Effects of cod intake in pregnancy on iodine nutrition and infant development: study protocol for Mommy's Food - a randomized controlled trial

Maria Wik Markhus, Ingrid Kvestad, Lisa Kolden Midtbø, Ive Nerhus, Elisabeth R Ødegaard, Ingvild Eide Graff, Øyvind Lie, Lisbeth Dahl, Mari Hysing, Marian Kjellevold, Maria Wik Markhus, Ingrid Kvestad, Lisa Kolden Midtbø, Ive Nerhus, Elisabeth R Ødegaard, Ingvild Eide Graff, Øyvind Lie, Lisbeth Dahl, Mari Hysing, Marian Kjellevold

Abstract

Background: Iodine is a key component of thyroid hormones that are critical for normal development of the brain and nervous system in utero. Recent results indicate that two thirds of pregnant women in Europe have sub-optimal iodine nutrition. In Norway, milk and seafood are the most important dietary iodine sources and contributes to about 80% of the intake.

Method: Two-armed randomized trial where 137 pregnant women were randomized to either receiving cod twice weekly, or continue with habitual diet for 16 weeks (pregnancy week 20-36). Socioeconomic- and demographic factors, dietary information and biological (urine, blood, and hair) samples are collected pre- and post-intervention, and at six weeks, three-, six-, and eleven months postpartum. Biological samples (urine, blood, and hair) of the infant are collected at six weeks, three-, six-, and eleven months postnatal. Child development is assessed by The Bayley Scale of Infant and Toddler Development, 3rd edition, at eleven months, and by parent report on the Ages and Stages Questionnaire, 3rd edition, and Ages and Stages Questionnaire: Social Emotional at three-, six-, and eleven months.

Discussion: The Mommy's Food study will provide knowledge on changes in iodine nutrition when consuming iodine rich fish during pregnancy and contribute to the understanding of the impact of iodine status in pregnancy on infant neurodevelopment.

Trial registration: This study is registered in ClinicalTrials.gov (NCT02610959). Registered November 17, 2015.

Keywords: Bayley scales of infant and toddler development; Fish; Infant nutrition; Iodine intake; Iodine status; Maternal diet; Neurodevelopment; Nutritional status; Pregnancy; RCT; UIC.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s). 2018.

Figures

Fig. 1
Fig. 1
Overview of study schedule and main activities. *Six consecutive days between GW 18 and GW 19 and between GW 35 and GW 36 (last days of intervention meal). †Questionnaire includes: participant characteristics; self-reported maternal mental health; and parent-reported infant mental health. Abbreviations: GW, gestational week; M, mother; I, infant; U, urine; S, serum; T4, thyroxine; T3, triiodothyronine; RBC, red blood cells; FA, fatty acids; H, hair; FFQ, Food Frequency Questionnaire; ASQ-3, The Ages and Stages Questionnaire; ASQ:SE, The Ages and Stages Questionnaire: Social Emotional; BISQ, Brief Infant Sleep Questionnaire; EPDS, The Edinburgh Postnatal Depression Scale; HADS, The Hospital Anxiety and Depression Scale. ‡Screening tool for eating disorders

References

    1. Zimmermann MB. Iodine deficiency in pregnancy and the effects of maternal iodine supplementation on the offspring: a review. Am J Clin Nutr. 2009;89:668S–672S. doi: 10.3945/ajcn.2008.26811C.
    1. WHO UNICEF ICCIDD: Assessment of iodine deficiency disorders and monitoring their elimination. World Health Organisation 2007.
    1. The Norwegian Directorate of Health: Norske Anbefalinger for Ernæring og Fysisk Aktivitet. Rapport IS 2005, 1219.
    1. Brantsaeter AL, Haugen M, Hagve TA, Aksnes L, Rasmussen SE, Julshamn K, Alexander J, Meltzer HM. Self-reported dietary supplement use is confirmed by biological markers in the Norwegian mother and child cohort study (MoBa) Ann Nutr Metab. 2007;51:146–154. doi: 10.1159/000103275.
    1. Seldal CF. Seafood intake and iodine status in pregnant and postpartum Norwegian women. University of Bergen, Faculty of Medicine and Dentistry Department of Medicine. 2012;
    1. Berg V, Nost TH, Skeie G, Thomassen Y, Berlinger B, Veyhe AS, Jorde R, Odland JO, Hansen S. Thyroid homeostasis in mother-child pairs in relation to maternal iodine status: the MISA study. Eur J Clin Nutr. 2017;
    1. van Mil NH, Tiemeier H, Bongers-Schokking JJ, Ghassabian A, Hofman A, Hooijkaas H, Jaddoe VWV, Keizer-Schrama SMD, Steegers EAP, Visser TJ, et al. Low Urinary Iodine Excretion during Early Pregnancy Is Associated with Alterations in Executive Functioning in Children. J Nutr. 2012;142:2167–2174. doi: 10.3945/jn.112.161950.
    1. Abel MH, Caspersen IH, Meltzer HM, Haugen M, Brandlistuen RE, Aase H, Alexander J, Torheim LE, Brantsaeter AL. Suboptimal maternal iodine intake is associated with impaired child neurodevelopment at 3 years of age in the Norwegian mother and child cohort study. J Nutr. 2017;
    1. Zhou SJ, Anderson AJ, Gibson RA, Makrides M. Effect of iodine supplementation in pregnancy on child development and other clinical outcomes: a systematic review of randomized controlled trials. Am J Clin Nutr. 2013;98:1241–1254. doi: 10.3945/ajcn.113.065854.
    1. EFSA PoCitFC: Scientific Opinion on the risk for public health related to the presence of mercury and methylmercury in food. EFSA Journal 2012, 10:2985-n/a.
    1. Scientific Committee on Food: Opinion of the SCF on the risk assessment of dioxins and dioxin-like PCBs in food European Commission - Health and Concumer Protection Directorate General 2001.
    1. Dahl L, Meltzer HM, Opsahl JA, Julshamn K: Iodine intake and status in two groups of Norwegians. 2003 2003:9.
    1. ERBA. Diagnostics France: MAXMAT CREATININE PAP REAG. In Book MAXMAT CREATININE PAP REAG. ERBA Diagnostics France.
    1. Araujo P, Nguyen TT, Froyland L, Wang J, Kang JX. Evaluation of a rapid method for the quantitative analysis of fatty acids in various matrices. J Chromatogr A. 2008;1212:106–113. doi: 10.1016/j.chroma.2008.10.006.
    1. Dahl L, Opsahl JA, Meltzer HM, Julshamn K. Iodine concentration in Norwegian milk and dairy products. Br J Nutr. 2003;90:679–685. doi: 10.1079/BJN2003921.
    1. Lincoln RA, Shine JP, Chesney EJ, Vorhees DJ, Grandjean P, Senn DB. Fish consumption and mercury exposure among Louisiana recreational anglers. Environ Health Perspect. 2011;119:245–251. doi: 10.1289/ehp.1002609.
    1. Markhus MW, Graff IE, Dahl L, Seldal CF, Skotheim S, Braarud HC, Stormark KM, Malde MK. Establishment of a seafood index to assess the seafood consumption in pregnant women. Food and Nutr Res. 2013;57:1–11. doi: 10.3402/fnr.v57i0.19272.
    1. Squires J, Bricker D, Potter L. Revision of a parent-completed developmental screening tool: ages and stages questionnaires. J Pediatr Psychol. 1997;22:313–328. doi: 10.1093/jpepsy/22.3.313.
    1. Richter J, Janson H. A validation study of the Norwegian version of the ages and stages questionnaires. Acta Paediatr. 2007;96:748–752. doi: 10.1111/j.1651-2227.2007.00246.x.
    1. Squires J, Bricker D, Heo K, Twombly E. Identification of social-emotional problems in young children using a parent-completed screening measure☆ ☆developmental screening tests, unlike medical screenings such as thyroid and vision tests, have no “gold standard”; therefore the criterion measures as well as the screening instrument may be in error regarding the developmental status of the child (Meisels, 1988) Early Childhood Research Quarterly. 2001;16:405–419. doi: 10.1016/S0885-2006(01)00115-6.
    1. Heo KH, Squires J. Cultural adaptation of a parent completed social emotional screening instrument for young children: ages and stages questionnaire-social emotional. Early Hum Dev. 2012;88:151–158. doi: 10.1016/j.earlhumdev.2011.07.019.
    1. Sadeh A. A brief screening questionnaire for infant sleep problems: validation and findings for an internet sample. Pediatrics. 2004;113:E570–E577. doi: 10.1542/peds.113.6.e570.
    1. Røysamb E, Vittersø J, Tambs K. The relationship satisfaction scale-psychometric properties. Norsk epidemiologi. 2014;24:187–194. doi: 10.5324/nje.v24i1-2.1821.
    1. Berle J, Aarre T, Mykletun A, Dahl A, Holsten F. Screening for postnatal depression. Validation of the Norwegian version of the Edinburgh postnatal depression scale, and assessment of risk factors for postnatal depression. J Affect Disord. 2003;76:151–156. doi: 10.1016/S0165-0327(02)00082-4.
    1. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale - An updated literature review. J Psychosom Res. 2002;52:69–77. doi: 10.1016/S0022-3999(01)00296-3.
    1. Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: a new screening tool for eating disorders (reprinted from BMJ, vol 319, pg 1467-1468, 1999) West J Med. 2000;172:164–165. doi: 10.1136/ewjm.172.3.164.
    1. The Minestry of Education and Research: Ot.prp. nr. 58 Om lov om behandling av etikk og rederlighet i forskning. https://wwwregjeringenno/no/dokumenter/otprp-nr-58-2005-2006−/id187808/ 2006, 14, 3.5.2.
    1. Institute of Medicine AoS . USA: Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Maganese, Molbdenum, Nickel; Silicon, Vanadium and Zinc. Washington, DC: The National Academies Press; 2001.
    1. Nasjonalt råd for Ernæring, Risiko for jodmangel i Norge -Identifisering av et akutt behov for tiltak (in Norwegian), June 2016 [].
    1. Bath S, Steer C, Golding J, Emmett P, Rayman M. 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. doi: 10.1016/S0140-6736(13)60436-5.

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