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Minerals, trace elements, Vit. D and bone health

Iodine deficiency in pregnant women in Austria

Abstract

Background/Objectives:

In Austria, iodine deficiency has been considered to be eliminated owing to table salt fortification with iodine, but whether this also applies to pregnant women is unclear. Even mild iodine deficiency during gestation may lead to neurocognitive sequelae in the offspring.

Subjects/Methods:

This is a cross-sectional investigation of urinary iodine excretion in 246 pregnant women (first trimester n=2, second trimester n=53, third trimester n=191, gestational diabetes mellitus n=115, no gestational diabetes mellitus n=131). The iodine content of morning spot urine samples was determined using inductively coupled plasma mass spectrometry.

Results:

Pregnant women in the Vienna area had a median urinary iodine concentration (UIC) of 87 μg/l. Only 13.8% of the cohort were in the recommended range of 150–249 μg/l, whereas 21.5% had a UIC of 0–49 μg/l, 40.2% had a UIC of 50–99 μg/l and 19.5% had a UIC of 100–149 μg/l. In all, 4.9% had a UIC over 250 μg/l. A total of 137 women of foreign origin had a significantly higher iodine excretion compared with Austrian-born women. Maternal or gestational age had no influence on UIC. Although 79 women on iodine supplementation had a significantly higher iodine concentration compared with women without iodine supplementation (97.3 vs 80.1 μg/l, P=0,006), their UIC was below the recommended range, indicating that doses of 100–150 μg per day are not sufficient to normalize iodine excretion. Sodium and iodine concentrations in the urine were tightly correlated (R=0.539, n=61), suggesting that low intake of iodized salt might contribute to insufficient iodine supply.

Conclusions:

This study shows that pregnant women in the Vienna area have a potentially clinically significant iodine deficiency and that currently recommended doses of iodine supplementation may not be sufficient.

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References

  1. Berbel P, Obregón MJ, Bernal J, Escobar del Rey F . Morreale de Escobar G. Iodine supplementation during pregnancy: a public health challenge. Trends Endocrinol Metab 2007; 18: 338–343.

    CAS  Article  Google Scholar 

  2. Zimmermann MB . Iodine deficiency. Endocr Rev 2009; 30: 376–408.

    CAS  Article  Google Scholar 

  3. Zimmermann B . The role of iodine in human growth and development. Semin Cell Dev Biol 2011; 22: 645–652.

    CAS  Article  Google Scholar 

  4. World Health Organization United Nations Children's Fund, International Council for the Control of Iodine Deficiency Disorders, Assessment of iodine deficiency disorders and monitoring their elimination: A guide for programme managers. 3rd edition 2007.

  5. Williams GR . Neurodevelopmental and neurophysiological actions of thyroid hormone. J Neuroendocrinol 2008; 20: 784–794.

    CAS  Article  Google Scholar 

  6. Morreale de Escobar G, Obregon MJ, Escobar del Rey F . Role of thyroid hormone during early brain development. Eur J Endocrinol 2004; 151: U25–U37.

    CAS  Article  Google Scholar 

  7. Berbel P, Mestre JL, Santamaría A, Palazón I, Franco A, Graells M et al. Delayed neurobehavioral development in children born to pregnant women with mild hypothyroxinemia during the first month of gestation: the importance of early iodine supplementation. Thyroid 2009; 19: 511–519.

    CAS  Article  Google Scholar 

  8. Hynes KL, Otahal P, Hay I, Burgess JR . Mild iodine deficiency during pregnancy is associated with reduced educational outcomes in the offspring: 9-year follow-up of the gestational iodine cohort. J Clin Endocrinol Metab 2013; 98: 1954–1962.

    CAS  Article  Google Scholar 

  9. Bath SC, Steer CD, Golding J, Emmett P, Rayman MP . Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet 2013; 382: 331–337.

    CAS  Article  Google Scholar 

  10. Zimmermann MB . Nutrition: are mild maternal iodine deficiency and child IQ linked? Nat Rev Endocrinol 2013; 9: 505–506.

    CAS  Article  Google Scholar 

  11. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011; 21: 1081–1125.

    Article  Google Scholar 

  12. De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97: 2543–2565.

    CAS  Article  Google Scholar 

  13. Sager M . Mengen- und Spurenelemente in österreichischen Hühnereiern. Ernährung/Nutrition 2011; 35: 53–58.

    CAS  Google Scholar 

  14. Office of Dietary Supplements, National Institute of Health Dietary supplement fact sheet: Iodine. Available at http://ods.od.nih.gov/factsheets/Iodine-HealthProfessional/ Accessed February 2014.

  15. Sager M, Hobegger M . Contents of elements in raw milk from three regions in lower Austria. Ernährung/Nutrition 2013; 37: 277–290.

    CAS  Google Scholar 

  16. Bundesgesetz über den Verkehr mit Speisesalz (Speisesalzgesetz) - BGBl. Nr. 112/1963 and BGBl. Nr. 288/1990. https://www.ris.bka.gv.at/GeltendeFassung.wxe?Abfrage=Bundesnormen&Gesetzesnummer=10010311.

  17. Lind P, Klima G, Wakonig P, Wawschinek O, Eber O . [Urinary excretion of iodide and incidence of goiter in Styria—studies 20 years after the introduction of compulsory iodinated salt prophylaxis]. Acta Med Austriaca 1985; 12: 45–50.

    CAS  PubMed  Google Scholar 

  18. Gallowitsch HJ, Mikosch P, Kresnik E, Gomez I, Plöb J, Pipam W et al. [Thyroid volume and iodine supply of 6 to 17 year old students. Results 3 years after the introduction of increased iodized salt]. Nuklearmedizin 1994; 33: 235–238.

    CAS  Article  Google Scholar 

  19. Heinisch M, Kumnig G, Asböck D, Mikosch P, Gallowitsch HJ, Kresnik E et al. Goiter prevalence and urinary iodide excretion in a formerly iodine-deficient region after introduction of statutory iodization of common salt. Thyroid 2002; 12: 809–814.

    CAS  Article  Google Scholar 

  20. Zimmermann MB, Andersson M . Prevalence of iodine deficiency in Europe in 2010. Ann Endocrinol (Paris) 2011; 72: 164–166.

    CAS  Article  Google Scholar 

  21. Elmadfa I . Österr. Ernährungsbericht 2012; 1, Auflage: Wien, Austria.

    Google Scholar 

  22. Wagner B, Karup SB, Raber W, Schneider B, Nowotny P, Waldhäusl W et al. [Preventive iodine administration and iodine excretion in the Vienna area and in the forest quarter]. Wien Klin Wochenschr 1998; 110: 751–754.

    CAS  PubMed  Google Scholar 

  23. Azizi F, Aminorroya A, Hedayati M, Rezvanian H, Amini M, Mirmiran P . Urinary iodine excretion in pregnant women residing in areas with adequate iodine intake. Public Health Nutr 2003; 6: 95–98.

    CAS  Article  Google Scholar 

  24. Gowachirapant S, Winichagoon P, Wyss L, Tong B, Baumgartner J, Melse-Boonstra A et al. Urinary iodine concentrations indicate iodine deficiency in pregnant Thai women but iodine sufficiency in their school-aged children. J Nutr 2009; 139: 1169–1172.

    CAS  Article  Google Scholar 

  25. Oguz Kutlu A, Kara C . Iodine deficiency in pregnant women in the apparently iodine-sufficient capital city of Turkey. Clin Endocrinol 2012; 77: 615–620.

    CAS  Article  Google Scholar 

  26. Sager M . Microwave-assisted digestion of organic materials with KClO3/HNO3 for the analysis of trace metals and non metals. Anal Chem Indian J 2011; 10: 2.

    Google Scholar 

  27. Women in Austria 2011 (Registry census 2011) STATcube - Statistical database of Statistics Austria (database on the Internet) (accessed 29 July 2014). Available from http://statcube.at/superwebguest/login.do?guest=guest&db=deregz_rzpers.

  28. Elmadfa I, Meyer AL . Vitamins for the first 1000 days: preparing for life. Int J Vitam Nutr Res 2012; 82: 342–347.

    CAS  Article  Google Scholar 

  29. Charlton K, Yeatman H, Lucas C, Axford S, Gemming L, Houweling F et al. Poor knowledge and practices related to iodine nutrition during pregnancy and lactation in Australian women: pre- and post-iodine fortification. Nutrients 2012; 4: 1317–1327.

    CAS  Article  Google Scholar 

  30. Brantsæter AL, Abel MH, Haugen M, Meltzer HM . Risk of suboptimal iodine intake in pregnant norwegian women. Nutrients 2013; 5: 424–440.

    Article  Google Scholar 

  31. Gahche JJ, Bailey RL, Mirel LB, Dwyer JT . The prevalence of using iodine-containing supplements is low among reproductive-age women, NHANES 1999–2006. J Nutr 2013; 143: 872–877.

    CAS  Article  Google Scholar 

  32. Leung AM, Braverman LE, Pearce EN . A dietary iodine questionnaire: correlation with urinary iodine and food diaries. Thyroid 2007; 17: 755–762.

    CAS  Article  Google Scholar 

  33. Pedersen KM, Laurberg P, Iversen E, Knudsen PR, Gregersen HE, Rasmussen OS et al. Amelioration of some pregnancy-associated variations in thyroid function by iodine supplementation. J Clin Endocrinol Metab 1993; 77: 1078–1083.

    CAS  PubMed  Google Scholar 

  34. Liesenkötter KP, Göpel W, Bogner U, Stach B, Grüters A . Earliest prevention of endemic goiter by iodine supplementation during pregnancy. Eur J Endocrinol 1996; 134: 443–448.

    Article  Google Scholar 

  35. Caldwell KL, Pan Y, Mortensen ME, Makhmudov A, Merrill L, Moye J . Iodine status in pregnant women in the National Children's Study and in U.S. women (15-44 Years), National Health and Nutrition Examination Survey 2005-2010. Thyroid 2013; 23: 927–937.

    CAS  Article  Google Scholar 

  36. Bath SC, Rayman MP . Iodine deficiency in the UK: an overlooked cause of impaired neurodevelopment? Proc Nutr Soc 2013; 72: 226–235.

    CAS  Article  Google Scholar 

  37. Al-Attas OS, Al-Daghri NM, Alkharfy KM, Alokail MS, Al-Johani NJ, Abd-Alrahman SH et al. Urinary iodine is associated with insulin resistance in subjects with diabetes mellitus type 2. Exp Clin Endocrinol Diabetes 2012; 120: 618–622.

    CAS  Article  Google Scholar 

  38. Stilwell G, Reynolds PJ, Parameswaran V, Blizzard L, Greenaway TM, Burgess JR . The influence of gestational stage on urinary iodine excretion in pregnancy. J Clin Endocrinol Metab 2008; 93: 1737–1742.

    CAS  Article  Google Scholar 

  39. Ainy E, Ordookhani A, Hedayati M, Azizi F . Assessment of intertrimester and seasonal variations of urinary iodine concentration during pregnancy in an iodine-replete area. Clin Endocrinol 2007; 67: 577–581.

    CAS  Google Scholar 

  40. Smyth PP . Variation in iodine handling during normal pregnancy. Thyroid 1999; 9: 637–642.

    CAS  Article  Google Scholar 

  41. Mian C, Vitaliano P, Pozza D, Barollo S, Pitton M, Callegari G et al. Iodine status in pregnancy: role of dietary habits and geographical origin. Clin Endocrinol 2009; 70: 776–780.

    CAS  Article  Google Scholar 

  42. Sager M . Über die Elementzusammensetzung von in Österreich erhältlichen Fertiggerichten und Wurstwaren. Ernährung/Nutrition 2010; 34: 57–64.

    CAS  Google Scholar 

  43. Recommended iodine levels in salt and guidelines for monitoring their adequacy and effectiveness. WHO reference number: WHO/NUT/96.13 1996.

  44. WHO Guideline: Sodium Intake for Adults and Children. World Health Organization (WHO): Geneva, Switzerland, 2012.

  45. Whelton PK, Appel LJ, Sacco RL, Anderson CA, Antman EM, Campbell N et al. Sodium, blood pressure, and cardiovascular disease: further evidence supporting the American Heart Association sodium reduction recommendations. Circulation 2012; 126: 2880–2889.

    CAS  Article  Google Scholar 

  46. Tayie FA, Jourdan K . Hypertension, dietary salt restriction, and iodine deficiency among adults. Am J Hypertens 2010; 23: 1095–1102.

    CAS  Article  Google Scholar 

  47. Simpson FO, Thaler BI, Paulin JM, Phelan EL, Cooper GJ . Iodide excretion in a salt-restriction trial. N Z Med J 1984; 97: 890–893.

    CAS  PubMed  Google Scholar 

  48. Johner SA, Thamm M, Nöthlings U, Remer T . Iodine status in preschool children and evaluation of major dietary iodine sources: a German experience. Eur J Nutr 2012; 52: 1711–1719.

    Article  Google Scholar 

  49. Charlton KE, Jooste PL, Steyn K, Levitt NS, Ghosh A . A lowered salt intake does not compromise iodine status in Cape Town, South Africa, where salt iodization is mandatory. Nutrition 2013; 29: 630–634.

    CAS  Article  Google Scholar 

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Correspondence to A Gessl.

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Lindorfer, H., Krebs, M., Kautzky-Willer, A. et al. Iodine deficiency in pregnant women in Austria. Eur J Clin Nutr 69, 349–354 (2015). https://doi.org/10.1038/ejcn.2014.253

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