Iodine status in pregnant women in northern Spain. Effect of iodised salt and iodine supplements on thyroid function.

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.

TSH neonatal como marcador del estado de nutrición de yodo. Influencia de la yoduria y la función tiroidea maternas sobre la TSH neonatal / Neonatal TSH as a marker of iodine nutrition status. Effect of maternal ioduria and thyroid function on neonatal TSH

Introducción: La TSH neonatal (TSHn) es un marcador de nutrición de yodo en la población. La OMS relaciona una prevalencia<3% de TSHn>5mUI/L, obtenida a partir de las 72h del nacimiento, con un adecuado estado nutricional de yodo. El objetivo de este estudio es conocer la prevalencia de TSHn>5mUI/L en una población yodosuficiente y su relación con factores maternos, neonatales y obstétricos. Materiales y métodos: Se reclutaron 243 gestantes entre mayo-junio de 2017 en nuestra área sanitaria. Se realizó un cuestionario sobre consumo de yodo y determinación de yoduria, función y autoinmunidad tiroideas en el primer trimestre de gestación. Se analizó la TSHn entre 48-72h del nacimiento, así como otros factores obstétricos y neonatales. Resultados: La TSHn media fue 2,43±1,68mUI/L, con un 7,8% de neonatos con TSHn>5mUI/L. La TSHn más elevada pertenecía a los neonatos de madres con yodurias insuficientes (p=0,021) o con TSH>2,5mUI/L, tanto en autoinmunidad tiroidea negativa (p=0,049) como positiva (p=0,006). La yoduria materna<150μg/L fue un factor de riesgo de TSHn>5mUI/L (3,70 [1,06-14,60], p=0,046), mientras que el peso neonatal ≥2500g fue un factor protector (0,14 [0,02-1,00], p=0,038). Conclusiones: La prevalencia de TSHn>5mUI/L en nuestra área sanitaria fue elevada, según las recomendaciones de la OMS. Se asoció el déficit de yodo materno con mayor riesgo de TSHn>5mUI/L. Dado que en la actualidad la determinación de la TSHn se realiza antes de las 72h del nacimiento, precisamos de nuevos puntos de corte para continuar empleando la TSHn como marcador de nutrición de yodo. (AU)

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 5mIU/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 5mIU/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 (1.68mIU/L), with 7.8% of neonates having levels greater than 5mIU/L. The highest nTSH levels corresponded to neonates of mothers with insufficient ioduria (p=.021) or TSH levels greater than 2.5mIU/L, in both the case of negative (p=0.049) and positive (p=0.006) thyroid autoimmunity results. Maternal ioduria greater than 150μg/L was a risk factor for nTSH levels greater than 5mIU/L (3.70 [1.06–14.60]; p=0.046), while a neonatal weight of 2500g or greater was a protective factor (0.14 [0.02–1.00]; p=0.038). Conclusions: The prevalence of nTSH levels greater than 5mIU/L in our health area was high based on the WHO recommendations. Maternal iodine deficiency was associated with a higher risk of nTSH levels less than 5mIU/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. (AU)

Neonatal TSH as a marker of iodine nutrition status. Effect of maternal ioduria and thyroid function on neonatal TSH.

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.

Incidence, prevalence and risk factors related to anxiety symptoms during pregnancy / Incidencia, prevalencia y factores de riesgo relacionados con los síntomas de ansiedad durante el embarazo

BACKGROUND: Symptoms of anxiety are one of the most prevalent emotional responses in women during their reproductive phase and especially during pregnancy. Objective: Estimate the incidence and prevalence of anxiety throughout the three trimesters of pregnancy in addition to studying the possible risk factors associated with anxiety symptoms. Method: A sample of 385 pregnant women participated in a longitudinal study in which the GAD-7 questionnaire was used. Results: Anxiety prevalence was 19.5% in the first trimester. In the second trimester, it was 16.8%, with an incidence of 0.048%. In the third trimester, it was 17.2%, with an incidence of 0.068%. The following predictive factors of anxiety symptoms were identified: being a smoker, presence of previous illness and changes in social relationships. Conclusions: High incidence and prevalence of anxiety symptoms occur during pregnancy; consequently, applicable preventive policies should be developed

ANTECEDENTES: Los síntomas de ansiedad son una de las respuestas emocionales más prevalentes en las mujeres durante su fase reproductiva y especialmente en el embarazo. Objetivo: estimar la incidencia y prevalencia de la ansiedad a lo largo de los tres trimestres del embarazo además de estudiar los posibles factores de riesgo asociados a los síntomas de ansiedad. Método: una muestra de 385 gestantes participaron en un estudio longitudinal en el que se utilizó el cuestionario GAD-7. Resultados: la prevalencia fue de 19,5% en el primer trimestre. En el segundo trimestre fue de 16,8%, y una incidencia de 0.048%. En el tercer trimestre fue de 17,2%, y la incidencia de 0.068%. Como factores predictores de los síntomas de ansiedad se han encontrado: ser fumadora, la presencia de enfermedades previas y cambios en las relaciones sociales. Conclusiones: durante el embarazo aparecen unas altas tasas de incidencia y prevalencia en los síntomas de ansiedad, por lo que se deberían desarrollar políticas preventivas al respecto

Resultados perinatales en función de la dosis de betametasona administrada en gestantes / Perinatal outcomes depending on the doses of betamethasone administered in pregnant women

Objetivos: Evaluar los resultados perinatales entre diferentes dosis de corticoides antenatales. Sujetos y métodos: Estudio retrospectivo de61 gestaciones únicas con amenaza de parto prematuro, sin otra patología asociada, y con al menos una dosis estándar de betametasona por vía intramuscular (2 dosis de 12 mg/24 h). Dos grupos de estudio: grupo 1: dosis estándar, y grupo 2: una o más dosis adicionales semanales de 12 mg de betametasona. Variables maternas: semanas de gestación al inicio del tratamiento corticoideo, semanas al parto, tipo de parto, patología puerperal, entre otras; variables neonatales: sexo, índice de Apgar, peso, talla, perímetro cefálico y patología neonatal. Se realizó un estudio descriptivo y comparativo de ambos grupos. Resultados: No hubo diferencias estadísticamente significativas en los grupos. Sin embargo, se registraron más casos de displasia broncopulmonar(p = 0,09) en el grupo 1.Conclusiones: La repetición semanal de las dosis de corticoides no mejora los resultados perinatales ni asocia efectos adversos (AU)

Objectives: To evaluate perinatal outcomes between different doses of antenatal corticosteroids.Subjects and methods: Retrospective study of 61single pregnancies at risk of premature birth, withn o other associated pathology and with at least one standard dose of intramuscular betamethasone (two doses of 12 mg/24h). There were two study groups: Group 1: standard dose, and Group 2: one or more additional weekly doses of 12 mg. Maternal variables: gestational weeks at the beginning of steroid treatment, weeks at delivery, type of birth, puerperal pathology; neonatal variables: sex, Apgar score, weight, height and cephalic perimeter at birth, and neonatal pathology. We performed a descriptive and comparative study on both groups. Results: No statistically significant differences were found between the groups. However, there were more cases of bronchopulmonary dysplasia (P=.09) in group 1.Conclusions: Repeated weekly doses of corticosteroids do not improve perinatal outcomes and are not associated with adverse effects (AU)