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Similarities and differences of dietary and other determinants of iodine status in pregnant women from three European birth cohorts

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Abstract

Purpose

As a component of thyroid hormones, adequate iodine intake is essential during pregnancy for fetal neurodevelopment. Across Europe, iodine deficiency is common in pregnancy, but data are lacking on the predictors of iodine status at this life stage. We, therefore, aimed to explore determinants of iodine status during pregnancy in three European populations of differing iodine status.

Methods

Data were from 6566 pregnant women from three prospective population-based birth cohorts from the United Kingdom (ALSPAC, n = 2852), Spain (INMA, n = 1460), and The Netherlands (Generation R, n = 2254). Urinary iodine-to-creatinine ratio (UI/Creat, µg/g) was measured in spot-urine samples in pregnancy (≤ 18-weeks gestation). Maternal dietary intake, categorised by food groups (g/day), was estimated from food-frequency questionnaires (FFQs). Multivariable regression models used dietary variables (energy-adjusted) and maternal characteristics as predictors of iodine status.

Results

Median UI/Creat in pregnant women of ALSPAC, INMA, and Generation R was 121, 151, and 210 µg/g, respectively. Maternal age was positively associated with UI/Creat in all cohorts (P < 0.001), while UI/Creat varied by ethnicity only in Generation R (P < 0.05). Of the dietary predictors, intake of milk and dairy products (per 100 g/day) was positively associated with UI/Creat in all cohorts [ALSPAC (B = 3.73, P < 0.0001); INMA (B = 6.92, P = 0.002); Generation R (B = 2.34, P = 0.001)]. Cohort-specific dietary determinants positively associated with UI/Creat included fish and shellfish in ALSPAC and INMA, and eggs and cereal/cereal products in Generation R.

Conclusions

The cohort-specific dietary determinants probably reflect not only dietary habits but iodine-fortification policies; hence, public-health interventions to improve iodine intake in pregnancy need to be country-specific.

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Abbreviations

ALSPAC:

The Avon Longitudinal Study of Parents and Children

BMI:

Body mass index

CI:

Confidence interval

CRM:

Certified reference material

EXP:

Exponentiation

FFQ:

Food-frequency questionnaire

INMA:

INfancia y Medio Ambiente

IQ:

Intelligence quotient

RSD:

Relative standard deviation

SD:

Standard deviation

SEE:

Standard error of estimate

SFFQ:

Semi-quantitative food-frequency questionnaire

UI/Creat:

Urinary iodine-to-creatinine ratio

UIC:

Urinary iodine concentration

UK:

United Kingdom

WHO:

World Health Organisation

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Acknowledgements

EUthyroid project: This project has received funding from the European Union´s Horizon 2020 research and innovation programme under Grant agreement no. 634453.

ALSPAC: We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses. The UK Medical Research Council and Wellcome (Grant ref.: 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. This publication is the work of the authors and Dr Bath will serve as a guarantor for the contents of this paper. ALSPAC data collection is funded from a wide range of sources, a comprehensive list of which is available on the ALSPAC website (http://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf). The existing iodine measurements in ALSPAC were funded from (1) the NUTRIMENTHE project, which received a research grant from the European Community’s 7th Framework Programme (FP7/2008–2013) under grant agreement 212652 and (2) a Ph.D. studentship that was funded by Wassen International and the Waterloo Foundation (2009–2012). We would like to thank Dr Pauline Emmett for helping with the dietary analysis of the ALSPAC food-frequency questionnaire.

Generation R: The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with the Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service Rotterdam area, Rotterdam, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR-MDC), Rotterdam. The Generation R Study is supported by the Erasmus Medical Center, Rotterdam, the Erasmus University Rotterdam, The Netherlands Organization for Health Research and Development (ZonMw), The Netherlands Organization for Scientific Research (NWO), the Ministry of Health, Welfare and Sport. A grant from the Sophia Children’s Hospital Research Funds supports the neurodevelopmental work on thyroid; Robin P. Peeters is supported by a clinical fellowship from ZonMw, project number 90700412.

INMA: This study was funded by grants from UE (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1) and Spain: Instituto de Salud Carlos III (Red INMA G03/176; CB06/02/0041; FIS-FEDER: PI041436, PI05/1079, PI06/0867, PI081151, FIS-and PS09/00090, PI11/01007, PI11/02591, PI11/02038, PI13/1944, PI13/2032, PI14/00891, PI14/01687, and PI16/1288; Miguel Servet-FEDER CP11/00178, CP15/00025, and CPII16/00051, MS13/00054), Generalitat Valenciana: FISABIO (UGP 15-230, UGP-15-244, and UGP-15-249), Generalitat de Catalunya-CIRIT 1999SGR 00241, Fundació La marató de TV3 (090430), Department of Health of the Basque Government (2005111093 and 2009111069), and the Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001).

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Authors and Affiliations

  1. Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK

    Mariana Dineva, Margaret P. Rayman & Sarah C. Bath

  2. The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands

    Deborah Levie & Tim I. M. Korevaar

  3. Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands

    Deborah Levie, Robin P. Peeters & Tim I. M. Korevaar

  4. Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children’s Hospital, Rotterdam, The Netherlands

    Deborah Levie & Mònica Guxens

  5. ISGlobal, Barcelona, Spain

    Deborah Levie, Mònica Guxens & Jordi Sunyer

  6. Pompeu Fabra University, Barcelona, Spain

    Deborah Levie, Mònica Guxens & Jordi Sunyer

  7. Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain

    Deborah Levie, Mònica Guxens, Jesus Vioque, Jesús Ibarluzea & Jordi Sunyer

  8. Nutritional Epidemiology Unit, Miguel Hernández University, ISABIAL-FISABIO, Alicante, Spain

    Jesus Vioque

  9. Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain

    Llúcia González

  10. Predepartamental Unit of Medicine, University Jaume I, Castelló, Spain

    Llúcia González

  11. Departamento de Salud del Gobierno Vasco, Public Health Laboratory of Bilbao, Basque Government, Derio, Spain

    Mercedes Espada

  12. BIODONOSTIA Health Research Institute, Donostia-San Sebastián, Spain

    Mercedes Espada & Jesús Ibarluzea

  13. Departamento de Salud del Gobierno Vasco, Subdirección de Salud Pública de Guipúzcoa, Donostia-San Sebastián, Spain

    Jesús Ibarluzea

  14. Facultad de Psicología, University of the Basque Country UPV/EHU, Donostia-San Sebastián, Spain

    Jesús Ibarluzea

  15. Hospital del Mar Research Institute (IMIM), Barcelona, Spain

    Jordi Sunyer

Authors
  1. Mariana Dineva
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  2. Margaret P. Rayman
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  3. Deborah Levie
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  4. Mònica Guxens
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  5. Robin P. Peeters
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  6. Jesus Vioque
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  7. Llúcia González
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  8. Mercedes Espada
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  11. Tim I. M. Korevaar
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  12. Sarah C. Bath
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Contributions

MD performed statistical analyses, interpreted the data, and wrote the first version of the manuscript. MPR, SCB, RPP, TIMK, MG, and DL contributed to statistical analyses, interpretation of the data, and writing of the manuscript. JV, LG, ME, JI, and JS helped with writing of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sarah C. Bath.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All studies in these analyses have been approved by the appropriate ethics committees and have, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Detailed information is included as part of the main text (see “Methods”, sub-section “Ethics”).

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Dineva, M., Rayman, M.P., Levie, D. et al. Similarities and differences of dietary and other determinants of iodine status in pregnant women from three European birth cohorts. Eur J Nutr 59, 371–387 (2020). https://doi.org/10.1007/s00394-019-01913-w

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