Thyroglobulin in serum as an indicator of iodine status during pregnancy. Scand J Clin Lab Invest 2000; 60(1): 1–7.

22. Nohr SB, Laurberg P. Opposite variations in maternal and neonatal thyroid function induced by iodine supplementation during pregnancy. J Clin Endocrinol Metab 2000; 85(2): 623–627.

23. Ma ZF, Skeaff SA. Thyroglobulin as a biomarker of iodine deficiency: a review. Thyroid 2014; 24(8): 1195–1209. Dostupné z DOI: <http://dx.doi.org/10.1089/thy.2014.0052>.

24. Jiskra J, Fait T, Bílek R et al. Mild iodine deficiency in women after spontaneous abortions living in an iodine-sufficient area of Czech Republic: prevalence and impact on reproductive health. Clin Endocrinol (Oxf) 2014; 80(3): 452–458. Dostupné z DOI: <http://dx.doi.org/10.1111/cen.12298>.

25. Bilek R, Bednar J, Zamrazil V. Spectrophotometric determination of urinary iodine by the Sandell-Kolthoff reaction subsequent to dry alkaline ashing: Results from the Czech Republic in the period 1994–2002. Clin Chem Lab Med 2005; 43(6): 573–850.

26. Zamrazil V, Bilek R, Cerovska J et al. The elimination of iodine deficiency in the Czech Republic: the steps toward success. Thyroid 2004; 14(1): 49–56.

27. Límanová Z. Thyroid gland and pregnancy – summary of important findings. Vnitř Lék 2015; 61(10): 862–867.

28. Zygmunt A, Lewinski A. Iodine prophylaxis in pregnant women in Poland – where we are? (update 2015). Thyroid Res 2015; 8: 17. Dostupné z DOI: <http://dx.doi.org/10.1186/s13044–015–0029-z>.

29. Lindorfer H, Krebs M, Kautzky-Willer A et al. Iodine deficiency in pregnant women in Austria. Eur J Clin Nut 2015; 69(3): 349–354. Dostupné z DOI: <http://dx.doi.org/10.1038/ejcn.2014.253>.

30. Bühling KJ, Schaff J, Bertram H et al. Supply of iodine during pregnancy-an inventory in Berlin, Germany. Z Geburtshilfe Neonatol 2003; 207(1): 12–16.

31. Tajtakova M, Capova J, Bires J et al. Thyroid volume, urinary and milk iodine in mothers after delivery and their newborns in iodine-replete country. Endocr Regul 1999; 33(1): 9–15.

32. Raverot V, Bournaud C, Sassolas G et al. Pregnant French women living in the Lyon area are iodine deficient and have elevated serum thyroglobulin concentrations. Thyroid 2012; 22(5): 522–528. Dostupné z DOI: <http://dx.doi.org/10.1089/thy.2011.0184>.

33. Combet E, Bouga M, Pan B et al. Iodine and pregnancy – a UK cross-sectional survey of dietary intake, knowledge and awareness. Br J Nutr 2015; 114(1): 108–117. Dostupné z DOI: <http://dx.doi.org/10.1017/S0007114515001464>.

34. Granfors M, Andersson M, Stinca S et al. Iodine deficiency in a study population of pregnant women in Sweden. Acta Obstet Gynecol Scand 2015; 94(11): 1168–1174. Dostupné z DOI: <http://dx.doi.org/10.1111/aogs.12713>.

35. Dominguez I, Reviriego S, Rojo-Martinez G et al. Iodine deficiency and thyroid function in healthy pregnant women. Med Clin (Barc) 2004; 122(12): 449–453.

36. Leung AM, Pearce EN, Braverman LE et al. AAP recommendations on iodine nutrition during pregnancy and lactation. Pediatrics 2014; 134(4): e1282. Dostupné z DOI: <http://dx.doi.org/10.1542/peds.2014–2111A>.

37. Rogan WJ, Paulson JA, Baum C et al. [Council on Environmental Health]. Iodine deficiency, pollutant chemicals, and the thyroid: new information on an old problem. Pediatrics 2014; 133(6): 1163–1166. Dostupné z DOI: <http://dx.doi.org/10.1542/peds.2014–0900>.

38. Nishiyama S, Mikeda T, Okada T et al. Transient hypothyroidism or persistent hyperthyrotropinemia in neonates born to mothers with excessive iodine intake. Thyroid 2004; 14(12): 1077–1083.

39. Fuse Y, Shishiba Y, Irie M. Gestational changes of thyroid function and urinary iodine in thyroid antibody-negative Japanese women. Endocr J 2013; 60(9): 1095–1106. Erratum in Endocr J 2014; 61(7): 743.

40. Völzke H, Caron P, Dahl L et al. Ensuring Effective Prevention of Iodine Deficiency Disorders. Thyroid 2016; 26(2): 189–196. Dostupné z DOI: <http://dx.doi.org/10.1089/thy.2015.0543>.