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      Situación actual del estado nutricional del yodo en gestantes de la región de Murcia, España Translated title: Current situation of nutritional state of iodide in pregnant women in Murcia region, Spain Translated title: Situação atual do estado nutricional do iodo em gestantes da região de Múrcia, Espanha

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          Abstract

          El objetivo de este trabajo consistió en identificar los niveles de yodo en el primer trimestre del embarazo en mujeres atendidas en centros de salud, pertenecientes al área sanitaria I de Murcia (España), así como la relación de dichos niveles con la ingesta y los suplementos de yodo. Por otra parte se realizó el estudio de la función tiroidea en el mismo grupo. Se realizó un estudio descriptivo funcional. El grupo de estudio consistió en 37 mujeres embarazadas, que habían acudido a la primera visita en su centro de salud correspondiente desde los meses de marzo hasta agosto de 2011. Las variables de estudio fueron: niveles de yodo en orina medidos en una muestra aislada de orina, frecuencia de la ingesta de yodo relacionada con la alimentación y suplementos (datos obtenidos mediante una entrevista personal y un cuestionario estructurado realizado entre las participantes del estudio), niveles de hormona tiroestimulante TSH y T4 libre ambas obtenidas a partir de una muestra de sangre. El 86% del grupo en estudio presentaba deficiencia de yodo. Hubo diferencias estadísticamente significativas en cuanto a la excreción urinaria de yodo, en la ingesta de sal iodada y de pescado. Sin embargo, cualquier otra variable no presentó diferencias significativas. Se hallaron tres embarazadas con hipotiroidismo subclínico y una presentó hipertiroidismo subclínico. Además, estos resultados mostraron que los niveles de TSH pueden ser más bajos en embarazadas que en la población general. En base a los datos de ioduria obtenidos, los suplementos de yodo en este grupo se consideraron insuficientes. Además, se concluye que sería recomendable incluir la determinación sistemática de T4 libre y TSH en el primer trimestre del embarazo, para corregir una posible disfunción tiroidea tan pronto como sea posible y así evitar daños al feto.

          Translated abstract

          The aim of this work was to identify iodine levels in the first term of pregnancy in women attending health care centers of Sanitary Area I of Murcia (Spain), and the relationship of said levels with food intake and iodine supplements. Apart from that, thyroid gland function was assessed in the same group. A descriptive transversal study was performed. The sample group consisted of 37 pregnant women who had a first appointment at the corresponding midwifery service from March to August 2011. The variables studied were urinary iodine levels through isolated sample collection, frequency of intake of iodine related to food and iodine supplements (data obtained through a face to face interview and a structured questionnaire administered among the participats in the study), and levels of thyroid-stimulating hormone TSH and free T4 obtained from a blood sample. Eighty-six per cent of the study group had iodine deficiency. Statistically significant differences were found in urinary iodine excretion, in intake of iodine salt and of sea food. However, no other variable studied presented any statistically significant difference. Three pregnant women were found with subclinical hypothyroidism and one presented subclinical hyperthyroidism. Furthermore, these results showed that TSH levels can be lower in pregnant women than in the general population. On the basis of the normal urinary iodine excretion obtained, the supply of iodine in the study group is insufficient. Moreover, It would be desirable to include the systematic determination of free T4 and TSH in the first term of pregnancy so as to to correct a likely thyroid dysfunction as soon as possible in order to avoid possible damage to the foetus.

          Translated abstract

          O objetivo deste trabalho consistiu em identificar os níveis de iodo no primeiro trimestre de gravidez em mulheres atendidas em centros de saúde, pertencentes à área sanitária I de Múrcia (Espanha), bem como na relação de tais níveis com a ingestão e os suplementos de iodo. Por outra parte foi realizado o estudo da função tireoidiana no mesmo grupo. Foi feito um estudo descritivo funcional. O grupo de estudo consistiu em 37 mulheres grávidas, que tinham assistido à primeira visita no centro de saúde correspondente, desde março até agosto de 2011. As variáveis de estudo foram: níveis de iodo em urina, medidos numa amostra isolada de urina, frequência da ingestão de iodo relacionada com a alimentação e suplementos (dados obtidos através de uma entrevista pessoal e um questionário estruturado realizado entre as participantes do estudo), níveis de hormônio tiroestimulante TSH e T4 livre, ambas obtidas a partir de uma amostra de sangue. 86% do grupo em estudo apresentava deficiência de iodo. Houve diferenças estatisticamente significativas quanto à excreção urinária de iodo, na ingestão de sal iodado e de peixe. Entretanto, qualquer outra variável não apresentou diferenças significativas. Foram encontradas três mulheres grávidas com hipotireoidismo subclínico e uma apresentou hipertireoidismo subclínico. Além disso, estes resultados mostraram que os níveis de TSH podem ser mais baixos em mulheres grávidas que na população geral. Com base nos dados de iodúria obtidos, os suplementos de iodo neste grupo foram considerados insuficientes. Além do mais, seria recomendável incluir a determinação sistemática de T4 livre e TSH no primeiro trimestre da gravidez, para corrigir uma possível disfunção tireoidiana assim que for possível e, desse modo, evitar danos no feto.

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          Most cited references 55

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          Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development: a prospective population-based cohort study in China.

           Qin Xu,  Yuan Xu,  Qin Yan (2011)
          There are a few prospective population-based cohort studies evaluating the effects of maternal thyroid dysfunctions on fetal and infant developments, but they are inconsistent. The objective of the study was to investigate the effects of maternal thyroid dysfunction on fetal and infant development. The study was nested within a prospective population-based China-Anhui Birth Defects and Child Development study. A total of 1017 women with singleton pregnancies participated in this study. Maternal serum samples in the first 20 wk of pregnancy were tested for thyroid hormones (TSH and free T(4)). Pregnant women were classified by hormone status into percentile categories based on laboratory assay and were compared accordingly. Outcomes included fetal loss, malformation, birth weight, preterm delivery, fetal stress, neonatal death, and infant development. Clinical hypothyroidism was associated with increased fetal loss, low birth weight, and congenital circulation system malformations; the adjusted odds ratios [95% confidence interval (CI)] were 13.45 (2.54-71.20), 9.05 (1.01-80.90), and 10.44 (1.15-94.62), respectively. Subclinical hypothyroidism was associated with increased fetal distress, preterm delivery, poor vision development, and neurodevelopmental delay; the adjusted odds ratios (95% CI) were 3.65 (1.44-9.26), 3.32 (1.22-9.05), 5.34 (1.09-26.16), and 10.49 (1.01-119.19), respectively. Isolated hypothyroxinemia was related to fetal distress, small for gestational age, and musculoskeletal malformations; the adjusted odds ratios (95% CI) were 2.95 (1.08-8.05), 3.55 (1.01-12.83), and 9.12 (1.67-49.70), respectively. Isolated hyperthyroxinemia was associated with spontaneous abortion; the adjusted odds ratio (95% CI) was 6.02 (1.25-28.96). Clinical hyperthyroidism was associated with hearing dysplasia; the adjusted odds ratio (95% CI) was 12.14 (1.22-120.70). Thyroid dysfunction in the first 20 wk of pregnancy may result in fetal loss and dysplasia and some congenital malformations.
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            Thyroid disease in pregnancy.

            Thyroid testing during pregnancy should be performed on symptomatic women or those with a personal history of thyroid disease. Overt hypothyroidism complicates up to 3 of 1,000 pregnancies and is characterized by nonspecific signs or symptoms that are easily confused with complaints common to pregnancy itself. Physiologic changes in serum thyroid-stimulating hormone (TSH) and free thyroxine (T(4)) related to pregnancy also confound the diagnosis of hypothyroidism during pregnancy. If the TSH is abnormal, then evaluation of free T(4) is recommended. The diagnosis of overt hypothyroidism is established by an elevated TSH and a low free T(4). The goal of treatment with levothyroxine is to return TSH to the normal range. Overt hyperthyroidism complicates approximately 2 of 1,000 pregnancies. Clinical features of hyperthyroidism can also be confused with those typical of pregnancy. Clinical hyperthyroidism is confirmed by a low TSH and elevation in free T(4) concentration. The goal of treatment with thioamide drugs is to maintain free T(4) in the upper normal range using the lowest possible dosage. Postpartum thyroiditis requiring thyroxine replacement has been reported in 2% to 5% of women. Most women will return to the euthyroid state within 12 months.
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              • Record: found
              • Abstract: not found
              • Article: not found

              Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline.

               ,  ,   (2007)
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                Author and article information

                Affiliations
                [1 ] Hospital Clínico Universitario Virgen de la Arrixaca España
                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                abcl
                Acta bioquímica clínica latinoamericana
                Acta bioquím. clín. latinoam.
                Federación Bioquímica de la Provincia de Buenos Aires (La Plata )
                1851-6114
                June 2015
                : 49
                : 2
                : 235-256
                S0325-29572015000200008

                http://creativecommons.org/licenses/by/4.0/

                Product
                Product Information: SciELO Argentina
                Categories
                BIOLOGY

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