一项在瑞典进行的妊娠期碘补充随机、双盲研究：母体碘状态和甲状腺功能的初步评估。
A randomized, double-blind study of iodine supplementation during pregnancy in Sweden: pilot evaluation of maternal iodine status and thyroid function.
机构信息
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
Frölunda Specialist Hospital, Marconigatan 31, 42144, Västra Frölunda, Sweden.
出版信息
Eur J Nutr. 2021 Sep;60(6):3411-3422. doi: 10.1007/s00394-021-02515-1. Epub 2021 Feb 23.
PURPOSE
Pregnant women in Sweden are mildly iodine deficient. We investigated the effect of daily iodine supplementation on the iodine and thyroid status of pregnant women.
METHODS
In this pilot, randomized, double-blind trial, 200 thyroid-healthy pregnant women were recruited at mean (standard deviation) pregnancy week 8.85 (1.62) and assigned (1:1) to daily intake of a multivitamin tablet with or without 150 μg of iodine. Urine and serum samples were collected at baseline and once during the second and third trimesters. Urinary iodine concentration (UIC), serum thyroglobulin (Tg), thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibodies (TPOabs) were analyzed. Neonatal TSH data were collected. UIC and Tg were also analyzed in a group of 89 thyroid-healthy non-pregnant women of reproductive age (WRA).
RESULTS
At baseline, the intervention and the control groups had similar median UIC (interquartile range (IQR)): 110 μg/L (74-119) and 111 μg/L (66-168), respectively. The intervention group reached iodine sufficiency with median UIC (IQR) 139 μg/L (89-234) and 136 μg/L (91-211) in the second and third trimester, respectively, without significant difference from the lower limit of the recommended range, i.e. 150-250 μg/L (p = 0.42 and p = 0.87, respectively). The intervention group had higher median UIC and lower median Tg compared to the control group during the second (p < 0.001 and p = 0.019, respectively) and third trimester (p < 0.001 and p = 0.003, respectively), whereas thyroid hormones, serum TPOabs, and neonatal TSH were similar. The WRA group presented median UIC (IQR) 65 μg/L (30-98) and median Tg (IQR) 18 μg/L (13-27).
CONCLUSION
A daily supplement containing 150 μg of iodine to a group of pregnant women with mild iodine deficiency improved the iodine status from mild ID to iodine sufficiency. This improvement seems to have had a positive impact on maternal thyroglobulin. This study is now under extension to investigate the children's neuropsychological development.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier NCT02378246, May 3, 2015, retrospectively registered.
目的
瑞典的孕妇碘营养处于轻度缺乏状态。我们研究了每日碘补充对孕妇碘和甲状腺功能的影响。
方法
在这项先导、随机、双盲试验中，在孕 8.85（1.62）周时招募了 200 名甲状腺健康的孕妇，并将其（1:1）随机分配至每日摄入含有 150μg 碘的多种维生素片或安慰剂。在基线时、妊娠中期和妊娠晚期各采集一次尿液和血清样本。分析尿液碘浓度（UIC）、血清甲状腺球蛋白（Tg）、促甲状腺激素（TSH）、游离甲状腺素（FT4）和甲状腺过氧化物酶抗体（TPOab）。还收集了新生儿 TSH 数据。分析了 89 名甲状腺健康的育龄期（WRA）非孕妇的 UIC 和 Tg。
结果
在基线时，干预组和对照组的中位数 UIC（四分位间距（IQR））相似：110μg/L（74-119）和 111μg/L（66-168）。干预组在妊娠中期和晚期 UIC（IQR）分别达到 139μg/L（89-234）和 136μg/L（91-211），中位数均处于碘充足范围下限（150-250μg/L），差异无统计学意义（p=0.42 和 p=0.87，分别）。与对照组相比，干预组在妊娠中期（p<0.001 和 p=0.019，分别）和妊娠晚期（p<0.001 和 p=0.003，分别）的中位数 UIC 更高，中位数 Tg 更低，而甲状腺激素、血清 TPOab 和新生儿 TSH 相似。WRA 组的中位数 UIC（IQR）为 65μg/L（30-98），中位数 Tg（IQR）为 18μg/L（13-27）。
结论
对轻度碘缺乏的孕妇每日补充 150μg 碘，可将碘营养状况从轻度碘缺乏改善至碘充足。这种改善似乎对孕妇甲状腺球蛋白产生了积极影响。目前正在进行扩展研究，以调查儿童的神经心理学发育情况。
试验注册
ClinicalTrials.gov 标识符 NCT02378246，2015 年 5 月 3 日，回顾性注册。
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