Iodine and Reproduction

先兆子痫是一种妊娠期疾病，包括高血压和蛋白尿，是孕产妇和胎儿发病率和死亡率的主要原因。一些研究，但不是全部，发现患有先兆子痫的妇女的碘水平明显低于健康孕妇。解决这个问题很重要，因为怀孕期间碘缺乏症在美国和包括芬兰在内的欧洲部分地区很常见。我们进行了一项巢式病例对照研究，以确定先兆子痫的风险是否与碘营养状况有关。我们测量了血清碘，甲状腺球蛋白（Tg），促甲状腺激素（TSH）在10-14周胎龄的204名妇女与先兆子痫和246名未受影响的对照组从所有出生在芬兰。我们发现碘没有显著差异（病例平均值= 26.04 ng/mL，对照平均值= 27.88 ng/mL，p = 0.995），Tg（病例平均值= 31.11 ng/mL，对照组平均值= 29.61 ng/mL，p = 0.996）和TSH（病例平均值= 1.30 mIU/L，对照平均值= 1.24 mIU/L，p = 0.896）。校正已知危险因素后，先兆子痫风险与碘、Tg或TSH之间无显著相关性。鉴于妊娠期碘缺乏症的高发率，这些结果令人放心。 妊娠期严重碘缺乏或过量可导致先天性甲状腺功能减退症（CH）。碘缺乏症在美国孕妇中很常见。我们在加州的250万新生儿队列中进行了一项巢式病例对照研究，以确定碘状态是否与美国人群中的CH相关。从加州新生儿筛查项目中获得了907名通过新生儿筛查确定的CH新生儿和909名出生月份匹配的未受影响的对照新生儿的干血斑，以测量全血碘浓度。比较病例组和对照组的碘状态，并采用逻辑回归分析评估CH状态与血碘浓度之间的关系。还比较了在新生儿重症监护室（NICU）接受治疗的婴儿中病例和对照组之间的碘状态，因为在NICU中暴露于高水平碘的婴儿中报告了CH。 病例组（中位数：20.0 ng/mL; IQR：12.1-29.8 ng/mL）和对照组（中位数：20.3 ng/mL; IQR：12.5-30.9 ng/mL; P = 0.59）的血碘浓度无显著差异。极高或极低血碘浓度（分布的第1、5、95和99位）在病例中均不常见。然而，在NICU治疗的婴儿中，与对照组（中位数：17.3 ng/mL; IQR：8.3-26.6 ng/mL）相比，病例的碘（中位数：22.7 ng/mL; IQR：16.4-32.1 ng/mL）显著（P = 0.01）更高。 CH病例在这一人群中没有明显的高碘或低碘，这是令人放心的，因为母亲碘缺乏在美国很常见。在NICU的新生儿中，CH病例的血碘浓度高于对照组，这表明NICU中过量的碘暴露可能导致CH。监测来自外科手术、成像和含碘消毒剂的碘暴露并考虑非碘替代品可能是有益的。

Preeclampsia, a pregnancy disorder that includes hypertension and proteinuria, is a major cause of maternal and fetal morbidity and mortality. Some studies, but not all, have found that women with preeclampsia have significantly lower iodine levels than healthy pregnant women. Resolving this issue is important because iodine deficiency in pregnancy is common in the USA and parts of Europe including Finland. We conducted a nested case-control study to determine whether the risk for preeclampsia is associated with iodine status. We measured serum iodine, thyroglobulin (Tg), and thyroid stimulating hormone (TSH) at 10-14 weeks gestational age in 204 women with preeclampsia and 246 unaffected controls selected from all births in Finland. We found no significant difference in iodine (case mean = 26.04 ng/mL, control mean = 27.88 ng/mL, p = 0.995), Tg (case mean = 31.11 ng/mL, control mean = 29.61 ng/mL, p = 0.996), and TSH (case mean = 1.30 mIU/L, control mean = 1.24 mIU/L, p = 0.896) levels between cases and controls. There was no significant relationship between preeclampsia risk and iodine, Tg, or TSH after adjustment for known risk factors. These results are reassuring given the high prevalence of iodine deficiency in pregnancy. Severe iodine deficiency or excess during pregnancy can cause congenital hypothyroidism (CH). Iodine deficiency is common in pregnant women in the United States. We conducted a nested case-control study in a cohort of 2.5 million births in California to determine whether iodine status is related to CH in a US population. Dried blood spots from 907 newborns with CH identified by newborn screening and 909 unaffected controls matched by month of birth were obtained from the California Newborn Screening Program to measure whole-blood iodine concentration. Iodine status was compared between cases and controls, and logistic regression was used to assess the association between CH status and blood iodine concentrations. Iodine status was also compared between cases and controls among infants treated in a neonatal intensive care unit (NICU) because CH has been reported in infants exposed to high levels of iodine in the NICU. Blood iodine concentrations did not differ significantly between cases (median: 20.0 ng/mL; IQR: 12.1-29.8 ng/mL) and controls (median: 20.3 ng/mL; IQR: 12.5-30.9 ng/mL; P = 0.59). Neither extremely high nor extremely low blood iodine concentrations (1st, 5th, 95th, and 99th percentiles of the distribution) were more common in cases. Among infants treated in NICUs, however, cases had significantly (P = 0.01) higher iodine (median: 22.7 ng/mL; IQR: 16.4-32.1 ng/mL) compared with controls (median: 17.3 ng/mL; IQR: 8.3-26.6 ng/mL). CH cases did not have significantly higher or lower iodine in this population, which is reassuring given that maternal iodine deficiency is common in the United States. Among newborns in the NICU, CH cases had higher blood iodine concentrations compared with controls, suggesting that excess iodine exposure in the NICU could be causing CH. It may be beneficial to monitor iodine exposure from surgical procedures, imaging, and iodine-containing disinfectants and to consider non-iodine alternatives.