Copeland Daphne L, Sullivan Kevin M, Houston Robin, May Warwick, Mendoza Ivan, Salamatullah Quazi, Solomons Noel, Nordenberg Dale, Maberly Glen F
Department of Epidemiology, Rollins School of Publilc Health of Emory University, Atlanta, GA 30322, USA.
Public Health Nutr. 2002 Feb;5(1):81-7. doi: 10.1079/PHN2001306.
To compare thyroid-stimulating hormone (TSH) levels in neonatal cord blood between study sites in Bangladesh, Guatemala and the United States. Also, to compare neonatal TSH results with indicators of iodine deficiency in school children.
Consecutive births and, in school children, cross-sectional surveys.
Savar, Bangladesh; San Pedro Sacatepequez, Guatemala; and Atlanta, United States.
In each study site, cord blood was spotted on to filter paper and TSH levels determined using a sensitive monoclonal assay. In the USA, heel stick blood specimens from newborns spotted on to filter paper were also obtained as well as exposure to iodine-containing antiseptics during the birthing process. Urine specimens were collected from mothers of newborns and tested for iodine concentration. School children in the same areas were surveyed for thyroid size by palpation and ultrasonography, and urine specimens collected for iodine concentration.
Between 141 and 243 cord blood specimens were collected from each study site. The prevalence of elevated cord blood TSH levels (> 5 mUl(-1)) was high in all study sites, from 58% to 84%. All sites would be categorised as having 'severe' iodine deficiency based on WHO/UNICEF/ICCIDD criteria. Iodine-containing antiseptics were used during 98% of the births in the USA but not in Bangladesh or Guatemala. The neonatal TSH classification indicated more severe iodine deficiency levels than classifications based on urinary iodine and goitre in school children.
In the USA, elevated TSH levels may be partially attributed to use of beta-iodine-containing antiseptics prior to birth. We recommend the cautious interpretation of TSH results in newborns for the assessment of iodine deficiency disorders when iodine-containing antiseptics are used during the birthing process.
比较孟加拉国、危地马拉和美国各研究地点新生儿脐带血中促甲状腺激素（TSH）水平。此外，将新生儿TSH结果与学龄儿童碘缺乏指标进行比较。
对新生儿进行连续出生调查，对学龄儿童进行横断面调查。
孟加拉国萨瓦尔；危地马拉圣佩德罗德萨卡特佩克斯；美国亚特兰大。
在每个研究地点，将脐带血滴在滤纸上，使用灵敏的单克隆检测法测定TSH水平。在美国，还采集了新生儿足跟血标本滴在滤纸上，并记录分娩过程中接触含碘防腐剂的情况。收集新生儿母亲的尿液标本并检测碘浓度。对同一地区的学龄儿童进行触诊和超声检查甲状腺大小，并收集尿液标本检测碘浓度。
每个研究地点收集了141至243份脐带血标本。所有研究地点脐带血TSH水平升高（>5 mU/L）的患病率都很高，从58%到84%。根据世界卫生组织/联合国儿童基金会/国际控制碘缺乏病理事会的标准，所有地点都将被归类为“严重”碘缺乏地区。美国98%的分娩过程中使用了含碘防腐剂，而孟加拉国和危地马拉则未使用。新生儿TSH分类显示的碘缺乏水平比基于学龄儿童尿碘和甲状腺肿的分类更为严重。
在美国，TSH水平升高可能部分归因于出生前使用含β碘的防腐剂。我们建议，在分娩过程中使用含碘防腐剂时，对新生儿TSH结果进行谨慎解读，以评估碘缺乏症。
