妊娠期碘营养与亚临床性甲状腺功能减退症和妊娠结局的关系
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摘要
碘是影响甲状腺功能的重要元素,妊娠期碘营养状况与甲状腺功能异常密切相关。亚临床性甲状腺功能减退症是常见的妊娠并发症,碘缺乏或碘过量均可引起亚临床性甲状腺功能减退症。碘缺乏可导致孕妇产生妊娠期高血压、流产、胎膜早破等不良妊娠结局,同时导致后代神经和认知缺陷等。早期补碘对治疗严重碘缺乏至关重要,但对轻中度碘缺乏的疗效仍存在争议。碘过量则会引起巨大儿、后代甲状腺功能紊乱等不良结果,故妊娠期筛查尿碘和指导合理补碘非常重要。
Iodine is an important element which can affect thyroid function. The iodine nutritional status during pregnancy is closely related to thyroid dysfunction. Subclinical hypothyroidism is a common pregnancy complication,and iodine deficiency or excess can cause subclinical hypothyroidism. Iodine deficiency can lead to adverse pregnancy outcomes such as pregnancy-induced hypertension,miscarriage,and premature rupture of membranes,as well as neurological and cognitive deficits in offsprings. Iodine supplementation in early time is essential for severe iodine deficiency therapy,but the efficacy of iodine supplementation for mild to moderate iodine deficiency remains controversial. Excessive iodine can cause adverse effects such as macrosomia and thyroid dysfunction in the offsprings. Therefore,it is very important to screen urine iodine and guide the reasonable supplementation of iodine during pregnancy.
Iodine is an important element which can affect thyroid function. The iodine nutritional status during pregnancy is closely related to thyroid dysfunction. Subclinical hypothyroidism is a common pregnancy complication,and iodine deficiency or excess can cause subclinical hypothyroidism. Iodine deficiency can lead to adverse pregnancy outcomes such as pregnancy-induced hypertension,miscarriage,and premature rupture of membranes,as well as neurological and cognitive deficits in offsprings. Iodine supplementation in early time is essential for severe iodine deficiency therapy,but the efficacy of iodine supplementation for mild to moderate iodine deficiency remains controversial. Excessive iodine can cause adverse effects such as macrosomia and thyroid dysfunction in the offsprings. Therefore,it is very important to screen urine iodine and guide the reasonable supplementation of iodine during pregnancy.
引文
[1] Niwattisaiwong S,Burman KD,Li-Ng M. Iodine deficiency:Clinicalimplications[J]. Cleve Clin J Med,2017,84(3):236-244.
[2] Pearce EN. The American Thyroid Association:Statement on Uni-versal Salt Iodization[J]. Thyroid,2017,27(2):137.
[3] Su PY,Huang K,Hao JH,et al. Maternal thyroid function in thefirst twenty weeks of pregnancy and subsequent fetal and infantdevelopment:A prospective population-based cohort study inChina[J]. J Clin Endocrinol Metab,2011,96(10):3234-3241.
[4]中华医学会内分泌学分会,中华医学会围产医学分会.妊娠和产后甲状腺疾病诊治指南[J].中华内分泌代谢杂志,2012,5(28):354-371.
[5] Bath SC,Walter A,Taylor A,et al. Iodine deficiency in pregnantwomen living in the South East of the UK:The influence of dietand nutritional supplements on iodine status[J]. Br J Nutr,2014,111(9):1622-1631.
[6] Caldwell KL,Pan Y,Mortensen ME,et al. Iodine status in preg-nant women in the National Children's Study and in U. S. women(15-44 years),National Health and Nutrition Examination Survey2005-2010[J]. Thyroid,2013,23(8):927-937.
[7] Kirkegaard-Klitbo DM,Perslev K,Andersen SL,et al. Iodinedeficiency in pregnancy is prevalent in vulnerable groups in Den-mark[J]. Dan Med J,2016,63(11). pii:A5286.
[8] Mao G,Zhu W,Mo Z,et al. Iodine deficiency in pregnant womenafter the adoption of the new provincial standard for salt iodizationin Zhejiang province,China[J]. BMC Pregnancy Childbirth,2018,18(1):313.
[9] Yang J,Zheng H,Li X,et al. Assessment of iodine status andassociated factors in vulnerable populations in Henan province,China,in 2012[J]. Asia Pac J Clin Nutr,2014,23(4):626-633.
[10] Wang K,Zhang J,Li F,et al. Urinary iodine in early pregnancy isassociated with subclinical hypothyroidism in Tianjin,China:Anobservational study[J]. BMC Endocr Disord,2017,17(1):10.
[11] Knudsen N,Christiansen E,Brandt-Christensen M,et al. Age-andsex-adjusted iodine/creatinine ratio. A new standard in epidemio-logical surveys? Evaluation of three different estimates of iodineexcretion based on casual urine samples and comparison to 24 hvalues[J]. Eur J Clin Nutr,2000,54(4):361-363.
[12] Knig F,Andersson M,Hotz K,et al. Ten repeat collections forurinary iodine from spot samples or 24-hour samples are needed toreliably estimate individual iodine status in women[J]. J Nutr,2011,141(11):2049-2054.
[13] Zimmermann MB. Iodine deficiency[J]. Endocr Rev,2009,30(4):376-408.
[14] Bath SC,Steer CD,Golding J,et al. Effect of inadequate iodine statusin UK pregnant women on cognitive outcomes in their children:Results from the Avon Longitudinal Study of Parents and Children(ALSPAC)[J]. Lancet,2013,382(9889):331-337.
[15] Ma ZF,Skeaff SA. Thyroglobulin as a biomarker of iodine deficiency:A review[J]. Thyroid,2014,24(8):1195-1209.
[16] Zimmermann MB,Aeberli I,Andersson M,et al. Thyroglobulin isa sensitive measure of both deficient and excess iodine intakes inchildren and indicates no adverse effects on thyroid function inthe UIC range of 100-299 mug/L:A UNICEF/ICCIDD studygroup report[J]. J Clin Endocrinol Metab,2013,98(3):1271-1280.
[17] Andersen SL,Nohr SB,Wu CS,et al. Thyroglobulin in smokingmothers and their newborns at delivery suggests autoregulation ofplacental iodide transport overcoming thiocyanate inhibition[J].Eur J Endocrinol,2013,168(5):723-731.
[18] Katko M,Gazso AA,Hircsu I,et al. Thyroglobulin level at week16 of pregnancy is superior to urinary iodine concentration inrevealing preconceptual and first trimester iodine supply[J]. MaternChild Nutr,2018,14(1).[2018-10-11]. https://onlinelibrary.wiley. com/doi/full/10. 1111/mcn. 12470.[published onlineahead of print Jun 7,2017].
[19]龙燕,时娟娟,张晓璐,等.妊娠20周前甲状腺功能参考范围和甲状腺功能异常患病率[J].中华围产医学杂志,2012,15(12):737-742.
[20] Zhao W,Li X,Xia X,et al. Iodine nutrition during pregnancy:Past,present,and future[J]. Biol Trace Elem Res,2018.[2018-10-11]. https://link. springer. com/article/10. 1007%2Fs12011-018-1502-z.[published online ahead of print Sep 14,2018].
[21] Mao S,Wu L. Iodine supplementation in pregnant women andchild neurodevelopment[J]. Lancet Diabetes Endocrinol,2018,6(1):10.
[22] Mioto VCB,Monteiro ACCNG,de Camargo RYA,et al. Highprevalence of iodine deficiency in pregnant women living in ade-quate iodine area[J]. Endocr Connect,2018,7(5):762-767.
[23]王晓雪,贾方,田晶,等.妊娠期碘营养、甲状腺自身抗体与甲状腺功能关系的研究[J].中华内分泌代谢杂志,2014,30(5):408-410.
[24] Shan Z,Chen L,Lian X,et al. Iodine status and prevalence ofthyroid disorders after introduction of mandatory universal saltIodization for 16 years in China:A cross-sectional study in 10 cit-ies[J]. Thyroid,2016,26(8):1125-1130.
[25] LímanováZ. Thyroid gland and pregnancy-summary of importantfindings[J]. Vnitr Lek,2015,61(10):862-867.
[26] Du Y,Gao Y,Meng F,et al. Iodine deficiency and excess coexistin China and induce thyroid dysfunction and disease:A cross-sec-tional study[J]. PLo S One,2014,9(11):e111937.
[27] Wolff J,Chaikoff IL. The temporary nature of the inhibitory action ofexcess iodine on organic iodine synthesis in the normal thyroid[J].Endocrinology,1949,45(5):504-513.
[28] Leung AM,Braverman LE. Consequences of excess iodine[J].Nat Rev Endocrinol,2014,10(3):136-142.
[29] Weng W,Dong M,Zhan J,et al. A PRISMA-compliant systematicreview and meta-analysis of the relationship between thyroiddisease and different levels of iodine intake in mainland China[J].Medicine(Baltimore),2017,96(25):e7279.
[30] Sang Z,Wei W,Zhao N,et al. Thyroid dysfunction during lategestation is associated with excessive iodine intake in pregnantwomen[J]. J Clin Endocrinol Metab,2012,97(8):E1363-1369.
[31] Koukkou EG,Roupas ND,Markou KB. Effect of excess iodine intakeon thyroid on human health[J]. Minerva Med,2017,108(2):136-146.
[32] Hussein Ael-A,Abbas AM,El Wakil GA,et al. Effect of chronicexcess iodine intake on thyroid function and oxidative stress inhypothyroid rats[J]. Can J Physiol Pharmacol,2012,90(5):617-625.
[33] Ramakrishnan U,Grant F,Goldenberg T,et al. Effect of women'snutrition before and during early pregnancy on maternal and infantoutcomes:A systematic review[J]. Paediatr Perinat Epidemiol,2012,26 Suppl 1:285-301.
[34] Akturk M,Oruc AS,Danisman N,et al. Na+/I-symporter andtype 3 iodothyronine deiodinase gene expression in amniotic mem-brane and placenta and its relationship to maternal thyroid hor-mones[J]. Biol Trace Elem Res,2013,154(3):338-344.
[35] Skeaff SA. Iodine deficiency in pregnancy:The effect on neurode-velopment in the child[J]. Nutrients,2011,3(2):265-273.
[36] Trofimiuk-Mudlner M,Hubalewska-Dydejczyk A. Iodine deficiencyand iodine prophylaxis in pregnancy[J]. Recent Pat EndocrMetab Immune Drug Discov,2017,10(2):85-95.
[37] Zimmermann MB. The effects of iodine deficiency in pregnancyand infancy[J]. Paediatr Perinat Epidemiol,2012,26 Suppl 1:108-117.
[38] Bricaire L,Groussin L. Pregnancy and thyroid disorders[J]. RevMed. Interne,2015,36(3):203-210.
[39] Harding KB,Pea-Rosas JP,Webster AC,et al. Iodine supple-mentation for women during the preconception,pregnancy andpostpartum period[J/CD]. Cochrane Database Syst Rev,2017,3:CD11761.
[40] Herter-Aeberli I,Cherkaoui M,El Ansari N,et al. Iodine supple-mentation decreases hypercholesterolemia in iodine-deficient,overweight women:A randomized controlled trial[J]. J Nutr,2015,145(9):2067-2075.
[41] Xiao Y,Sun H,Li C,et al. Effect of Iodine nutrition on pregnancyOutcomes in an iodine-Sufficient Area in China[J]. Biol TraceElem Res,2018,182(2):231-237.
[42] Charoenratana C,Leelapat P,Traisrisilp K,et al. Maternal iodineinsufficiency and adverse pregnancy outcomes[J]. Matern ChildNutr,2016,12(4):680-687.
[43] Dandamrongrak P,Chawanpaiboon S. Correlation between IodineSupplement in Pregnancy and Neonatal TSH Level[J]. J MedAssoc Thai,2016,99(12):1257-1262.
[44] Abel MH,Korevaar TIM,Erlund I,et al. Iodine Intake is Associ-ated with Thyroid Function in Mild to Moderately Iodine DeficientPregnant Women[J]. Thyroid,2018,28(10):1359-1371.
[45] Murcia M,Espada M,Julvez J,et al. Iodine intake from supple-ments and diet during pregnancy and child cognitive and motordevelopment:The INMA Mother and Child Cohort Study[J].J Epidemiol Community Health,2018,72(3):216-222.
[46] Rydbeck F,Rahman A,Grandér M,et al. Maternal urinary iodineconcentration up to 1. 0 mg/L is positively associated with birthweight,length,and head circumference of male offspring[J].J Nutr,2014,144(9):1438-1444.
[47] Bürgi H. Iodine excess[J]. Best Pract Res Clin EndocrinolMetab,2010,24(1):107-115.
[2] Pearce EN. The American Thyroid Association:Statement on Uni-versal Salt Iodization[J]. Thyroid,2017,27(2):137.
[3] Su PY,Huang K,Hao JH,et al. Maternal thyroid function in thefirst twenty weeks of pregnancy and subsequent fetal and infantdevelopment:A prospective population-based cohort study inChina[J]. J Clin Endocrinol Metab,2011,96(10):3234-3241.
[4]中华医学会内分泌学分会,中华医学会围产医学分会.妊娠和产后甲状腺疾病诊治指南[J].中华内分泌代谢杂志,2012,5(28):354-371.
[5] Bath SC,Walter A,Taylor A,et al. Iodine deficiency in pregnantwomen living in the South East of the UK:The influence of dietand nutritional supplements on iodine status[J]. Br J Nutr,2014,111(9):1622-1631.
[6] Caldwell KL,Pan Y,Mortensen ME,et al. Iodine status in preg-nant women in the National Children's Study and in U. S. women(15-44 years),National Health and Nutrition Examination Survey2005-2010[J]. Thyroid,2013,23(8):927-937.
[7] Kirkegaard-Klitbo DM,Perslev K,Andersen SL,et al. Iodinedeficiency in pregnancy is prevalent in vulnerable groups in Den-mark[J]. Dan Med J,2016,63(11). pii:A5286.
[8] Mao G,Zhu W,Mo Z,et al. Iodine deficiency in pregnant womenafter the adoption of the new provincial standard for salt iodizationin Zhejiang province,China[J]. BMC Pregnancy Childbirth,2018,18(1):313.
[9] Yang J,Zheng H,Li X,et al. Assessment of iodine status andassociated factors in vulnerable populations in Henan province,China,in 2012[J]. Asia Pac J Clin Nutr,2014,23(4):626-633.
[10] Wang K,Zhang J,Li F,et al. Urinary iodine in early pregnancy isassociated with subclinical hypothyroidism in Tianjin,China:Anobservational study[J]. BMC Endocr Disord,2017,17(1):10.
[11] Knudsen N,Christiansen E,Brandt-Christensen M,et al. Age-andsex-adjusted iodine/creatinine ratio. A new standard in epidemio-logical surveys? Evaluation of three different estimates of iodineexcretion based on casual urine samples and comparison to 24 hvalues[J]. Eur J Clin Nutr,2000,54(4):361-363.
[12] Knig F,Andersson M,Hotz K,et al. Ten repeat collections forurinary iodine from spot samples or 24-hour samples are needed toreliably estimate individual iodine status in women[J]. J Nutr,2011,141(11):2049-2054.
[13] Zimmermann MB. Iodine deficiency[J]. Endocr Rev,2009,30(4):376-408.
[14] Bath SC,Steer CD,Golding J,et al. Effect of inadequate iodine statusin UK pregnant women on cognitive outcomes in their children:Results from the Avon Longitudinal Study of Parents and Children(ALSPAC)[J]. Lancet,2013,382(9889):331-337.
[15] Ma ZF,Skeaff SA. Thyroglobulin as a biomarker of iodine deficiency:A review[J]. Thyroid,2014,24(8):1195-1209.
[16] Zimmermann MB,Aeberli I,Andersson M,et al. Thyroglobulin isa sensitive measure of both deficient and excess iodine intakes inchildren and indicates no adverse effects on thyroid function inthe UIC range of 100-299 mug/L:A UNICEF/ICCIDD studygroup report[J]. J Clin Endocrinol Metab,2013,98(3):1271-1280.
[17] Andersen SL,Nohr SB,Wu CS,et al. Thyroglobulin in smokingmothers and their newborns at delivery suggests autoregulation ofplacental iodide transport overcoming thiocyanate inhibition[J].Eur J Endocrinol,2013,168(5):723-731.
[18] Katko M,Gazso AA,Hircsu I,et al. Thyroglobulin level at week16 of pregnancy is superior to urinary iodine concentration inrevealing preconceptual and first trimester iodine supply[J]. MaternChild Nutr,2018,14(1).[2018-10-11]. https://onlinelibrary.wiley. com/doi/full/10. 1111/mcn. 12470.[published onlineahead of print Jun 7,2017].
[19]龙燕,时娟娟,张晓璐,等.妊娠20周前甲状腺功能参考范围和甲状腺功能异常患病率[J].中华围产医学杂志,2012,15(12):737-742.
[20] Zhao W,Li X,Xia X,et al. Iodine nutrition during pregnancy:Past,present,and future[J]. Biol Trace Elem Res,2018.[2018-10-11]. https://link. springer. com/article/10. 1007%2Fs12011-018-1502-z.[published online ahead of print Sep 14,2018].
[21] Mao S,Wu L. Iodine supplementation in pregnant women andchild neurodevelopment[J]. Lancet Diabetes Endocrinol,2018,6(1):10.
[22] Mioto VCB,Monteiro ACCNG,de Camargo RYA,et al. Highprevalence of iodine deficiency in pregnant women living in ade-quate iodine area[J]. Endocr Connect,2018,7(5):762-767.
[23]王晓雪,贾方,田晶,等.妊娠期碘营养、甲状腺自身抗体与甲状腺功能关系的研究[J].中华内分泌代谢杂志,2014,30(5):408-410.
[24] Shan Z,Chen L,Lian X,et al. Iodine status and prevalence ofthyroid disorders after introduction of mandatory universal saltIodization for 16 years in China:A cross-sectional study in 10 cit-ies[J]. Thyroid,2016,26(8):1125-1130.
[25] LímanováZ. Thyroid gland and pregnancy-summary of importantfindings[J]. Vnitr Lek,2015,61(10):862-867.
[26] Du Y,Gao Y,Meng F,et al. Iodine deficiency and excess coexistin China and induce thyroid dysfunction and disease:A cross-sec-tional study[J]. PLo S One,2014,9(11):e111937.
[27] Wolff J,Chaikoff IL. The temporary nature of the inhibitory action ofexcess iodine on organic iodine synthesis in the normal thyroid[J].Endocrinology,1949,45(5):504-513.
[28] Leung AM,Braverman LE. Consequences of excess iodine[J].Nat Rev Endocrinol,2014,10(3):136-142.
[29] Weng W,Dong M,Zhan J,et al. A PRISMA-compliant systematicreview and meta-analysis of the relationship between thyroiddisease and different levels of iodine intake in mainland China[J].Medicine(Baltimore),2017,96(25):e7279.
[30] Sang Z,Wei W,Zhao N,et al. Thyroid dysfunction during lategestation is associated with excessive iodine intake in pregnantwomen[J]. J Clin Endocrinol Metab,2012,97(8):E1363-1369.
[31] Koukkou EG,Roupas ND,Markou KB. Effect of excess iodine intakeon thyroid on human health[J]. Minerva Med,2017,108(2):136-146.
[32] Hussein Ael-A,Abbas AM,El Wakil GA,et al. Effect of chronicexcess iodine intake on thyroid function and oxidative stress inhypothyroid rats[J]. Can J Physiol Pharmacol,2012,90(5):617-625.
[33] Ramakrishnan U,Grant F,Goldenberg T,et al. Effect of women'snutrition before and during early pregnancy on maternal and infantoutcomes:A systematic review[J]. Paediatr Perinat Epidemiol,2012,26 Suppl 1:285-301.
[34] Akturk M,Oruc AS,Danisman N,et al. Na+/I-symporter andtype 3 iodothyronine deiodinase gene expression in amniotic mem-brane and placenta and its relationship to maternal thyroid hor-mones[J]. Biol Trace Elem Res,2013,154(3):338-344.
[35] Skeaff SA. Iodine deficiency in pregnancy:The effect on neurode-velopment in the child[J]. Nutrients,2011,3(2):265-273.
[36] Trofimiuk-Mudlner M,Hubalewska-Dydejczyk A. Iodine deficiencyand iodine prophylaxis in pregnancy[J]. Recent Pat EndocrMetab Immune Drug Discov,2017,10(2):85-95.
[37] Zimmermann MB. The effects of iodine deficiency in pregnancyand infancy[J]. Paediatr Perinat Epidemiol,2012,26 Suppl 1:108-117.
[38] Bricaire L,Groussin L. Pregnancy and thyroid disorders[J]. RevMed. Interne,2015,36(3):203-210.
[39] Harding KB,Pea-Rosas JP,Webster AC,et al. Iodine supple-mentation for women during the preconception,pregnancy andpostpartum period[J/CD]. Cochrane Database Syst Rev,2017,3:CD11761.
[40] Herter-Aeberli I,Cherkaoui M,El Ansari N,et al. Iodine supple-mentation decreases hypercholesterolemia in iodine-deficient,overweight women:A randomized controlled trial[J]. J Nutr,2015,145(9):2067-2075.
[41] Xiao Y,Sun H,Li C,et al. Effect of Iodine nutrition on pregnancyOutcomes in an iodine-Sufficient Area in China[J]. Biol TraceElem Res,2018,182(2):231-237.
[42] Charoenratana C,Leelapat P,Traisrisilp K,et al. Maternal iodineinsufficiency and adverse pregnancy outcomes[J]. Matern ChildNutr,2016,12(4):680-687.
[43] Dandamrongrak P,Chawanpaiboon S. Correlation between IodineSupplement in Pregnancy and Neonatal TSH Level[J]. J MedAssoc Thai,2016,99(12):1257-1262.
[44] Abel MH,Korevaar TIM,Erlund I,et al. Iodine Intake is Associ-ated with Thyroid Function in Mild to Moderately Iodine DeficientPregnant Women[J]. Thyroid,2018,28(10):1359-1371.
[45] Murcia M,Espada M,Julvez J,et al. Iodine intake from supple-ments and diet during pregnancy and child cognitive and motordevelopment:The INMA Mother and Child Cohort Study[J].J Epidemiol Community Health,2018,72(3):216-222.
[46] Rydbeck F,Rahman A,Grandér M,et al. Maternal urinary iodineconcentration up to 1. 0 mg/L is positively associated with birthweight,length,and head circumference of male offspring[J].J Nutr,2014,144(9):1438-1444.
[47] Bürgi H. Iodine excess[J]. Best Pract Res Clin EndocrinolMetab,2010,24(1):107-115.