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Kampouri M, Tofail F, Rahman SM, Gustin K, Vahter M, Kippler M. Gestational and childhood urinary iodine concentrations and children's cognitive function in a longitudinal mother-child cohort in rural Bangladesh. Int J Epidemiol 2022; 52:144-155. [PMID: 35613019 PMCID: PMC9908062 DOI: 10.1093/ije/dyac110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Severe iodine deficiency adversely affects neurodevelopment; however, evidence regarding the association of non-severe deficiency and child cognitive functioning is inconclusive. METHODS This prospective mother-child cohort study was nested in a population-based nutritional supplementation trial in Bangladesh (Maternal and Infant Nutrition Interventions in Matlab [MINIMat]). Participants with data on cognitive abilities at 5 and 10 years of age (n = 1530) and at least one measurement of urinary iodine concentration (UIC) (gestational week 8, 5, and 10 years) were selected. Cognitive abilities were assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) and Wechsler Intelligence Scale for Children (WISC-IV). UICs were measured with inductively coupled plasma mass spectrometry and thereafter adjusted for specific gravity. RESULTS Median UICs in our population: (282 μg/L [pregnancy]; 406 μg/L [5 years]; 294 μg/L [10 years]) indicated that iodine intake corresponded to above 'adequate' or even 'excessive', according to the WHO classification. Maternal 'UIC <150 μg/L' was associated with lower full-scale and verbal scores at 5 and 10 years, although the associations were weakened in the fully adjusted models. A tendency of decreased verbal scores was also observed for maternal 'UIC ≥500 μg/L' but not for the corresponding child iodine category (≥300 μg/L). Child 'UIC <100 μg/L' was associated with lower processing speed (B=-3.1, 95% CI [-6.2, -0.1]; P-value = 0.041) compared with the reference group (100 μg/L≤ UIC <300 μg/L). CONCLUSIONS Current findings add to the growing evidence of a causal association of early-life iodine intake with cognitive development, indicating that low iodine intake during childhood is associated with reduced processing speed and non-optimal gestational iodine intake is weakly associated with slightly poorer verbal development outcomes.
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Affiliation(s)
- Mariza Kampouri
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fahmida Tofail
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Syed Moshfiqur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh,Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Klara Gustin
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marie Vahter
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Kippler
- Corresponding author. Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77, Stockholm, Sweden. E-mail:
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Murphy MSQ, Chakraborty P, Pervin J, Rahman A, Wilson LA, Lamoureux M, Denize K, Henderson M, Hawken S, Potter BK, Little J, Wilson K. Incidental screen positive findings in a prospective cohort study in Matlab, Bangladesh: insights into expanded newborn screening for low-resource settings. Orphanet J Rare Dis 2019; 14:25. [PMID: 30700313 PMCID: PMC6354381 DOI: 10.1186/s13023-018-0993-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/28/2018] [Indexed: 12/29/2022] Open
Abstract
Background Newborn screening programs are essential preventative public health initiatives but are not widely available in low-resource settings. The objective of this study was to describe the frequency and nature of screen positive determinations as made by a Canadian newborn screening program in a cohort of infants born in Matlab, Bangladesh. Dried newborn cord and heel-prick blood spot samples collected as part of a validation study nested within a preterm birth research cohort were collected between January 2017 and July 2018 and analyzed in a Canadian newborn screening laboratory where the laboratory’s disease panel and screening thresholds were applied. Results A total of 1661 newborn samples (520 heel-prick and 1141 cord blood samples) were available for analysis. Based on the applied screening thresholds, 61 samples (22 by heel-prick and 39 by cord blood) were screen positive for conditions included in the Canadian disease panel. Congenital hypothyroidism was the most common determination for heel-prick (n = 17) and cord blood (n = 12) samples. Carriers of hemoglobinopathy variants were identified in 6.9% of both tested heel-prick and cord blood samples. Conclusions This study provides insight into the nature and frequency of treatable congenital conditions in a rural Bangladesh community where such data were previously unavailable. As comment to the feasibility of newborn screening in the region we confirm that screening based on cord blood sampling continues to be the most acceptable modality to parents in such settings. Acknowledged barriers include early infant discharge, which may affect the reliability of initial screening thresholds to determine disease risk. We further highlight the importance of continuing efforts in the country to identify infants with congenital hypothyroidism. Electronic supplementary material The online version of this article (10.1186/s13023-018-0993-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Malia S Q Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, K1Y 4E9, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, K1H 5B2, Canada
| | - Jesmin Pervin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Anisur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Lindsay A Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, K1Y 4E9, Canada
| | - Monica Lamoureux
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, K1H 5B2, Canada
| | - Kathryn Denize
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, K1H 5B2, Canada
| | - Matthew Henderson
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, K1H 5B2, Canada
| | - Steve Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, K1Y 4E9, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, K1G 5Z3, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, K1G 5Z3, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, K1Y 4E9, Canada.
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Kotwal A, Priya R, Qadeer I. Goiter and other iodine deficiency disorders: A systematic review of epidemiological studies to deconstruct the complex web. Arch Med Res 2007; 38:1-14. [PMID: 17174717 DOI: 10.1016/j.arcmed.2006.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2006] [Accepted: 08/21/2006] [Indexed: 11/21/2022]
Abstract
A systematic review of the available literature on goiter and other iodine deficiency disorders (IDDs) was carried out with the aim of analyzing available evidence and providing inputs to the policy makers and program formulators regarding the entire issue. The findings point to major issues such as the following: methodological issues in epidemiology of goiter and other iodine deficiency disorders (IDDs); lacunae in causal linkages; inadequate attention to multicausality; flawed assessment of the impact of intervention, i.e., iodized salt; and harmful effects of iodine not given due cognizance. Most of the research to date has been unidirectional and does not provide comprehensive data on all aspects of IDDs. To further compound the issue, many independent researchers, on finding something different from the existing dominant paradigm (iodized salt as panacea for goiter) have tended to ignore these in their final conclusions and recommendations. Thus, evidence from this systematic review demonstrates enough basis to start a debate on the entire issue, recognizing opposing research findings while continuing with the present strategy. This imposes specific problems and necessitates area-specific solutions instead of a universal solution, which apart from being less effective may be harmful in the long run.
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Affiliation(s)
- Atul Kotwal
- Management Information Systems Organization, Integrated HQ Min of Defence (Army), New Delhi, India.
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