Iodine Nutrition and Thyroid Disease During Pregnancy and Lactation

妊娠期和哺乳期的碘营养与甲状腺疾病

• 批准号: 8826793
• 负责人: Angela Mei-Tin Leung
• 金额: $ 12.87万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-01 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8826793
• 关键词: Academic Medical Centers; Academic advising; Address; Advisory Committees; Affect; Appointment; Area; Award; Biological Markers; Biostatistical Methods; Boston; Breast; Breast Feeding; Caucasians; Childhood; Clinical; Clinical Investigator; Clinical Research; Clinical Research Curriculum Award; Country; Cross-Sectional Studies; Data; Databases; Development Plans; Diabetic Diet; Dietary Iodine; Discipline of obstetrics; Educational process of instructing; Endocrine; Endocrinology; Environment; Environmental Exposure; Epidemiologic Methods; Epidemiology; Exposure to; Faculty; Fellowship; Female of child bearing age; First Pregnancy Trimester; Fostering; Funding; Future; Grant; Guidelines; Health; Hour; Human Milk; Hypothyroidism; Infant; Infant Health; Ingestion; Institutes; Intake; Interdisciplinary Study; Iodine; Knowledge; Laboratories; Lactation; Los Angeles; Master of Science; Measures; Medicine; Mental Retardation; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Mothers; NCI Scholars Program; National Health and Nutrition Examination Survey; National Research Service Awards; Outcome; Perchlorates; Perinatal; Physiology; Population; Population Database; Postpartum Women; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Prenatal Nutrition; Public Health; Public Health Schools; Publications; Regression Analysis; Research; Research Personnel; Research Project Grants; Research Training; Residencies; SECTM1 gene; Serum; Site; Standardization; Testing; Thiocyanates; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland; Thyroid Hormones; Time; Training; Training Programs; Trust; United States National Institutes of Health; Universities; Urine; Variant; Woman; Women' s Health; Work; World Health Organization; career; career development; cigarette smoking; college; design; experience; fetal; hatching; infant nutrition; instructor; interest; iodine deficiency syndrome; meetings; member; neurodevelopment; nutrition; perinatal outcomes; pregnant; premature; prenatal; professor; programs; reproductive; screening; skills; sodium-iodide symporter; symposium; uptake; urinary

DESCRIPTION (provided by applicant): My research experience began with laboratory projects at Occidental College in Los Angeles. During my residency and fellowship training at Boston University Medical Center (BUMC), I undertook several clinical research projects with Drs. Lewis Braverman and Elizabeth Pearce. In June 2009, I completed a clinical and research fellowship in the Section of Endocrinology, Diabetes, and Nutrition at Boston University Medical Center (BUMC), the last 2 years of which were supported by an NIH T32 National Research Service Award. I completed the BUMC Clinical Research Training (CREST) program (an NIH K30 Clinical Research Curriculum Award) from 2007-2009. In July 2009, I became a junior faculty member at Boston University, a Clinical and Translational Institute (CTSI) site, (BU-BRIDGE). I received a Master of Science in Epidemiology degree at the Boston University School of Public Health in January 2010. I have had 5 original research publications related to the topics of the current proposal, including 3 as first author. I am supported by a Charles A. King Trust Postdoctoral Fellowship Award and an NIH K12 Building Interdisciplinary Research Careers in Women's Health (BIRCWH) grant at Boston University. The BIRCWH scholars program promotes career development of young investigators through mentored research, monthly research meetings, academic guidance, and national research presentations. During the K23 award period, my career development plans include participation in research-oriented seminars, presenting at national endocrine meetings, attending BUMC didactic conferences, teaching activities, and formal coursework at BUMC. I have assembled a research advisory committee who will assess my progress and provide ongoing guidance as I pursue my research plan. The skills and mentorship I will obtain through the BIRCWH and K23 awards will allow me to develop future research hypotheses aimed at specific strategies of achieving adequate iodine nutrition and normal thyroid function during pregnancy and lactation. This work will then prepare me to embark on the design and implementation of an R01 award aimed at specific strategies to achieve universal adequate iodine nutrition and normal thyroid function during pregnancy and lactation. Environment I am currently an Instructor of Medicine in the Section of Endocrinology, Diabetes, and Nutrition (Shalender Bhasin, MD; Chief) at BUMC, where the majority of my current appointment is devoted to research. The Section is comprised of 45 full-time faculty members (including one of the largest thyroid groups in the country with 7 fulltime MD faculty) and boasts over 12 million dollars in research funding, an NIH training grant, and several program and center projects. My mentor on this proposal is Dr. Lewis Braverman, Professor of Medicine at BUMC and an accomplished mentor to over 60 fellows in various aspects of thyroid physiology over his nearly 50-year career. My co-mentor is Dr. Elizabeth Hatch, Associate Professor of Epidemiology at Boston University School of Public Health, who has extensive experience and research interests in prenatal and childhood exposures relating to adverse reproductive outcomes. Research Iodine deficiency is debilitating, prevalent, and the leading cause of mental retardation worldwide. Dietary iodine is necessary for thyroid hormone synthesis. Normal thyroid function is particularly important during pregnancy and lactation, as maternal thyroid hormone levels are crucial for proper fetal and infant neurodevelopment. The impact of breast milk iodine levels on infant thyroid function is unknown. In addition, environmental exposures to perchlorate and cigarette smoke (which is metabolized to thiocyanate) decrease iodine uptake into the lactating breast, thereby further impairing iodine availability to the infant and potentially directly affecting infant thyroid function. The broad objective of this proposal is to test the hypotheses that: 1) hypothyroidism during pregnancy is associated with premature birth and other adverse obstetric/perinatal outcomes, and 2) breast milk perchlorate and thiocyanate levels, by their inhibition of NIS, decrease breast milk iodine levels (which fluctuate in relationship to dietary iodine ingestion), and are associated with infant hypothyroidism. The results of this research will have important public health implications for thyroid function screening among pregnant women and adequate maternal iodine nutrition during pregnancy and lactation. Specific Aim 1 will be a database review studying the relationships between maternal hypothyroidism during pregnancy and obstetric/perinatal outcomes. Specific Aim 2 will be an interventional assessment of an iodine load on the effects and timing of peak breast milk iodine levels in postpartum women. Specific Aim 3 will be a cross-sectional study of maternal and infant iodine intake, maternal and infant perchlorate and cigarette smoke (thiocyanate) exposures, and infant thyroid function. The pursuit of these projects, in conjunction with formal coursework in biostatistical and epidemiological methods, is intended to foster my career as an independent academic clinical investigator in thyroid disease as it relates to women's and infant health.

描述(申请人提供)：我的研究经历始于洛杉矶西方学院的实验室项目。在波士顿大学医学中心(BUMC)住院医师和研究员培训期间，我与Lewis Braverman博士和Elizabeth Pearce博士一起承担了几个临床研究项目。2009年6月，我在波士顿大学医学中心(BUMC)完成了内分泌学、糖尿病和营养科的临床和研究奖学金，这两年的研究得到了NIH T32国家研究服务奖的支持。我在2007-2009年间完成了北大临床研究培训(CREST)项目(NIH K30临床研究课程奖)。2009年7月，我成为波士顿大学的初级教员，这是一个临床和翻译研究所(CTSI)网站(BU-Bridge)。2010年1月，我在波士顿大学公共卫生学院获得了流行病学理学硕士学位。我已经有5份与当前提案主题相关的原创研究出版物，其中3份是第一作者。我得到了查尔斯·A·金信托基金会博士后奖学金和波士顿大学NIH K12建设妇女健康跨学科研究事业(BIRCWH)赠款的支持。BIRCWH学者计划通过有指导的研究、每月的研究会议、学术指导和国家研究报告来促进年轻研究人员的职业发展。在K23获奖期间，我的职业发展计划包括参加以研究为导向的研讨会，在全国内分泌会议上发表演讲，参加北大教学会议，教学活动，以及北大的正式课程。我已经组建了一个研究咨询委员会，该委员会将评估我的进展，并在我实施研究计划时提供持续的指导。我将通过BIRCWH和K23奖项获得的技能和指导将使我能够开发未来的研究假设，旨在制定特定的策略，在怀孕和哺乳期间实现足够的碘营养和正常的甲状腺功能。然后，这项工作将使我做好准备，着手设计和实施R01奖励，旨在制定具体战略，以实现怀孕和哺乳期间普遍充分的碘营养和正常的甲状腺功能。环境我目前是北京理工大学内分泌学、糖尿病和营养科(Shalender Bhasin医学博士，首席)的一名医学讲师，我目前的大部分时间都致力于研究。该部门由45名全职教员组成(包括全国最大的甲状腺组织之一，拥有7名全职MD教员)，拥有超过1200万美元的研究资金、NIH培训补助金以及几个项目和中心项目。我的这项提议的导师是刘易斯·布雷弗曼博士，他是北卡罗来纳大学的医学教授，在他近50年的职业生涯中，他在甲状腺生理的各个方面为60多名研究员提供了卓有成效的指导。我的共同导师是波士顿大学公共卫生学院流行病学副教授伊丽莎白·哈奇博士，她在产前和儿童时期暴露于与不良生殖结果有关的风险方面拥有丰富的经验和研究兴趣。研究缺碘使人虚弱、普遍，是世界范围内精神发育迟缓的主要原因。膳食碘是甲状腺激素合成所必需的。正常的甲状腺功能在怀孕和哺乳期间尤其重要，因为母亲的甲状腺激素水平对胎儿和婴儿的神经发育至关重要。母乳碘水平对婴儿甲状腺功能的影响尚不清楚。此外，环境中暴露于高氯酸盐和香烟烟雾(代谢为硫氰酸盐)会减少哺乳乳房对碘的吸收，从而进一步损害婴儿获得碘的能力，并可能直接影响婴儿的甲状腺功能。这项建议的广泛目标是检验以下假设：1)妊娠期甲状腺功能低下与早产和其他产科/围产期不良结局有关，2)母乳中的高氯酸盐和硫氰酸盐水平，通过抑制NIS，降低母乳碘水平(与饮食中碘摄入量的关系而波动)，并与婴儿甲状腺功能低下有关。本研究结果对孕妇甲状腺功能筛查和孕妇孕期及哺乳期适量碘营养具有重要的公共卫生意义。具体目标1将是一项数据库审查，研究孕期母亲甲状腺功能减退与产科/围产期结局之间的关系。具体目标2将是对产后妇女碘负荷对母乳碘水平峰值的影响和时间的干预性评估。具体目标3将是对母婴碘摄入量、母婴高氯酸盐和香烟烟雾(硫氰酸盐)暴露以及婴儿甲状腺功能的横断面研究。这些项目的实施，加上生物统计学和流行病学方法的正式课程，旨在促进我作为甲状腺疾病独立学术临床调查员的职业生涯，因为它关系到妇女和婴儿的健康。

项目成果

The state of U.S. Iodine nutrition: how can we ensure adequate iodine for all?

美国碘营养状况：如何确保所有人都有足够的碘？

• DOI: 10.1089/thy.2013.0295
• 发表时间: 2013
• 期刊: Thyroid : official journal of the American Thyroid Association
• 作者: Pearce,ElizabethN;Leung,AngelaM
• 通讯作者: Leung,AngelaM

Impact of Hypothyroidism and Heart Failure on Hospitalization Risk.

甲状腺功能减退症和心力衰竭对住院风险的影响。

• DOI: 10.1089/thy.2017.0362
• 发表时间: 2018
• 期刊: Thyroid : official journal of the American Thyroid Association
• 作者: Ro,Kevin;Yuen,AlexanderD;Du,Lin;Ro,ClarissaC;Seger,Christian;Yeh,MichaelW;Leung,AngelaM;Rhee,ConnieM
• 通讯作者: Rhee,ConnieM

Perchlorate, iodine and the thyroid.

• DOI: 10.1016/j.beem.2009.08.009
• 发表时间: 2010-02
• 期刊: Best practice & research. Clinical endocrinology & metabolism
• 作者: Leung AM;Pearce EN;Braverman LE
• 通讯作者: Braverman LE

Prognostic indicators for the development of strabismus among patients with graves' ophthalmopathy.

• DOI: 10.1016/j.jcte.2017.06.005
• 发表时间: 2017-09
• 期刊: Journal of clinical & translational endocrinology
• 影响因子: 3
• 作者: Lin TY;Li N;Yeh MW;Leung AM;Rootman DB
• 通讯作者: Rootman DB

Factors determining the persistence or recurrence of well-differentiated thyroid cancer treated by thyroidectomy and/or radioiodine in the Boston, Massachusetts area: A retrospective chart review.

马萨诸塞州波士顿地区通过甲状腺切除术和/或放射性碘治疗的高分化甲状腺癌持续存在或复发的决定因素：回顾性图表回顾。

• DOI: 10.1186/1756-6614-4-9
• 发表时间: 2011
• 期刊: Thyroid research
• 影响因子: 2.2
• 作者: Leung,AngelaM;Dave,Shalini;Lee,StephanieL;Campion,FrancisX;Garber,JeffreyR;Pearce,ElizabethN
• 通讯作者: Pearce,ElizabethN