Schistosomiasis screening in non-endemic countries from a cost perspective: Knowledge gaps and research priorities. The case of African long-term residents in a Metropolitan Area, Spain.

BACKGROUND: Imported schistosomiasis is an emerging issue in European countries as a result of growing global migration from schistosomiasis-endemic countries, mainly in sub-Saharan Africa. Undetected infection may lead to serious long-term complications with an associated high cost for public healthcare systems especially among long-term migrants. OBJECTIVE: To evaluate from a health economics perspective the introduction of schistosomiasis screening programs in non-endemic countries with high prevalence of long-term migrants. METHODOLOGY: We calculated the costs associated with three approaches-presumptive treatment, test-and-treat and watchful waiting-under different scenarios of prevalence, treatment efficacy and the cost of care resulting from long-term morbidity. Costs were estimated for our study area, in which there are reported to reside 74,000 individuals who have been exposed to the infection. Additionally, we methodically reviewed the potential factors that could affect the cost/benefit ratio of a schistosomiasis screening program and need therefore to be ascertained. RESULTS: Assuming a 24% prevalence of schistosomiasis in the exposed population and 100% treatment efficacy, the estimated associated cost per infected person of a watchful waiting strategy would be €2,424, that of a presumptive treatment strategy would be €970 and that of a test-and-treat strategy would be €360. The difference in averted costs between test-and-treat and watchful waiting strategies ranges from nearly €60 million in scenarios of high prevalence and treatment efficacy, to a neutral costs ratio when these parameters are halved. However, there are important gaps in our understanding of issues such as the efficacy of treatment in infected long-term residents, the natural history of schistosomiasis in long-term migrants and the feasibility of screening programs. CONCLUSION: Our results support the roll-out of a schistosomiasis screening program based on a test-and-treat strategy from a health economics perspective under the most likely projected scenarios, but important knowledge gaps should be addressed for a more accurate estimations among long-term migrants.

Congenital Cytomegalovirus Awareness and Knowledge among Health Professionals and Pregnant Women: An Action towards Prevention.

INTRODUCTION: Cytomegalovirus (CMV) is a major cause of childhood disabilities, and consensus recommendations emphasize the importance of hygienic measures to reduce perinatal infection. Our study aimed to evaluate the level of awareness about CMV among health professionals and pregnant women. METHODS: We submitted a 20-item online survey regarding CMV perinatal infection to all obstetricians and midwives in Catalonia (Spain) and a 7-item lay version of the questionnaire to 700 pregnant women. Levels of knowledge were compared among groups. RESULTS: Of the 1,449 health professionals approached, 338 surveys were answered. 72% of professionals considered CMV a relevant problem. 47% of obstetricians and 28% of midwives (p ≤ 0.001) routinely informed pregnant women, and less than half knew the risk of fetal transmission. We observed significant differences in knowledge between obstetricians and midwives concerning the risks of recurrent infections, risk of transmission, and risk of severe infection (60.7% vs. 45.6%, p = 0.006 and 50.6% vs. 22.5%, p ≤ 0.001); and regarding maternal and neonatal symptoms and newborn sequelae (23% vs. 8.8%, p ≤ 0.001). Of the 700 women approached, we obtained a response rate of 72%. Only 23% had previously heard about CMV, 22% identified transmission routes, and 15% preventive measures. Compared to women without risk factors for CMV infection, women at greater risk had heard more about CMV (mothers of children <3 years: 36% vs. 20%, p < 0.001; occupational exposure: 43% vs. 20%, p ≤ 0.001) and had received more information (mothers of children <3 years: 18% vs. 9.5%, p ≤ 0.001; occupational exposure: 23% vs. 9.3%, p = 0.001). CONCLUSION: Health care professionals have limited knowledge about CMV and may fail to enforce preventive measures. While pregnant women have limited awareness about CMV infection, they recognize the need for information. Health campaigns should be promoted to enhance awareness about this perinatal infection.

Impact of Dietary Habit, Iodine Supplementation and Smoking Habit on Urinary Iodine Concentration During Pregnancy in a Catalonia Population.

(1) Background: The nutritional status of women during pregnancy can have a considerable effect on maternal and fetal health, and on the perinatal outcome. Aim: to assess the changes occurring in dietary iodine intake, potassium iodide supplementation, and smoking habit, and the impact of these changes on the urinary iodine concentration (UIC) during pregnancy in a population of women in Catalonia (Spain). (2) Methods: Between 2009-2011, an observational study included a cohort of women whose pregnancies were monitored in the public health system in the Central and North Metropolitan areas of Catalonia. Women received individual educational counseling, a dietary questionnaire was completed, and a urine sample was collected for iodine determination at each trimester visit. (3) Results: 633 (67.9%) women answered the questionnaire at all 3 visits. The percentage of women with a desirable UIC (≥150 µg/L) increased from the first to the second trimester and remained stable in the third (57.3%, 68.9%, 68%; p < 0.001). Analysis of the relationship between UIC≥150 µg/L and the women's dietary habits showed that the percentage with UIC ≥150 µg/L increased with greater consumption of milk in the first trimester, and the same was true for iodized salt use in all three trimesters and iodine supplementation in all three. (4) Conclusion: During pregnancy, increased intake of milk, iodized salt, and iodine supplements were associated with an increase in the UIC.

Tipos de lactancia materna y factores que influyen en su abandono hasta los 6 meses. Estudio LACTEM / Types of breastfeeding and reasons that influence to stop it before 6 months. LACTEM Study

Objetivo: Conocer la evolución de la lactancia materna (LM) y la lactancia materna exclusiva (LME) desde el nacimiento hasta los 6 meses de edad. Identificar las principales dificultades, las causas de abandono y las expectativas de las usuarias sobre la lactancia. Material y métodos: Estudio observacional, de seguimiento longitudinal de una cohorte de madres/hijos desde las 35 semanas de embarazo, el puerperio temprano y tardío, y hasta los 6 meses de vida en el Área Metropolitana Norte de Barcelona. Se realizó un seguimiento final de 541 sujetos. Los datos fueron recogidos por las matronas a través de un cuestionario específico. Se recogen los tipos de lactancia definidos por la Organización Mundial de la Salud, las dificultades, las causas de abandono y la intención de duración de ésta. Resultados: Al alta, la LM y la LME fueron del 94,8 y el 75,3%, respectivamente, y a los 6 meses del 63,3 y 16,8%. Los accesorios (chupetes, tetinas, pezoneras) son los principales elementos que dificultan la lactancia (20,2%). Las principales causas de abandono fueron la sensación subjetiva de hambre en el niño (35%) y de hipogalactia (22,8%). El 95% de las madres manifestaron la voluntad de iniciar la lactancia y una duración de ésta mayor a 1 año. Conclusiones: Por primera vez disponemos de información relativa a la LME a los 6 meses en nuestro territorio, que pone de manifiesto la necesidad de nuevas estrategias de promoción de la lactancia que permitan aumentar la LME, dirigidas a las causas evitables de destete, así como programas de información, asesoramiento, apoyo y seguimiento, antes y después del parto, para evitar destetes precoces por causas evitables y no deseados por las madres

Objective: To understand the current evolution of de breastfeeding (BF) and exclusive breastfeeding (EBF) from birth to 6 months of age. To identify the main difficulties and causes for abandonment. Methodology: Longitudinal, observational study of a cohort of mothers/children from the Barcelona's Northern Metropolitan Area, from the 35th gestation weeks, puerperium until at 6 months of age. Final follow-up of 541 subjects. The data was collected by midwifes through a specific questionnaire. The types of lactation defined by the WHO, difficulties, causes of abandonment and the intention of its duration are listed. Results: At discharge BF and EBF were 94.8 and 75.3%, respectively, and at 6 month 63.3 and 16.8%. Accessories (pacifiers, teats, liners) are the biggest obstacle (20.2%). The main causes for abandonment were the child's subjective sensation of hungry (35%) and the subjective sensation of hypogalactia (22.8%). 95% of the mothers expressed their willingness to start breastfeeding and its duration was greater than one year. Conclusions: For the first time we have relative information on EBF at 6 months in our territory. New strategies for the promotion of breastfeeding are needed to allow increasing EBF which should be directed at avoidable causes of weaning. Breastfeeding information, good advice and follow-up and support programs, before and after delivery, to prevent early weaning unwanted by mothers and for avoidable causes

Iodine nutritional status of women in their first trimester of pregnancy in Catalonia.

BACKGROUND: Sufficient iodine intake is needed during pregnancy to ensure proper fetal development. The iodine levels of women in their first trimester of pregnancy in Catalonia are currently unknown. This data would help to determine whether our public health services should establish recommendations or interventions in this line. The aim of this study was to investigate the iodine nutritional status, prevalence of urinary iodine <150 µg/L, and tobacco use in the first trimester of pregnancy in our setting. METHODS: Cross-sectional study. Data were collected during 2008-2009 from women in their first trimester at the primary care centers of the province of Barcelona (Spain). Pregnant women included in the study completed a questionnaire on eating habits and underwent urinary iodine concentration (UIC) assessment. RESULTS: Nine hundred forty five women completed the dietary questionnaire and urinary iodine testing. Median UIC was 172 µg/L, with 407 participants (43.1%) showing levels <150 µg/L. On multivariate logistic regression analysis, intake of 1-2 glasses of milk per day, OR = 0.636 95% CI (0.45-0.90) or >2 glasses, OR = 0.593 95% CI (0.37-0.95); iodized salt consumption, OR = 0.678 95% CI (0.51-0. 90); and use of iodine supplementation, OR = 0.410 95% CI (0.31-0.54), protected against the risk of UIC <150 µg/L. Simultaneous consumption of iodized salt and milk (≥1 glass/day) showed a larger protective effect: OR = 0.427, 95% CI (0.31-0.54). CONCLUSION: The median UIC of the pregnant women surveyed indicated an acceptable iodine nutritional status according to the criteria established by the WHO and ICCIDD. The risk of urinary iodine <150 µg/L decreased with simultaneous consumption of milk and iodized salt, similar to the decrease seen with iodine supplementation.

Adherencia y cumplimiento del método anticonceptivo hormonal oral / Adherence and compliance of oral contraceptive pill

OBJETIVO: Identificar los factores relacionados con la adherencia y el cumplimiento de las mujeres con los anticonceptivos hormonales orales (ACO). METODOLOGÍA: Revisión bibliográfica. Se realizó una búsqueda en las bases de datos PubMed, CINAHL, Cochrane Library, MEDES y ENFISPO en los últimos 10 años. RESULTADOS: Se seleccionaron un total de 35 artículos originales y una revisión bibliográfica. Los factores que mejoran el cumplimiento de los ACO son los conocimientos que tiene la mujer sobre la píldora, iniciar el método de forma inmediata y el apoyo de la pareja. Los factores que influyen en la adherencia son el coste de los ACO, la falta de conocimientos ante los olvidos y la práctica de descansos de la píldora. CONCLUSIONES: El consejo contraceptivo debe ser individualizado, teniendo en cuenta los factores que afectan a la adherencia y el cumplimiento

AIM: To identify the factors related with the adherence and compliance of women that use the oral contraceptives (OC). METHODOLOGY: Literature review. A search in PubMed, CINAHL, Cochrane Library, MEDES, and ENFISPO databases has been performed in the last 10 years. RESULTS: A total number of 35 original articles and a review were selected. The factors which improve the compliance of OC are the knowledge of women about the pill, "the quick start" contraceptive method and the partner support. The highlighted factors which concern the adherence are the OC cost, the shortage of knowledge facing oversights and the resting periods of pill. CONCLUSIONS: The contraceptive counselling must be personalized considering the factors which concern the compliance and adherence

El cribado del cáncer de cuello de útero en el Sistema Público de Salud de Cataluña. Evaluación y seguimiento durante el período 2006-2012 / Cervical cancer screening in the public health system of Catalonia (Spain). Evaluation and follow-up between 2006 and 2012

La evaluación del cribado de cáncer de cuello uterino en el sistema público de salud de Cataluña ha identificado, en mujeres de 25-65 años, una cobertura citológica a 3 años del 40,8%; un intervalo entre citologías de 2,4 años y una pérdida de seguimiento del 50% a 3 años. La introducción de la prueba de detección del virus del papiloma humano en el seguimiento de mujeres con resultados citológicos de atipias intraepiteliales de significado indeterminado y como adyuvante a la citología en mujeres con una historia de cribado inadecuada facilita el manejo y detección de las mujeres en riesgo de desarrollar una neoplasia intraepitelial cervical de grado 2 o peor (CIN2 + ). La prueba de detección del virus del papiloma humano ha demostrado tener una buena sensibilidad y especificidad a tres años para la detección de CIN2+ resultando ser sensiblemente superior a la citología. Por otro lado, ha demostrado tener unos niveles de reproducibilidad altos entre laboratorios y un fácil manejo en situaciones de rutina. El uso de protocolos homogéneos y la existencia de herramientas informáticas de amplio uso han permitido una evaluación equitativa y fiable entre centros. El protocolo ha sido complementado con actividades de formación a profesionales y una monitorización periódica de todas las actividades. En conclusión, la implantación de un programa de cribado poblacional y la introducción de la prueba de detección del virus del papiloma humano en mujeres mayores de 30 años puede mejorar considerablemente los esfuerzos para la prevención secundaria del cáncer de cuello uterino en Cataluña (AU)

Analysis of the cervical cancer screening activity in the National Health System of Catalonia has identified a cytological coverage at 3 years of 40.8%, an interval of 2.4 years between Pap smears and a loss to follow-up of 50% at 3 years in women aged 25-65 years old. The introduction of human papillomavirus testing in the management of women with cytological results of atypical squamous cell of undetermined significance and as an adjunct to cytology in women with a history of inadequate screening has facilitated the management and detection of women at risk of developing cervical intraepithelial neoplasia grade 2 or worse (CIN2 + ). Human papillomavirus testing has demonstrated high sensitivity and specificity at 3 years in the detection of CIN2 + and was substantially superior to cytology. Furthermore, it had good inter-laboratory reproducibility and was easy to perform in routine situations. The use of uniform protocols and the extensive availability of software tools have allowed comprehensive and reliable assessment across Catalonia. The protocol has been complemented with educational interventions for healthcare professionals and regular monitoring of all activities. We conclude that the introduction of organized screening programs and human papillomavirus testing among women older than 30 years can greatly enhance efforts for the secondary prevention of CC in Catalonia (AU)

Screening of cervical cancer in Catalonia 2006-2012.

The early detection of intraepithelial lesions of the cervix, through the periodic examination of cervical cells, has been fundamental for the prevention of invasive cervical cancer and its related mortality. In this report, we summarise the cervical cancer screening activities carried out in Catalonia, Spain, within the National Health System during 2008-2011. The study population covers over two million women resident in the area. The evaluation includes 758,690 cervical cytologies performed on a total of 595,868 women. The three-year coverage of cervical cytology among women aged between 25 and 65 years was 40.8%. About 50% of first screened women with negative results had not returned to the second screening round. The introduction of high-risk human papillomavirus DNA (HPV) detection, as a primary screening cotest with cytology among women over age 40 with a poor screening history, significantly improved the detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+), being far superior to cytology alone. Cotesting did not improve the detection of CIN2+. The use of the HPV test for the triage of atypical squamous cell undetermined significance (ASC-US) improved the selection of women at high risk of CIN2+. Sampling (both cytology and HPV test) was largely performed by midwives (66.7%), followed by obstetricians (23.8%) and nurses (7%). Over half of the centres (54.8%) had full use of online medical records. During the study period, educational activities for professionals and for women were carried out periodically. The organisation of screening as a population activity in which women are actively called to the screening visit and the introduction of HPV testing as a primary screening tool are strongly recommended to ensure the maximum population impact in the reduction of the cervical cancer burden.

Nutritional status of iodine in pregnant women in Catalonia (Spain): study on hygiene-dietetic habits and iodine in urine.

BACKGROUND: It is a priority to achieve an adequate nutritional status of iodine during pregnancy since iodine deficiency in this population may have repercussions on the mother during both gestation and post partum as well as on the foetus, the neonate and the child at different ages. According to the WHO, iodine deficiency is the most frequent cause of mental retardation and irrreversible cerebral lesions around the world. However, few studies have been published on the nutritional status of iodine in the pregnant population within the Primary Care setting, a health care level which plays an essential role in the education and control of pregnant women. Therefore, the aim of the present study is: 1.- To know the hygiene-dietetic habits related to the intake of foods rich in iodine and smoking during pregnancy. 2.- To determine the prevalence of iodine deficiency and the factors associated with its appearance during pregnancy. METHODS/DESIGN: We will perform a cluster randomised, controlled, multicentre trial. Randomisation unit: Primary Care Team. STUDY POPULATION: 898 pregnant women over the age of 17 years attending consultation to a midwife during the first trimester of pregnancy in the participating primary care centres. OUTCOME MEASURES: consumption of iodine-rich foods and iodine deficiency. Points of assessment: each trimester of the gestation. INTERVENTION: group education during the first trimester of gestation on healthy hygiene-dietetic habits and the importance of an adequate iodine nutritional status. STATISTICAL ANALYSIS: descriptive analysis of all variables will be performed as well as multilevel logistic regression. All analyses will be done carried out on an intention to treat basis and will be fitted for potential confounding factors and variables of clinical importance. DISCUSSION: Evidence of generalised iodine deficiency during pregnancy could lead to the promotion of interventions of prevention such as how to improve and intensify health care educational programmes for pregnant women. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01301768.

[Prevalence and determining factors of acquiring C. trachomatis infection among adolescents and young adults in Catalonia]. / Prevalencia de la infección por C. trachomatis y N. gonhorroeae y determinantes para su adquisición en jóvenes y adultos-jóvenes en Cataluña.

OBJECTIVE: To determine the prevalence of Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonhorroeae) infections and the risk factors for acquiring them in individuals under 35 years-old attending sexual health clinics in Barcelona province in 2006. METHODS: Cross-sectional study of a convenience sample of 500 adolescents and young adults aged between 16 and 35 years. A total of 423 samples were analysed using real-time PCR. A standardised questionnaire was used to collect clinical, epidemiological, and behavioural data on the participants. Significant differences were analysed in the descriptive study using Pearson's ((2). The association between C. trachomatis infection and its determining factors was analysed using the Mantel-Haenszel test and a multivariate logistic regression model. RESULTS: The overall prevalence of C. trachomatis was 4%, and was significantly higher in those under 25 years of age. The overall prevalence of N. gonhorroeae was 0.2%. The independent risk factors for infection by C. trachomatis were as follows: foreign origin (OR: 3.74; CI 95%: 1.10-12.72), having had a sexual partner in the last 3 months (OR 3.91; CI 95%: 1.30-11.81), and tobacco use the last 12 months (OR: 4.99; CI 95%: 1.34-18.59). CONCLUSIONS: This is the first study performed in Catalonia that shows high prevalence of C. trachomatis in young people, thus confirming trends in the rest of Europe. Systematic monitoring of C. trachomatis infection in sentinel populations will provide valid information allowing us to assess the relevance of proposing targeted screening programs in our setting.

Prevalencia de la infección por C. trachomatis y N. gonhorroeae y determinantes para su adquisición en jóvenes y adultos-jóvenes en Cataluña / Prevalence and determining factors of acquiring C. trachomatis infection among adolescents and young adults in Catalonia

Objetivo Determinar la prevalencia de Chlamydia trachomatis (C. trachomatis) y Neisseria gonhorroeae (N. gonhorroeae) y los factores de riesgo para su adquisición en menores de 35 años, usuarios de centros de atención a la salud sexual de la provincia de Barcelona durante el año 2007.MètodosEstudio transversal de una muestra oportunista de 500 jóvenes y adultos-jóvenes de 16-35 años. Un total de 397 muestras endocervicales y 26 de orina fueron analizadas mediante PCR en tiempo real. Se utilizó un cuestionario estandarizado para recoger información clínica, epidemiológica y conductual. Se analizaron las diferencias significativas en el análisis descriptivo mediante Pearson's χ2 o Fisher's exact test. La asociación entre la infección por C. trachomatis y sus determinantes fueron examinados mediante el test Mantel-Haenszel y un modelo de regresión logística multivariante. Se calcularon las Odds ratio y los intervalos de confianza al 95%.ResultadosLa prevalencia global de C. trachomatis fue del 4%, significativamente más elevada en el grupo de menores de 25 años. La prevalencia de N. gonhorroeae fue del 0,2%. Los factores de riesgo independientes para la infección de C. trachomatis fueron: origen extranjero (OR: 3,74; IC 95%: 1,10-12,72), tener nueva pareja sexual < 3 meses (OR 3,91, IC 95%: 1,30-11,81) y el consumo de tabaco<12 meses (OR: 4,99, IC 95%: 1,34-18,59).Conclusiones Este es el primer estudio realizado en Cataluña, que muestra elevadas prevalencias de C. trachomatis en jóvenes, y que reafirma las tendencias encontradas en Europa. Sistematizar la monitorización de la infección por C. trachomatis en poblaciones centinela aportará información válida para valorar la pertinencia de proponer programas de cribado en nuestro entorno (AU)

Objective To determine the prevalence of Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonhorroeae) infections and the risk factors for acquiring them in individuals under 35 years-old attending sexual health clinics in Barcelona province in 2006.MethodsCross-sectional study of a convenience sample of 500 adolescents and young adults aged between 16 and 35 years. A total of 423 samples were analysed using real-time PCR. A standardised questionnaire was used to collect clinical, epidemiological, and behavioural data on the participants. Significant differences were analysed in the descriptive study using Pearson's (2. The association between C. trachomatis infection and its determining factors was analysed using the Mantel-Haenszel test and a multivariate logistic regression model. Results The overall prevalence of C. trachomatis was 4%, and was significantly higher in those under 25 years of age. The overall prevalence of N. gonhorroeae was 0.2%. The independent risk factors for infection by C. trachomatis were as follows: foreign origin (OR: 3.74; CI 95%: 1.10-12.72), having had a sexual partner in the last 3 months (OR 3.91; CI 95%: 1.30-11.81), and tobacco use the last 12 months (OR: 4.99; CI 95%: 1.34-18.59).Conclusions This is the first study performed in Catalonia that shows high prevalence of C. trachomatis in young people, thus confirming trends in the rest of Europe. Systematic monitoring of C. trachomatis infection in sentinel populations will provide valid information allowing us to assess the relevance of proposing targeted screening programs in our setting (AU)

Hábitos higiénico-dietéticos respecto alconsumo de alimentos ricos en yodo duranteel primer trimestre de la gestación / Hygiene and dietary habits with respect to the consumption of iodine-rich foods

Objetivo: Conocer los hábitos higiénico-dietéticos de las mujeresembarazadas respecto al consumo de alimentos ricos en yodo duranteel primer trimestre de la gestación.Material y método: Estudio observacional, descriptivo, transversaly multicéntrico. Se estudiaron las mujeres embarazadas en el primertrimestre de la gestación que acudieron a la consulta de control delembarazo del programa de atención a la salud sexual y reproductiva(ASSIR) de la Región Sanitaria del Ámbito Centro del Instituto Catalánde la Salud durante el año 2006. Para la recogida de datos se utilizóun cuestionario que cumplimentó la matrona en una entrevistaindividual en la primera visita de control de embarazo.Resultados: Se recogieron 823 cuestionarios cumplimentados. El 6%(50) de las gestantes no consumía pescado y el 83% (683) lo hacíamenos de cuatro veces por semana. El 17% (138) no consumía lechey el 39% (324) bebía un vaso al día. El 42% (342) de las gestantesutilizaba sal yodada para la preparación y condimentación de los alimentos,frente al 50% (412) que no la empleaba. El 22% (184) delas gestantes tomaba algún tipo de suplemento de yodo, y el 18%(148) de la muestra manifestó ser fumadora.Conclusiones: Las mujeres embarazadas de nuestro ámbito de estudiotienen un consumo reducido de alimentos ricos en yodo. Además, tantoel consumo de sal yodada como la utilización de suplementos que contenganyodo durante el embarazo resultan también insuficientes (AU)

Objective: To evaluate hygiene and dietary habits with respect to theconsumption of iodine-rich foods by pregnant women during the firsttrimester of pregnancy.Material and method: A cross-sectional, descriptive, observational,multicenter study was carried out. In 2006, we studied the women inthe first trimester of pregnancy who came to the clinics for pregnancymanagement pertaining to the sexual and reproductive health program(ASSIR) of the Central Health Region of Catalonia, Spain. Informationwas gathered by means of a questionnaire created by the research teamand completed by the midwife during the first visit to the pregnancymanagement clinic.Results: A total of 823 questionnaires were completed. Six percent(50) of those polled did not consume any fish and 83% (683) ate it lessthan four times a week. Seventeen percent (138) did not drink any milkand 39% (324) drank one glass per day. Forty-two percent (342) of thepregnant women used iodized salt for cooking while 50% (412) didnot. Twenty-two percent (184) of them were taking some kind of iodinesupplement and 18% (148) were smokers.Conclusions: The pregnant women included in our study consumedlow amounts of iodine-rich foods. Moreover, the consumption of bothiodized salt and iodine supplements was also insufficient (AU)