Sedigheh Hantoushzadeh Why iodine is necessory Iodine is an essential element for human survival since it is essential for making thyroid hormones Iodine deficiency disorders IDD have been recognized as a major public health problem worldwide ID: 929116
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Slide1
IODINE AND PREGNANCY
D
r
Sedigheh
Hantoushzadeh
Slide2Why iodine is
necessory
Iodine is an essential element for human survival since it is essential for making thyroid hormones.
Iodine deficiency disorders (IDD) have been recognized as a major public health problem worldwide
According to the reports of World Health Organization (WHO) and United Nations Children’s Fund (UNICEF), more than 30% of school-aged children (260 million) suffer from insufficient iodine intake
Slide3The term "iodine deficiency disorders" (
IDD)
refers to all of the consequences of iodine deficiency, which depend on its severity and the age of the affected subject
Iodine is an essential component of thyroxine (T4) and tri iodothyronine (T3), and it must be provided in the diet. Inadequate iodine intake leads to inadequate thyroid hormone production, and all the consequences of iodine deficiency stem from the associated hypothyroidism.
Iodine is particularly important during preconception and the first 16 weeks of pregnancy, when the developing fetus is entirely dependent on the mother for its supply of iodine and the thyroid hormone.
This topic will review the consequences of iodine deficiency, its geographical distribution, diagnostic measures, prophylaxis, and treatment.
Slide4RESOURSE
Iodine can be obtained by consumption of foods that naturally contain it (
fish, seafood, kelp, some drinking water, and vegetables grown in iodine-sufficient soil
) or to which it is added
(iodized table salt or foods enriched with iodine).
Cow's milk
is a source of iodine owing to iodine in cattle feed and the use of iodophor udder cleansers in the dairy industry.
Sea salt naturally contains only a small amount of iodine.
Dietary iodine is absorbed as iodide and rapidly distributed in the extracellular fluid, which also contains iodide released from the thyroid and by extrathyroidal deiodination of the iodothyronines. Iodide leaves this pool by transport into the thyroid and excretion into the urine.
Slide5Iodine Homeostasis in Pregnancy
Physiologic Changes in Pregnancy
Pregnancy induces several major changes to thyroid physiology.
Slide6Slide7Effects of Iodine Deficiency
Slide8Mild-to-Moderate Iodine Deficiency
The effects of mild-to-moderate iodine deficiency are less well understood than those of severe iodine deficiency.
Minor neuropsychological defects
A small study found a significantly greater prevalence of attention deficit hyperactivity disorder (ADHD)
Slide9The World Health Organization
(WHO)
recommends a daily intake of
90 mcg of iodine for infants and
children up to 5 years
120 mcg for children 6 to 12 years
150 mcg for children ≥12 years and adults
250 mcg during pregnancy and lactation
the National Academy of Medicine
recommended minimum daily intake of iodine
90 mcg for children 1 to 8 years old
120 mcg for children 9 to 13 years old
150 mcg for older adolescents and nonpregnant adults
220 mcg for pregnant women
290 mcg for lactating women
Slide10ASSESSMENT OF IODINE NUTRITION
In practice, urinary iodine is most often used to determine iodine nutrition at the population level.
The urinary iodine concentration indicates current iodine nutrition,
while thyroid size and the serum thyroglobulin concentration reflect iodine nutrition over a period of months or years.
Slide11Urinary iodine excretion
Mild iodine deficiency is defined as a median urinary iodine concentration of 50 to 99 mcg/L,
moderate deficiency as 20 to 49 mcg/L,
and severe deficiency as <20 mcg/L
Slide12Thyroid size
—
Thyroid size is a sensitive marker for iodine deficiency because goiter, although not the most severe consequence of iodine deficiency, is the most clinically evident.
Assessment by palpation is too crude to be anything more than qualitative except in severe deficiency, but ultrasonography is precise, quantifiable, and easily performed.
Slide13PROPHYLAXIS AND TREATMENT
Community
—
Iodine deficiency is a global public health problem and, in combating it, emphasis should be placed on diagnosis and correction at the level of the community rather than the individual.
Achieving sufficient iodine nutrition in the population would eliminate the need for specific supplementation during pregnancy and lactation.
Slide14During pregnancy and lactation
Slide15Slide16Slide17Iodine repletion in the doses used for iodization of salt and in prenatal supplements has few adverse effects
Iodine administration may result in clinically significant hyperthyroidism in patients with endemic goiter or in patients with nodular goiters containing autonomously functioning tissue.
In contrast, iodine administration may induce or exacerbate hypothyroidism in patients with underlying autoimmune thyroiditis .
Slide18Maternal and neonatal outcomes and determinants of iodine deficiency in third trimester of pregnancy in an iodine
sufficient area
Soraya Saleh
Gargari
,
Reyhaneh
Fateh
,
Mina
Bakhshali-bakhtiari
,
Masoumeh Saleh
,
Masoumeh
Mirzamoradi
&
Mahmood
Bakhtiyari
BMC Pregnancy and Childbirth volume 20, Article number: 174 (2020)
Iodine deficiency in pregnant women can be improved by appreciate planning for pregnancy, proper inter-pregnancy time interval (> 12 months to < 5 years), appropriate nutrition during pregnancy. Besides, controlling maternal urinary iodine concentrations is important to prevent neonatal complications such as preterm delivery and NICU admission.
Slide19Review of Iodine Nutrition in Iranian Population in the Past Quarter of Century
Hossein Delshad
1
and
Fereidoun
Azizi
1,*2017
The success of iodine deficiency control program depends on well designed programmatic steps and mandatory iodized salt consumption in certain situations. The iodine intake of school children is sufficient, however,
Iranian pregnant women are suffering from moderate iodine deficiency and need iodine supplementation
.
Slide20Appropriate Iodine Nutrition in Iran: 20 Years of Success
Hossein
Delshad
2010
Iodine Deficiency Disorders in the South of Iran during 1989-2012
: A Surveillance System Report Alireza Mirahmadizadeh1 , Elham Kavoosi2, Marzieh Vakili2,
Razieh
Shenavar2, Mohsen
Moghadami
Slide21Evaluation of Iodine Nutritional Status in Tehran, Iran: Iodine Deficiency Within Iodine Sufficiency
Pantea
Nazeri
Parvin
Mirmiran
Yadollah
Mehrabi
Mehdi
Hedayati
Hossein
Delshad
and
Fereidoun
Azizi
Mild iodine deficiency has recurred in
Tehranians
. The results emphasize the need for continuous monitoring in all regions, even in a country with iodine sufficiency.