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Businge CB, Phohlo K, Sewani-Rusike C. Thyroid peroxidase antibody titers, thyroid function, and iodine nutrition status of pregnant normotensive and preeclamptic women in Eastern Cape South Africa. AJOG GLOBAL REPORTS 2023; 3:100267. [PMID: 37954219 PMCID: PMC10632106 DOI: 10.1016/j.xagr.2023.100267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Autoimmune thyroid disease, one of the main risk factors for hypothyroidism, is associated with adverse pregnancy outcomes. The burden of autoimmune thyroid disease in pregnancy and its association with thyroid function among normotensive pregnant women and pregnant women with hypertension in South Africa are not known. OBJECTIVE This study aimed to establish the magnitude of thyroid peroxidase autoantibodies in pregnancy in the Eastern Cape of South Africa and its relationship with iodine nutrition status and preeclampsia. STUDY DESIGN Overall, 60 randomly selected normotensive pregnant controls at term and 120 pregnant participants with preeclampsia in the third trimester of pregnancy going to the Mthatha Regional Hospital and the Nelson Mandela Academic Hospital in the Eastern Cape Province who had complete data on thyroid peroxidase antibody titers, urinary iodine concentrations, serum thyroid-stimulating hormones, and free triiodothyronine, free thyroxine, and thyroglobulin levels were enrolled in this unmatched case-control study. RESULTS The cases and controls had similar mean chronological age (23.8 vs 24.0 years), body mass index (29.4 vs 28.8 kg/m2), and median parity (both 1) (P>.05). The controls had a higher mean gestational age than participants with preeclampsia (38.5 vs 33.7 weeks, respectively; P<.001). Both participants with preeclampsia and normotensive participants had median thyroid peroxidase antibody levels consistent with a negative thyroid autoimmune status. Participants with preeclampsia had higher but nonstatistically significant median thyroid peroxidase antibody (2.14 vs 1.77 IU/L), thyroglobulin (25.9 vs 21.3 µg/L), and thyroid-stimulating hormone (2.4 vs 2.3 mIU/L) levels (P>.05) and significantly lower median urinary iodine concentration (123.4 vs 188.6 µg/L), free thyroxine (13.2 vs 14.1 pmol/L), and free triiodothyronine (4.3 vs 4.6 pmol/L) levels (P<.05) than normotensive controls. Thyroid peroxidase antibodies were positively correlated with thyroglobulin, urinary iodine concentration, and thyroid-stimulating hormone. CONCLUSION In the rural Eastern Cape of South Africa, pregnant women in the third trimester of pregnancy have thyroid peroxidase antibody titers that show negative thyroid autoimmune status. Insufficient iodine intake, other than thyroid autoimmune disease, seems to be the underlying cause of the lower free triiodothyronine and free thyroxine levels observed among women with preeclampsia.
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Affiliation(s)
- Charles Bitamazire Businge
- Faculty of Health Sciences, Department of Obstetrics and Gynaecology, Walter Sisulu University, Mthatha, South Africa (Dr Businge)
| | - Keletso Phohlo
- Division of Medical Virology, Genital Mucosal STI/HIV Laboratory, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa (Mr Phohlo)
| | - Constance Sewani-Rusike
- Faculty of Health Sciences, Department of Human Biology, Walter Sisulu University, Mthatha, South Africa (Dr Sewani-Rusike)
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Liu ZM, Wu Y, Long HH, Chen CG, Wang C, Ye YB, Shen ZY, Ye MT, Zhang SJ, Li MM, Pan WJ. Associations of Maternal Serum Iodine Concentration with Obstetric Complications and Birth Outcomes-Longitudinal Analysis Based on the Huizhou Mother-Infant Cohort, South China. Nutrients 2023; 15:2868. [PMID: 37447195 DOI: 10.3390/nu15132868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023] Open
Abstract
This study aimed to explore the temporal associations between maternal serum iodine concentration (SIC) and common pregnancy outcomes in Chinese women. Eligible singleton pregnant women aged 20-34 years were selected, and their fasting blood samples were collected during early (T1, n = 1101) and mid-pregnancy (T2, n = 403) for SIC testing by inductively coupled plasma mass spectrometry. Multivariable linear regression indicated that log10SIC at T1 (β = -0.082), T2 (β = -0.198), and their % change (β = -0.131) were inversely associated with gestational weight gain (GWG, all p < 0.05). Maternal log10SIC at both T1 (β = 0.077) and T2 (β = 0.105) were positively associated with the Apgar score at 1 min (both p < 0.05). Women in the third quartile (Q3) of SIC at T1 had a lower risk of small for gestational age (SGA, OR = 0.405, 95% CI: 0.198-0.829) compared with those in Q4. Restricted cubic spline regression suggested a U-shaped association between SIC and SGA risk, and SIC above 94 μg/L at T1 was the starting point for an increased risk of SGA. The risk of premature rupture of membrane (PROM) increased by 96% (OR = 1.960, 95% CI: 1.010-3.804) in Q4 compared to that in Q1. Our longitudinal data from an iodine-replete region of China indicated that high maternal SIC could restrict GWG and improve Apgar scores at delivery, but might increase the risk of SGA and PROM.
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Affiliation(s)
- Zhao-Min Liu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, North Campus, Guangzhou 510080, China
| | - Yi Wu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, North Campus, Guangzhou 510080, China
| | - Huan-Huan Long
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, North Campus, Guangzhou 510080, China
| | - Chao-Gang Chen
- Department of Clinical Nutrition, Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Cheng Wang
- Department of Clinical Nutrition, Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Yan-Bin Ye
- Department of Clinical Nutrition, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Zhen-Yu Shen
- Department of Paediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Ming-Tong Ye
- Huizhou First Maternal and Child Health Care Hospital, Huizhou 516000, China
| | - Su-Juan Zhang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, North Campus, Guangzhou 510080, China
| | - Min-Min Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-sen University, North Campus, Guangzhou 510080, China
| | - Wen-Jing Pan
- Huizhou First Maternal and Child Health Care Hospital, Huizhou 516000, China
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Businge CB, Longo-Mbenza B, Kengne AP. Iodine deficiency in pregnancy along a concentration gradient is associated with increased severity of preeclampsia in rural Eastern Cape, South Africa. BMC Pregnancy Childbirth 2022; 22:98. [PMID: 35120491 PMCID: PMC8815178 DOI: 10.1186/s12884-021-04356-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 12/17/2021] [Indexed: 12/16/2022] Open
Abstract
Background Preeclampsia is a leading cause of maternal mortality and morbidity in South Africa. Iodine deficiency in pregnancy, which is amenable to correction through iodine supplementation, has been reported to increase the risk of preeclampsia. However, the association of iodine nutrition status with preeclampsia in South Africa has not been studied. Methods We enrolled 51 randomly selected normotensive pregnant controls at term together with 51 consecutively selected cases of preeclampsia and 51 cases of severe preeclampsia/eclampsia, all in the third trimester, from Mthatha Regional and Nelson Mandela Academic Hospital in the Eastern Cape Province. Urinary iodine concentration (UIC), serum thyroid-stimulating hormone (TSH), triiodothyronine (FT3), thyroxine (FT4) and thyroglobulin (Tg) levels were compared between cases and controls. Results The respective chronological and gestational ages at enrolment for normotensive, preeclampsia and severe preeclampsia/eclampsia participants were: age 23, 24 and 19 years (p = 0.001), and gestational age 38, 34, and 35 weeks (p < 0.001). The median gravidity was 1 for all three groups. The median UIC, FT4, FT3 revealed a decreasing and Tg a rising trend with the severity of preeclampsia (p < 0.05). TSH had a non-significant rising trend (p > 0.05). The respective median values for normotensive, preeclampsia and severe preeclampsia/eclampsia participants were UIC 217.1, 127.7, and 98.8 μg/L; FT4 14.2, 13.7, and 12. pmol/L; FT3 4.8, 4.4, and 4.0 pmol//L; Tg 19.4, 21.4, and 32. Nine microgram per liter; TSH 2.3, 2.3, and 2.5 mIU/L. UIC < 100 μg/L, Tg > 16 μg/L and FT4 < 11.3 pmol/L were independent predictors of preeclampsia/eclampsia syndrome. Conclusion Women with severe preeclampsia/eclampsia had significantly low UIC and high Tg, suggesting protracted inadequate iodine intake. Inadequate iodine intake during pregnancy severe enough to cause elevated Tg and FT4 deficiency was associated with an increased risk of severe preeclampsia/eclampsia.
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Affiliation(s)
- Charles Bitamazire Businge
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Walter Sisulu University, Private Bag x1 WSU, Mthatha, 5117, South Africa. .,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Benjamin Longo-Mbenza
- Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.,LOMO University of Research, Kinshasa, Democratic Republic of Congo
| | - Andre Pascal Kengne
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
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Urinary iodine as an important indicator for preeclampsia: a Polish perspective. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2021. [DOI: 10.2478/cipms-2021-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Abstract
Preeclampsia (PE) is one of the leading causes of perinatal and maternal morbidity. Although subclinical hypothyroidism in pregnancy is one of the established risk factors for PE, the link between iodine deficiency and PE is not fully understood. The aim of our study was to assess urinary iodine concentration (UIC), serum thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) levels in Polish women with PE (PE group, n=78) compared with healthy non-pregnant women (CNP group, n=30), and healthy pregnant women (CP group, n=46). The UIC was determined by inductively coupled plasma mass spectrometry (ICP-MS). Both the mean UIC of 144.6±36.4 μg/L in the CP group and the mean of 125.8±33.6 μg/L in the PE group, respectively, were lower compared to non-pregnant women (149.8±28.8 μg/L), and the difference between the PE and CNP groups was statistically significant. TSH values were the highest in the PE group, while the lowest average level was for the CNP group. The fT3 and fT4 values in the PE group were significantly lower compared to the CNP and CP groups. Despite iodine supplementation during pregnancy, the UIC was lower compared to non-pregnant women, while in women with PE it was at a significantly lower level. To reduce the incidence of possible health complications, proper iodine supplementation and monitoring of the UIC is recommended for pregnant women suffering from PE or at risk of developing PE.
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Reische EC, Männistö T, Purdue-Smithe A, Kannan K, Kim UJ, Suvanto E, Surcel HM, Gissler M, Mills JL. The Joint Role of Iodine Status and Thyroid Function on Risk for Preeclampsia in Finnish Women: a Population-Based Nested Case-Control Study. Biol Trace Elem Res 2021; 199:2131-2137. [PMID: 32821998 DOI: 10.1007/s12011-020-02341-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/09/2020] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Elijah C Reische
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Tuija Männistö
- Northern Finland Laboratory Center NordLab, Oulu University Hospital, 90120, Oulu, Finland
| | - Alexandra Purdue-Smithe
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Kurunthachalam Kannan
- Department of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, New York, NY, 10016, USA
| | - Un-Jung Kim
- Department of Earth and Environmental Sciences, University of Texas at Arlington, Arlington, TX, 76019, USA
| | - Eila Suvanto
- Northern Finland Laboratory Center NordLab, Oulu University Hospital, 90120, Oulu, Finland
| | - Heljä-Marja Surcel
- Biobank Borealis of Northern Finland, Oulu University Hospital, 90120, Oulu, Finland
- Faculty of Medicine, University of Oulu, 90120, Oulu, Finland
| | - Mika Gissler
- Finnish Institute of Health and Welfare, 00290, Helsinki, Finland
- Karolinska Institute, 17177, Stockholm, Sweden
| | - James L Mills
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA.
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Businge CB, Usenbo A, Longo-Mbenza B, Kengne AP. Insufficient iodine nutrition status and the risk of pre-eclampsia: a systemic review and meta-analysis. BMJ Open 2021; 11:e043505. [PMID: 33568375 PMCID: PMC7878161 DOI: 10.1136/bmjopen-2020-043505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Although subclinical hypothyroidism in pregnancy is one of the established risk factors for pre-eclampsia, the link between iodine deficiency, the main cause of hypothyroidism, and pre-eclampsia remains uncertain. We conducted a systematic review to determine the iodine nutrition status of pregnant women with and without pre-eclampsia and the risk of pre-eclampsia due to iodine deficiency. METHODS MEDLINE, EMBASE, Google Scholar, Scopus and Africa-Wide Information were searched up to 30th June 2020. Random-effect model meta-analysis was used to pool mean difference in urinary iodine concentration (UIC) between pre-eclamptic and normotensive controls and pool ORs and incidence rates of pre-eclampsia among women with UIC <150 µg/L. RESULTS Five eligible studies were included in the meta-analysis. There was a significant difference in the pooled mean UIC of 254 pre-eclamptic women and 210 normotensive controls enrolled in three eligible case-control studies (mean UIC 164.4 µg/L (95% CI 45.1 to 283.6, p<0.01, I2 >50)). The overall proportions of pre-eclampsia among women with UIC <150 µg/L and UIC >150 µg/L in two cross-sectional studies were 203/214 and 67/247, respectively, with a pooled OR of 0.01 (95% CI 0 to 4.23, p=0.14, I2 >50) for pre-eclampsia among women with UIC >150 µg/L. The overall incidence of pre-eclampsia among women with UIC <150 µg/L and UIC >150 µg/L in two cohort studies was 6/1411 and 3/2478, respectively, with a pooled risk ratio of 2.85 (95% CI 0.42 to 20.05, p=0.09, I2 <25). CONCLUSION Although pre-eclamptic women seem to have lower UIC than normotensive pregnant women, the available data are insufficient to provide a conclusive answer on association of iodine deficiency with pre-eclampsia risk. PROSPERO REGISTRATION NUMBER CRD42018099427.
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Affiliation(s)
- Charles Bitamazire Businge
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Anthony Usenbo
- Department of Anaesthesiolgy, Nelson Mandela Academic Hospital, Mthatha, South Africa
| | - Benjamin Longo-Mbenza
- Faculty of Medicine, University of Kinshasa and LOMO University of Research, Kinshasa, Democratic Republic of Congo
| | - A P Kengne
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
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Zhao J, Su Y, Zhang JA, Fang M, Liu X, Jia X, Li X. Inverse Association Between Iodine Status and Prevalence of Metabolic Syndrome: A Cross-Sectional Population-Based Study in a Chinese Moderate Iodine Intake Area. Diabetes Metab Syndr Obes 2021; 14:3691-3701. [PMID: 34447259 PMCID: PMC8384429 DOI: 10.2147/dmso.s322296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To investigate the relationship between iodine intake status and the prevalence of metabolic syndrome (MetS) through a population-based survey. PATIENTS AND METHODS In total, 2691 Chinese adults participated in this cross-sectional study, and they were stratified by urinary iodine concentration (UIC) and sex. Fasting blood samples were used to assess biochemical parameters, including thyroid function and antibodies. Urine samples were collected in the morning to measure UIC. Multivariate regression logistic analysis was performed for the overall population and sex subgroups. RESULTS An inverse association was observed between iodine intake status and MetS prevalence in Chinese adults. Compared with individuals with adequate iodine status, those with high-iodine status had significantly low MetS risks, and the adjusted odds ratios (95% confidence interval) were 0.70 (0.57-0.86, P <0.01) and 0.75 (0.6-0.95, P <0.05). A high MetS risk was observed in the iodine-deficient group, which did not reach statistical significance. There was a significant inverse linear trend between the risk of MetS and UIC in the total population and male subgroup (P for trend <0.05), which was not observed in the female subgroup (P for trend >0.05). CONCLUSION An inverse association was observed between iodine intake status and the risk of developing MetS in Chinese adults. Sufficient iodine status is a potential protective factor for MetS development. Males may benefit from increased iodine intake, while females would need to achieve a more-than-adequate iodine status to gain metabolic benefits.
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Affiliation(s)
- Jing Zhao
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People’s Republic of China
- Department of Endocrinology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, People’s Republic of China
| | - Yinbiao Su
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, People’s Republic of China
| | - Jin-An Zhang
- Department of Endocrinology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, People’s Republic of China
| | - Ming Fang
- Department of Cardiology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, People’s Republic of China
| | - Xuerong Liu
- Department of Endocrinology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, People’s Republic of China
| | - Xi Jia
- Department of Endocrinology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, People’s Republic of China
| | - Xinming Li
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People’s Republic of China
- Department of Cardiology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, People’s Republic of China
- Correspondence: Xinming Li Graduate School, Shanghai University of Traditional Chinese Medicine, Department of Cardiology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, People’s Republic of ChinaTel +86 21-68135590-3160 Email
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Habibi N, Grieger JA, Bianco-Miotto T. A Review of the Potential Interaction of Selenium and Iodine on Placental and Child Health. Nutrients 2020; 12:nu12092678. [PMID: 32887377 PMCID: PMC7551633 DOI: 10.3390/nu12092678] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 12/12/2022] Open
Abstract
A healthy pregnancy is important for the growth and development of a baby. An adverse pregnancy outcome is associated with increased chronic disease risk for the mother and offspring. An optimal diet both before and during pregnancy is essential to support the health of the mother and offspring. A key mediator of the effect of maternal nutrition factors on pregnancy outcomes is the placenta. Complicated pregnancies are characterized by increased oxidative stress in the placenta. Selenium and iodine are micronutrients that are involved in oxidative stress in placental cells. To date, there has been no comprehensive review investigating the potential synergistic effect of iodine and selenium in the placenta and how maternal deficiencies may be associated with increased oxidative stress and hence adverse pregnancy outcomes. We undertook a hypothesis-generating review on selenium and iodine, to look at how they may relate to pregnancy complications through oxidative stress. We propose how they may work together to impact pregnancy and placental health and explore how deficiencies in these micronutrients during pregnancy may impact the future health of offspring.
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Affiliation(s)
- Nahal Habibi
- School of Agriculture, Food and Wine, Waite Research Institute, and Robinson Research Institute, University of Adelaide, Adelaide 5005, Australia;
| | - Jessica A. Grieger
- Adelaide Medical School, and Robinson Research Institute, University of Adelaide, Adelaide 5005, Australia
- Correspondence: (J.A.G.); (T.B.-M.)
| | - Tina Bianco-Miotto
- School of Agriculture, Food and Wine, Waite Research Institute, and Robinson Research Institute, University of Adelaide, Adelaide 5005, Australia;
- Correspondence: (J.A.G.); (T.B.-M.)
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Gajewska K, Błażewicz A, Laskowska M, Niziński P, Dymara-Konopka W, Komsta Ł. Chemical elements and preeclampsia - An overview of current problems, challenges and significance of recent research. J Trace Elem Med Biol 2020; 59:126468. [PMID: 32007824 DOI: 10.1016/j.jtemb.2020.126468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 12/04/2019] [Accepted: 01/10/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Data on the elemental status, redistribution of the elements, role of occupational exposure and dietary assessment in preeclampsia (PE) are scarce. There are many disparities in the findings of essential and non-essential elements' role in PE. In this article we overview the changes in the content of selected elements in pregnancy complicated with the disorder of complex and not fully understood etiology. We have focused on important limitations and highlighted shortcomings in research from the last ten years period. METHODS The Scopus and PubMed electronic databases have been searched for English-language articles published within the time interval 2008-2018, with full text available and with the key words "preeclampsia" and "chemical element" (i.e. separately: Cd, Pb, As, Ni, Mo, Co, Cr, Mn, Se, I, Fe, Sr, Cu, Zn, Mg, K and Na) appearing in the title, abstract or keywords. RESULTS A total of 48 publications were eligible for this overview. Surprisingly only 4% of papers considered environmental exposure, 8%- diet and 2 %- comorbid diseases. In most published papers, occupational exposure was neglected. Meta-analysis was possible for seven elements in serum (Ca, Cu, Fe, Mg, Mn, Se, Zn), and two elements (Se, Zn) in plasma. It showed negative shift for most elements, however only several were statistically significant. CONLUSIONS The overview of the published data on PE and chemical elements yields varied results. Some of the reasons may be the difference in not duly validated method of determination, and huge discrepancies in study designs. The lack of detailed description of studied and control population and small number of samples constitute the most common limitations of such studies. Many of them describe the use of a single analytical procedure, therefore the quality of research may be insufficient to obtain reliable results. A history of elements' status and intake before and during pregnancy is usually not examined. Dietary assessment should be done at different stages of pregnancy, and whenever possible in the periconceptional period as well. It still needs to be established whether the deficiency of certain elements or their excess may be an etiopathogenic factor and a developmental cause of PE, and if it may serve as a target of actions in the causal treatment or even prevention of the occurrence of this disease.
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Affiliation(s)
- Katarzyna Gajewska
- Chair of Chemistry, Department of Analytical Chemistry, Medical University of Lublin, Poland.
| | - Anna Błażewicz
- Chair of Chemistry, Department of Analytical Chemistry, Medical University of Lublin, Poland
| | - Marzena Laskowska
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, Poland
| | - Przemysław Niziński
- Chair of Chemistry, Department of Analytical Chemistry, Medical University of Lublin, Poland
| | | | - Łukasz Komsta
- Department of Medicinal Chemistry, Faculty of Pharmacy with Division of Medical Analytics, Medical University of Lublin, Poland
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Businge CB, Madini N, Longo-Mbenza B, Kengne AP. Insufficient iodine nutrition status and the risk of pre-eclampsia: a protocol for systematic review and meta-analysis. BMJ Open 2019; 9:e025573. [PMID: 31129578 PMCID: PMC6538048 DOI: 10.1136/bmjopen-2018-025573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Pre-eclampsia is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. Although subclinical hypothyroidism (SCH) in pregnancy is one of the established risk factors for pre-eclampsia, the link between iodine deficiency, the main cause of hypothyroidism and pre-eclampsia remains uncertain. About two billion people live in areas with iodine insufficiency. The increased renal blood flow during pregnancy leading to increased renal iodine clearance together with the increased placental transfer of iodine to the fetus leads to further iodine deficiency in pregnancy. Iodine is one of the most potent exogenous antioxidants whose deficiency is associated with oxidant imbalance and endothelial dysfunction, one of the mechanisms associated with increased risk of pre-eclampsia. METHODS AND ANALYSIS A systematic search of published literature will be conducted for case-control studies that directly determined the iodine nutrition status of women with pre-eclampsia and appropriate normotensive controls. A similar search will be conducted for cohort studies in which the incidence of pre-eclampsia among pregnant women with adequate and inadequate iodine nutrition status was reported. Databases including MEDLINE, EMBASE, Google Scholar, SCOPUS and Africa Wide Information will be searched up to 31 December 2018. Screening of identified articles and data extraction will be conducted independently by two investigators. Risk of bias of the included studies will be assessed using a Newcastle-Ottawa Scale. Appropriate meta-analytic techniques will be used to pool prevalence and incidence rates, odds and relative risk of pre-eclampsia from studies with similar features, overall and by geographical regions. Heterogeneity of the estimates across studies will be assessed and quantified and publication bias investigated. This protocol is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocols (PRISMA-P) 2015 guidelines. ETHICS AND DISSEMINATION Since the proposed study will use published data, there is no requirement for ethical approval. This review seeks to identify the risk of pre-eclampsia associated with insufficient iodine nutrition in pregnancy. This will help to ascertain whether insufficient iodine intake may be an independent risk factor for pre-eclampsia. This will advise policy makers on the possibility of maximising iodine nutrition in pregnancy and reproductive age as one of the remedies for prevention of pre-eclampsia among populations at risk of inadequate iodine intake. This review is part of the thesis that will be submitted for the award of a PhD in Medicine to the Faculty of Health Sciences of the University of Cape Town. In addition the results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018099427.
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Affiliation(s)
- Charles Bitamazire Businge
- Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
- Department of Obstetrics and Gynaecology, Walter Sisulu University Faculty of Health Sciences, Mthatha, Eastern Cape, South Africa
| | - Namhla Madini
- Health Sciences Library, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
| | - Benjamin Longo-Mbenza
- Universite de Kinshasa Faculte de Medecine, Kinshasa, The Democratic Republic of the Congo
- LOMO Medical Centre, Kinshasa, The Democratic Republic of the Congo
| | - A P Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
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la Peña Sol D, Isela SR, Zendy OV, Mónica NM, Irene XR, Omar AH. Changes in trophoblasts gene expression in response to perchlorate exposition. Toxicol In Vitro 2018; 50:328-335. [PMID: 29673971 DOI: 10.1016/j.tiv.2018.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 03/19/2018] [Accepted: 04/12/2018] [Indexed: 10/17/2022]
Abstract
Contaminated water with chlorates is a public health problem associated with iodine deficiency. Epidemiological evidence shows that iodine deficiency is a risk factor for preeclampsia (PE). In this study we use human BeWo trophoblast cells exposed to perchlorate (KClO4) and changes in gene expression were analyzed by microarrays, quantitative RT-PCR (qRT-PCR) and immunoblot. The microarray analysis identified 48 transcripts up-regulated and 112 down-regulated in comparison with non-exposed trophoblast. The qRT-PCR analysis confirmed changes in GAS7, PKP2, Emilin, Dynatic 3, protocadherins 11, 15, gamma A12, EGFR, SAFB1, ACE2, ANXA2, Apoliprotein E, SREBF1, and C/EBP-β. KClO4 exposition decreased the mRNA and protein of C/EBP-β and GPX4. Also, we observed a nuclear translocation of HIF1α protein, and increase in both Snail and ACE2 protein by immunoblot. These effects were accompanied by an increases in ROS and nitric oxide. In conclusion, our results show that exposure to KClO4 alters genes involved in migration, adhesion, differentiation, and correlate with the increase of oxidative stress and nitric oxide production in trophoblast cells. It is possible that iodine deficiency is associated with these processes. However, further studies are required to corroborate the role of iodine in trophoblast cells.
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Affiliation(s)
- De la Peña Sol
- Laboratorio de Investigación Clínica, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Av. Lázaro Cárdenas S/N Ciudad Universitaria Sur, col. La Haciendita, Chilpancingo, Guerrero ZC 39087, Mexico
| | - Santiago-Roque Isela
- Facultad de Bioanálisis, Universidad Veracruzana. Odontólogos W/N, U.H. del Bosque, Xalapa, Veracruz, Mexico
| | - Olivo-Vidal Zendy
- Ecology and Health Laboratory, Public Health Institute, Universidad Veracruzana, Av. Luís Castelazo Ayala W/N, Col. Industrial Animas, Xalapa, Veracruz ZC 41190, Mexico
| | - Navarro-Meza Mónica
- Centro Universitario del Sur., Av. Enrique Arreola Silva no. 883, Col. Centro, Ciudad Guzmán, Jalisco ZC 49000, Mexico
| | - Xochihua-Rosas Irene
- Facultad de Idiomas, Universidad Veracruzana, Francisco Moreno esq. E. Alatriste S/N, col. Ferrer Guardia, Xalapa, Veracruz ZC91020, Mexico
| | - Arroyo-Helguera Omar
- Ecology and Health Laboratory, Public Health Institute, Universidad Veracruzana, Av. Luís Castelazo Ayala W/N, Col. Industrial Animas, Xalapa, Veracruz ZC 41190, Mexico.
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Olivo-Vidal ZE, Rodríguez RC, Arroyo-Helguera O. Iodine Affects Differentiation and Migration Process in Trophoblastic Cells. Biol Trace Elem Res 2016; 169:180-8. [PMID: 26152853 DOI: 10.1007/s12011-015-0433-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/30/2015] [Indexed: 01/22/2023]
Abstract
Iodine deficiency is associated with oxidative stress increase and preeclampsia during gestation, suggesting that iodine concentration plays an important role in the normal placenta physiology. The question raised is to analyze the effect of iodine deficiency on oxidative stress, viability, differentiation, and migration process and changes in the expression of differentiation and migration markers. Iodine deprivation was done using potassium perchlorate (KCLO4) to block sodium iodide symporter (NIS) transporter and 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid DIDS to inhibit pendrine (PEN) transport for 3-48 h. Then trophoblast cells were treated with low iodine doses of 5-500 μM and high iodine doses of 100-5000 μM. Oxidative stress, viability, and human chorionic gonadotropin (hGC) were measured by colorimetric methods. Migration throphoblast cells were evaluated by both wound healing and Boyden chamber assays. Changes in mRNA expression were analyzed by real-time RT-PCR. Iodine deprivation induces a significant increase of reactive oxygen species (ROS), viability, and migration process vs control cells. We found a significant overregulation in the mRNA's peroxisome proliferator-activated receptor (PPAR-gamma), Snail, and matrix metalloproteinase-9 (MMP-9) mRNA's in cells deprived of iodine, as well as a down glial cell missing-1 (GCM-1) regulation, hGC, pregnancy-associated plasma protein-A (PAPP-A), and E-cadherin mRNA expression. The expression of hypoxic induction factor alpha (HIFα) mRNA does not change with iodine deprivation. In cells deprived of iodine, supplementing low iodine doses (5-500 μM) does not induce any significant changes in viability. However, ROS and migration process were decreased, although we found an increased human chorionic gonadotropin (hCG) secretion as a differentiation marker. In addition, we found that PPAR-gamma, Snail, and MPP-9 mRNAs expression are downregulated with low iodine doses, in contrast with GCM-1, PAPP-A, hGC, and E-cadherin that increase their expression vs cells deprived of iodine. High iodine doses (1000-5000 μM) have shown cytotoxic effects. Based on our results, iodine is important for keeping the proliferation/differentiation balance in the placenta.
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Affiliation(s)
- Zendy Evelyn Olivo-Vidal
- Centro de investigaciones Biomédicas, Universidad Veracruzana, Av. Luís Castelazo Ayala S/N, Col. Industrial Ánimas, Xalapa, Veracruz, México
- Instituto de Salud Pública, Universidad Veracruzana, Av. Luís Castelazo Ayala S/N, Col. Industrial Ánimas, Xalapa, Veracruz, México
| | - Roció Coutiño Rodríguez
- Instituto de Salud Pública, Universidad Veracruzana, Av. Luís Castelazo Ayala S/N, Col. Industrial Ánimas, Xalapa, Veracruz, México
| | - Omar Arroyo-Helguera
- Instituto de Salud Pública, Universidad Veracruzana, Av. Luís Castelazo Ayala S/N, Col. Industrial Ánimas, Xalapa, Veracruz, México.
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Elhaj ET, Adam I, Alim A, Elhassan EM, Lutfi MF. Thyroid Function/Antibodies in Sudanese Patients with Preeclampsia. Front Endocrinol (Lausanne) 2015; 6:87. [PMID: 26124747 PMCID: PMC4464070 DOI: 10.3389/fendo.2015.00087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 05/12/2015] [Indexed: 11/13/2022] Open
Abstract
Preeclampsia is an important cause of maternal and prenatal morbidity and mortality in the developing countries. Changes in thyroid function/antibodies profiles in preeclamptic women are controversial and were never investigated before in Sudan. A case-control study was conducted at Medani Hospital, Sudan, to investigate thyroid function/antibodies in preeclampsia. The sociodemographic, medical history was gathered using questionnaires. Thyroid hormones [thyroid-stimulating hormone (TSH), free tri-iodothyronine (T3), and free thyroxine (T4)] and anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies were measured using ELISA. The three groups [controls, mild, and severe preeclampsia (SP) (55 women in each arm)] were matched in age and parity. While median (interquartile range) of TSH was significantly lower, both free T3 and free T4 levels were significantly higher in women with preeclampsia than in the healthy controls. There was no significant difference in the TSH levels in women with MP and SP. In comparison with women with MP, women with SP had significantly higher levels of free T3 and significantly lower levels of free T4. While anti-TPO antibodies were significantly higher, anti-TG antibodies were significantly lower in women with preeclampsia. Likewise, anti-TPO antibodies were significantly higher and anti-TG antibodies were significantly lower in women with SP than in women with MP. In linear regression, preeclampsia was significantly associated with TSH (-0.675 IU/ml, P = 0.009), free T3 (0.977 pg/ml, P < 0.001), and free T4 (0.186 ng/dl, P < 0.001) levels. In contrast to anti-TG antibodies and TSH, Sudanese patients with preeclampsia had higher levels of T3 and T4 hormones and anti-TPO antibodies irrespective of parity, gestational age, and hemoglobin levels.
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Affiliation(s)
- Enaam T. Elhaj
- Faculty of Applied Medical Science, Gezira University, Medani, Sudan
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- *Correspondence: Ishag Adam, Faculty of Medicine, University of Khartoum, P.O. Box 102, Khartoum 11111, Sudan,
| | - Ammar Alim
- Faculty of Applied Medical Science, Gezira University, Medani, Sudan
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Vidal ZEO, Rufino SC, Tlaxcalteco EH, Trejo CH, Campos RM, Meza MN, Rodríguez RC, Arroyo-Helguera O. Oxidative stress increased in pregnant women with iodine deficiency. Biol Trace Elem Res 2014; 157:211-7. [PMID: 24464603 DOI: 10.1007/s12011-014-9898-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/14/2014] [Indexed: 01/21/2023]
Abstract
Iodine is an essential element trace for the synthesis of maternal thyroid hormones needed to support normal fetal development; it also acts as an antioxidant directly or induce antioxidant enzymes indirectly. Iodine deficiency and oxidative stress are associated with pregnancy complications. This study aimed to assess the urinary iodine concentration and its relationship with the antioxidant and oxidative stress status during gestation. Pregnant women were consecutively recruited from an obstetric clinic during all gestation trimesters, and urinary iodine concentration, antioxidant, and oxidative stress were determined. Results showed that 70 % of pregnant women have optimal iodine levels (150-200 μg/L), while approximately 30 % showed mild iodine deficiency (50-99 μg/L). Oxidative stress was significantly higher, and the antioxidant status was also compromised as evidenced by decreased total antioxidant status and superoxide dismutase (SOD) activity in pregnant women with mild iodine deficiency than pregnant women with optimal iodine levels. Significant positive correlations were noted between optimal iodine levels and total antioxidant status. Oxidative stress was significantly correlated with mild iodine deficiency. However, no significant correlation was found between iodine levels and SOD and catalase activities. In conclusion, for the first time, these data suggest a correlation between iodine levels and the antioxidant status during pregnancy.
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Affiliation(s)
- Zendy Evelyn Olivo Vidal
- Instituto de Salud Pública, Universidad Veracruzana, Avenida Luís Castelazo Ayala S/N, Col. Industrial Ánimas, Xalapa, Veracruz, México
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Bénéfices et risques d’une supplémentation en iode des femmes enceintes : une revue des études observationnelles et expérimentales en régions de carence iodée légère à modérée. Rev Epidemiol Sante Publique 2014; 62:65-74. [DOI: 10.1016/j.respe.2013.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 07/26/2013] [Accepted: 08/19/2013] [Indexed: 11/19/2022] Open
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