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

Gemma Prieto, Maria Teresa Torres, Lidia Francés, Gemma Falguera, Lluis Vila, Josep María Manresa, Roser Casamitjana, Juan Ramón Barrada, Amèlia Acera, Dolors Guix, Anna Torrent, Josep Grau, Pere Torán, IODEGEST study group, Montse Abella, Nuria Sampedro, Glòria Miralpeix, Montse Villanueva, Concepción Manzano, Judit Cos, Pilar Soteras, Fermina Casas, Coloma Graells, Mireia Llucià, Rosalia Ibars, Encarna López, Montserrat Manzanares, Irene Lorente, Eva Artieda, Meritxell Casajoana, Dolors Muñoz, Llucia Burgos, Angelica Hidalgo, Anna Fusté, Dolors Lladó, Rosa Subirats, Angelina Masoliver, Imma Trujillo, Rosa Banús, Dolors Salas, Montse Pujol, Dolors Grau, Roser Sanglas, Anabel Mayos, Náyade Crespo, Rosa Codina, Rosa Forn, Montserrat Galí, Antonia Hidalgo, Teresa Macià, Mercè Vendrell, Montserrat Sallent, Montserrat Ribera, Rosa Oller, Teresa Riba, Esther Romero, Adelaida Expósito, Encarnació Santaeulàlia, Anna Viaseca, Dolors Guix, Gemma Olivera, Merche García, Rosa Sans, Marta Roman, Ma Jose Vila, Maite Martinez, Esther Serrano, Sonia Díaz, Carolina Alcaine, Sancho Remei Fenollosa, Encarna Gascón, Núria Risques, Araceli Santamaria, Remei Corominas, Xavi Espada, Maria Helena Perez, Concepción de la Fuente, Assumpta Prats, Maria Rosa Cabedo, Carme Magem, Mercedes Vigil, Carmen Biern, Montse Bach, Joana Relat, Carmen Bayascas, Olga Ezquerro, Patricia Reategui, Anna Campos, Rosa Bach, Eva Martinez, Anna Bartolí, Rosa Ferrer, Rocio Hernandez, Gemma Prieto, Maria Teresa Torres, Lidia Francés, Gemma Falguera, Lluis Vila, Josep María Manresa, Roser Casamitjana, Juan Ramón Barrada, Amèlia Acera, Dolors Guix, Anna Torrent, Josep Grau, Pere Torán, IODEGEST study group, Montse Abella, Nuria Sampedro, Glòria Miralpeix, Montse Villanueva, Concepción Manzano, Judit Cos, Pilar Soteras, Fermina Casas, Coloma Graells, Mireia Llucià, Rosalia Ibars, Encarna López, Montserrat Manzanares, Irene Lorente, Eva Artieda, Meritxell Casajoana, Dolors Muñoz, Llucia Burgos, Angelica Hidalgo, Anna Fusté, Dolors Lladó, Rosa Subirats, Angelina Masoliver, Imma Trujillo, Rosa Banús, Dolors Salas, Montse Pujol, Dolors Grau, Roser Sanglas, Anabel Mayos, Náyade Crespo, Rosa Codina, Rosa Forn, Montserrat Galí, Antonia Hidalgo, Teresa Macià, Mercè Vendrell, Montserrat Sallent, Montserrat Ribera, Rosa Oller, Teresa Riba, Esther Romero, Adelaida Expósito, Encarnació Santaeulàlia, Anna Viaseca, Dolors Guix, Gemma Olivera, Merche García, Rosa Sans, Marta Roman, Ma Jose Vila, Maite Martinez, Esther Serrano, Sonia Díaz, Carolina Alcaine, Sancho Remei Fenollosa, Encarna Gascón, Núria Risques, Araceli Santamaria, Remei Corominas, Xavi Espada, Maria Helena Perez, Concepción de la Fuente, Assumpta Prats, Maria Rosa Cabedo, Carme Magem, Mercedes Vigil, Carmen Biern, Montse Bach, Joana Relat, Carmen Bayascas, Olga Ezquerro, Patricia Reategui, Anna Campos, Rosa Bach, Eva Martinez, Anna Bartolí, Rosa Ferrer, Rocio Hernandez

Abstract

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.

References

    1. Morreale de Escobar G. In: Yodo y salud en el siglo XXI. European Pharmaceutical Law Group, editor. Madrid; 2004. Yodo y embarazo; pp. 107–108.
    1. Francés L, Torres MT. Déficit de yodo durante la gestación. Matronas profesión. 2003;11:37–43.
    1. Muñoz Márquez JA. In: Yodo y salud en el siglo XXI. European Pharmaceutical Law Group, editor. Madrid; 2004. Yodo y embarazo; pp. 177–216.
    1. WHO; UNICEF; ICCIDD. Assesment of the Iodine Deficiency Disorders and monitoring their elimination. Geneva: WHO publication. WHO/NHD/01.1; 2001. pp. 1–107. Geneve.
    1. Donnay Candil S. In: Yodo y salud en el siglo XXI. European Pharmaceutical Law Group, editor. Madrid; 2004. Enfermedades originadas por la deficiencia de yodo; pp. 145–175.
    1. Morreale G. Yodo y embarazo. Prog Diag Trat Prenat. 2005;17(3):129–146.
    1. Delange F. Optimal Iodine Nutrition Pregnancy, Lactation and Neonatal Period. Int J Endocrinol Metab. 2004;2:1–12.
    1. Caron P, Glinoer D, Lecomte P, Orgiazzi J, Wemeau JL. Status of iodine nutrition in France: prevention of iodine deficiency in pregnant and lactating women. Ann Endocrinol (Paris) 2006;67(4):281–286.
    1. Kibirige MS, Hutchinson S, Owen CJ, Delves HT. Prevalence of maternal dietary iodine insufficiency in the north east of England: Implications for the fetus. Arch Dis Child Fetal Neonatal Ed. 2004;89(5):436–439.
    1. Bühling KJ, Schaff J, Bertram H, Hansen R, Müller C, Wäscher C, Heinze T, Dudenhausen JW. Supply of iodine during pregnancy: an inventory in Berlín, Germany. Z Geburshife Neonatol. 2003;207(1):12–16.
    1. Brander L, Als C, Buess H, Haldimann F, Harder M, Hänggi W, Herrmann U, Lauber K, Niederer U, Zürcher T, Bürgi U, Gerber H. Urinary iodine concentration during pregnancy in an area of unstable dietary iodine intake in Switzerland. J Endocrinol Invest. 2003;26(5):389–396.
    1. Nawoor Z, Burns R, Smith DF, Sheehan S, O'Herlihy C, Smyth PP. Iodine intake in pregnancy in Ireland: a cause for concern? Ir J Med Sci. 2006;175(2):21–24.
    1. Mezosi E, Molnar I, Jakab A, Balogh E, Karanyi Z, Pakozdy Z, Nagy P, Gyory F, Szabo J, Bajnok L, Leovey A, Kakuk G, Nagy EV. Prevalence of iodine deficiency and goitre during pregnancy in east Hungry. Eur J Endocrinol. 2000;143(4):479–483.
    1. Laurberg P, Nohr SB, Pedersen KM, Fuglsang E. Iodine nutrition in breast-fed infants is impaired by maternal smoking. J Clin Endocrinol and Metab. 2004;89:181–187.
    1. Shields B, Hill A, Bilous M, Knight B, Hattersley AT, Bilous RW, Vaidya B. Cigarette smoking durig pregnancy is associated with alterations in maternal and fetal thyroid function. J Clin Endocrinol Metab. 2009;94(2):570–574.
    1. McDonald S, Walker M, Ohlsson A, Murphy K, Beyene J, Perkins S. The effect of tobacco exposure on maternal and fetal thyroid function. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2008;140:38–42.
    1. Santiago P, Rojo-Martínez G, Garcia-Fuentes E, Sánchez C, Garriga MJ, Soriguer F. Prevalencia de bocio endémico en la provincia de Jaén. Endocrinol Nutr. 2003;50(Supl 2):38.
    1. Vila L, Serra M, De Castro A, Palomera E, Casamitjana R, Muñoz J. et al.Prevalencia del déficit de yodo de la población gestante de los Pirineos Catalanes y del Maresme (costa) Endocrinología y Nutrición. 2005;52:117–118.
    1. Grupo de Trabajo de Trastornos por Déficit de Yodo. Sociedad Española de Endocrinología y Nutrición. Déficit de yo en España. Situación actual. Ministerio de Sanidad y Consumo. Fundación SEEN;; 2004.
    1. Soriguer F, Millón MC, Muñoz R, Mancha I, López Siguero JP, Martínez Aedo MJ, Gómez-Huelga R, Garriga MJ, Rojo-Martinez G, Esteva I, Tinahones FJ. The auditory threshold in a acholo-age population is related to iodine intake and thyroid function. Thyroid. 2000;10(11):991–999.
    1. De Luis DA, Aller R, Izaola O. Problemática de la deficiencia de yodo durante la gestación. An Med Interna (Madrid) 2005;22(9):445–448.
    1. López-Batllori J, Obiols G, Vila Ll, Wengrowicz S. Alteraciones provocadas por la deficiencia de yodo. Su prevención en Cataluña. Anales de Medicina. 2000;83(5):272–278.
    1. Muñoz M, Figueras F, Puig M. La hipotiroxinemia gestacional se asocia al síndrome de déficit de atención e hiperactividad. Prog Obstet Ginecol. 2009;52(12):681–685.
    1. Fernández PS. Capacidad intelectual y yodo en la dieta. Evidencias clínicas y epidemiológicas. Endocrilno Nutr. 2008;55(supl1):20–26.
    1. Vila L. La deficiencia de yodo en España: un problema pendiente que urge resolver. Endocrinol Nutr. 2002;49:1–4.
    1. González Mateo MC, Fernández Fernández M, Díez Hernández A, Delgado Gómez M, García Menéndez L, Díaz Cadórniga F. Bocio, función tiroidea y excreción de yodo en gestantes de la zona del Bierzo. Endocrinol Nutr. 2002;49:289–292.
    1. Domínguez I, Reviriego S, Rojo-Martínez G, Valdés MJ, Carrasco R, Coronas I, López-Ojeda J, Pacheco M, Garriga MJ, Garcia-Fuentes E, González-Romero S, C-Soriguer Escofet FJ. Déficit de yodo y función tiroidea en una población de mujeres embarazas sanas. Med Clin (Barc) 2004;122(12):449–453.
    1. Escobar del Rey F, Morreale de Escobar G. Yodación universal de la sal: un derecho humano de la infancia. Endocrinología. 1998;45:3–16.
    1. Morreale de Escobar G, Escobar del Rey F. El yodo durante la gestación, lactancia y primera infancia. Cantidades mínimas y máximas: de microgramos a gramos. An Esp Pediatr. 2000;53:1–5.
    1. McBride CM, Emmons KM, Lipkus IM. Understanding the potential of teachable moments: the case of smoking cessation. Health Education Research. 2003;18(2):156–170.
    1. Gagnon AJ, Sandall J. Educación prenatal grupal o individual para el parto, la maternidad/paternidad o ambos (Spanish translation) Oxford: Update Software Ltd; 2007. Biblioteca Cochrane Plus Número 4.
    1. Wolf FM, Guevara JP, Grum CM, Clark NM, Cates CJ. Intervenciones educativas para el asma infantil (Spanish translation) Oxford: Update Software Ltd; 2007. Biblioteca Cochrane Plus Número 4.
    1. Dalmau-Llorca MR. Educación grupal frente a individual en pacientes diabéticos tipo 2. Atención Primaria. 2003;32(1):36–41.
    1. Valbo A, Schioldborg P. Smoking cessation in pregnancy: mode of intervention and effect. Acta Obstetricia et Gynecologica Scandinavica. 1991;70:309–313.
    1. Hill PD. Effects of education on breastfeeding success. Maternal-Child Nursing Journal. 1987;16(2):145–146.
    1. Auba J, Altisent R, Cabezas C, Córdoba R, Fernández-Tenllado MA, Gobierno J, Efectividad de la educación sanitaria en grupo en el marco de la atención primaria. Ref Type: Electronic Citation; 1996. Informe Técnico del Grupo de Educación Sanitaria y Promoción de la Salud del PAPPS 16-4- 2008.
    1. Lumley J, Oliver SS, Chamberlain C, Oakley L. Intervenciones para promover el abandono del hábito de fumar durante el embarazo (Spanish translation) Oxford: Update Software Ltd; 2008. Biblioteca Cochrane Plus Número 2.
    1. Dyson L, McCormick F, Renfrew MJ. Intervenciones para promover el inicio de la lactancia materna (Spanish translation) Oxford: Update Software Ltd; 2008. Biblioteca Cochrane Plus Número 2.
    1. Guise JM, Palda V, Westhoff C, Chan BK, Helfand M, Lieu TA. The effectiveness of primary care-based interventions to promote breastfeeding: systematic evidence review and meta-analysis for the US Preventive Services Task Force. Ann Fam Med. 2003;1(2):70–78.
    1. Bonet-Manso MP, Atiénzar-Martínez MB, Fuentes-Gómez MI, Plaza-Vicente C. Concentraciones de yodo y su ingesta en una población de mujeres embarazadas sanas. Enferm Clin. 2007;17(6):293–301.
    1. Adams G, Gulliford MC, Ukoumunne OC, Eldridge S, Chinn S, Campbell MJ. Patterns of intra-cluster correlation from primary care research to inform study design and analysis. J Clin Epidemiol. 2004;57:785–794.
    1. Parker DR, Evangelou E, Eaton CB. Intraclass correlation coefficients for cluster randomized trials in primary care: the cholesterol education and research trial (CEART) Contemp Clin Trials. 2005;26:260–267.
    1. Ukoumunne OC, Gulliford MC, Chinn S, Sterne JA, Burney PG. Methods for evaluating area-wide and organisation-based interventions in health and health care: a systematic review. Health Technol Assess. 1999;3(5):iii–92.
    1. Campbell MK, Elbourne DR, Altman DG. Ensayos clínicos aleatorizados comunitarios (CONSORT CLUSTER) Med Clin (Barc) 2005;125(Supl 1):28–31.
    1. García-Fuentes E. Importancia del laboratorio clínico en el diagnóstico de la deficiencia de yodo. Endocrinol Nutr. 2008;55(supl 1):43–44.

Source: PubMed

3
購読する