Shanghai Putuo District Center for Disease Control and Prevention, Shanghai, 200033, China.
Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China.
Nutr J. 2022 Jan 29;21(1):7. doi: 10.1186/s12937-022-00760-6.
Pregnant women in Shanghai have long been at risk for mild iodine deficiency. Because thyroid autoimmunity in pregnant women can lead to premature birth and miscarriage as well as neurodevelopmental deficits in the fetus, the aim of this study was to explore the association of iodine nutrition status with thyroid antibodies during pregnancy.
A pregnancy-birth cohort was conducted including 4635 pregnant women in Shanghai, China. The eligible participants underwent a face-to-face interview and completed questionnaire surveys to collect baseline information and diet intake. Spot urine samples were collected to test urine iodine. Thyroid antibodies including thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and thyrotrophic antibodies (TRAb) were tested. Single-factor analysis and logistic regression were used to evaluate the association between iodine status and thyroid autoimmunity during pregnancy.
The median urinary iodine excretion level in the sample was 138.14 μg/L (interquartile range [IQR] 80.90-219.00 μg/L). Among all the subjects, 25.9% consumed non-iodized salt, 54.5% had iodine deficiency, and 31.0% had thyroid autoimmunity. The proportion of patients with iodine deficiency was significantly higher among those who consumed non-iodized salt (36.9% vs. 33.1%; p = 0.04). After adjusting for age, educational status, former smoker status, former drinker status, first pregnancy, and previous thyroid disease, non-iodized salt (odds ratio [OR] = 1.394 [confidence interval, CI, 1.165-1.562]; p = 0.003), iodine-rich food (OR = 0.681 [CI 0.585-0.793]; p = 0.003), iodized nutritional supplements (OR = 0.427 [CI 0.347-0.526]; p = 0.003), were found to be individually associated with thyroid autoimmunity in all participants. The results of the multivariable restricted cubic spline regression analysis showed a non-linear relationship between the continuous change in iodine intake and thyroid autoimmunity (p = 0.019). Participants with iodine deficiency (urinary iodine concentration, UIC,< 100 μg/L) had an increased risk of testing positive for thyroid antibodies (TPOAb/TgAb/TRAb[+]; OR = 1.324 [CI 1.125-1.559]; p < 0.001). Moreover, this associated existed even after removing participants with previous thyroid disease.
Inadequate iodine nutrition in pregnant women is an independent risk factor for thyroid autoimmunity in Shanghai. It's important to maintain the adequate iodine status in pregnant women.
上海的孕妇一直存在轻度碘缺乏的风险。由于孕妇的甲状腺自身免疫会导致早产和流产以及胎儿的神经发育缺陷，因此本研究旨在探讨妊娠期间碘营养状况与甲状腺抗体之间的关联。
在中国上海进行了一项妊娠-分娩队列研究，纳入了 4635 名孕妇。合格的参与者接受了面对面的访谈并完成了问卷调查，以收集基线信息和饮食摄入情况。采集了点尿样以检测尿碘。检测了甲状腺抗体，包括甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TgAb）和促甲状腺素抗体（TRAb）。采用单因素分析和逻辑回归评估碘状态与妊娠期间甲状腺自身免疫之间的关系。
样本中尿碘排泄中位数为 138.14μg/L（四分位距[IQR] 80.90-219.00μg/L）。在所有受试者中，25.9%食用非碘盐，54.5%碘缺乏，31.0%甲状腺自身免疫。食用非碘盐的患者中碘缺乏的比例明显更高（36.9%比 33.1%；p=0.04）。在校正年龄、教育程度、既往吸烟者状态、既往饮酒者状态、初产妇和既往甲状腺疾病后，非碘盐（比值比[OR] = 1.394[置信区间，CI，1.165-1.562]；p=0.003）、富碘食物（OR = 0.681[CI 0.585-0.793]；p=0.003）、碘营养补充剂（OR = 0.427[CI 0.347-0.526]；p=0.003）与所有参与者的甲状腺自身免疫均独立相关。多变量限制立方样条回归分析的结果表明，碘摄入量的连续变化与甲状腺自身免疫之间呈非线性关系（p=0.019）。碘缺乏（尿碘浓度，UIC，<100μg/L）的参与者检测到甲状腺抗体阳性（TPOAb/TgAb/TRAb[+]）的风险增加（OR = 1.324[CI 1.125-1.559]；p<0.001）。此外，即使去除了既往患有甲状腺疾病的参与者，这种关联仍然存在。
上海孕妇碘营养不足是甲状腺自身免疫的独立危险因素。维持孕妇的适当碘状态很重要。
