Abstract
Iodine, as a component of the thyroid hormones, is crucial for brain development and is therefore especially important during pregnancy when the brain is developing most rapidly. While randomised controlled trials of pregnant women in regions of severe iodine deficiency have shown that prenatal iodine deficiency causes impaired cognition, less is known of the effects in regions of mild deficiency. This is relevant to the UK as the World Health Organisation now classifies the UK as mildly iodine deficient, based on a national study of 14–15 year old schoolgirls in 2011. We have previously published a study using samples and data from the UK-based Avon Longitudinal Study of Parents and Children (ALSPAC) that found an association between low iodine status in early pregnancy (urinary iodine-to-creatinine ratio <150 μg/g) and lower verbal IQ and reading scores in the offspring. Though the women in ALSPAC were recruited in the early 1990s, the results of the study are still relevant as their iodine status was similar to that reported in recent studies of UK pregnant women. This review discusses the evidence that mild-to-moderate iodine deficiency during pregnancy has deleterious effects on child neurodevelopment and relates that evidence to the data on iodine status in the UK. It has highlighted a need for nationwide data on iodine status of pregnant women and that a randomised controlled trial of iodine supplementation in pregnant women in a region of mild-to-moderate iodine deficiency with child outcomes as the primary endpoint is required.
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References
Barnett, C., Visser, T., Williams, F., Toor, H., Duran, S., Presas, M., et al. (2002). Inadequate iodine intake of 40% of pregnant women from a region in Scotland. Journal of Endocrinological Investigation, 25(Suppl. No. 7) 90, p. 110.
Bates, B., Lennox, A., Prentice, A., Bates, C., Page, P., Nicholson, S. K., et al. (2014). National diet and nutrition survey, results from years 1–4 of the rolling programme. www.gov.uk/government/uploads/system/uploads/attachment_data/file/310995/NDNS_Y1_to_4_UK_report.pdf.
Bath, S. C., Jolly, K. B., & Rayman, M. P. (2013a). Iodine supplements during and after pregnancy. JAMA, 309(13), 1345. doi:10.1001/jama.2013.2237.
Bath, S., & Rayman, M. P. (2011). Iodine deficiency in UK schoolgirls. Lancet, 378(9803), 1623.; author reply 1624.
Bath, S. C., & Rayman, M. P. (2013). BDA food fact sheet—Iodine. www.bda.uk.com/foodfacts/Iodine. British Dietetic Association.
Bath, S. C., Sleeth, M. L., McKenna, M., Walter, A., Taylor, A., & Rayman, M. P. (2014a). Iodine intake and status of UK women of childbearing age recruited at the University of Surrey in the winter. British Journal of Nutrition, 112(10), 1715–1723.
Bath, S. C., Steer, C. D., Golding, J., Emmett, P., & Rayman, M. P. (2013b). Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: Results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet, 382(9889), 331–337. doi:10.1016/s0140-6736(13)60436-5.
Bath, S. C., Walter, A., Taylor, A., Wright, J., & Rayman, M. P. (2014b). Iodine deficiency in pregnant women living in the South East of the UK: The influence of diet and nutritional supplements on iodine status. British Journal of Nutrition, 111(9), 1622–1631.
Berbel, P., Mestre, J. L., Santamaria, A., Palazon, I., Franco, A., Graells, M., et al. (2009). Delayed neurobehavioral development in children born to pregnant women with mild hypothyroxinemia during the first month of gestation: The importance of early iodine supplementation. Thyroid, 19(5), 511–519.
Burgi, H. (2010). Iodine excess. Best Practice & Research Clinical Endocrinology & Metabolism, 24(1), 107–115.
Burns, R., O’Herlihy, C., & Smyth, P. P. (2011). The placenta as a compensatory iodine storage organ. Thyroid, 21(5), 541–546.
Chanoine, J. P., Bourdoux, P., Vo Thi, N.B., & Ermans, A. M. (1987). Iodine contamination of urine samples by test strips. Clinical Chemistry, 33(10), 1935.
Costeira, M. J., Oliveira, P., Santos, N. C., Ares, S., Saenz-Rico, B., Morreale de Escobar, G., et al. (2011). Psychomotor development of children from an iodine-deficient region. Journal of Pediatrics, 159(3), 447–453.
de Benoist, B., McLean, E., Andersson, M., & Rogers, L. (2008). Iodine deficiency in 2007: Global progress since 2003. Food and Nutrition Bulletin, 29(3), 195–202.
Department of Health. (1991). Report on Health and Social Subjects: 41. Dietary reference values for food, energy and nutrients for the United Kingdom. London: The Stationery Office.
Food and Nutrition Board Institute of Medicine. (2001). Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, manganese, molybdenum, nickel, silicon, vanadium and zinc. Washington, DC: National Academy Press.
Food Standards Agency. (2008). Retail survey of iodine in UK produced dairy foods. FSIS 02/08. www.food.gov.uk/multimedia/pdfs/fsis0208.pdf. Accessed October 11, 2010.
Furmidge-Owen, V., Bath, S. C., Redman, C. W. G., & Rayman, M. P. (2014). A longitudinal study of iodine status throughout gestation in UK women. The Proceedings of the Nutrition Society, 73(OCE1), E38.
Ghassabian, A., Steenweg-de Graaff, J., Peeters, R. P., Ross, H. A., Jaddoe, V. W., Hofman, A., et al. (2014). Maternal urinary iodine concentration in pregnancy and children’s cognition: Results from a population-based birth cohort in an iodine-sufficient area. BMJ Open,. doi:10.1136/bmjopen-2014-005520.
Glinoer, D. (2004). The regulation of thyroid function during normal pregnancy: Importance of the iodine nutrition status. Best Practice & Research Clinical Endocrinology & Metabolism, 18(2), 133–152.
Golding, J., Pembrey, M., & Jones, R. (2001). ALSPAC—the Avon Longitudinal Study of Parents and Children. I. Study methodology. Paediatric and Perinatal Epidemiology, 15(1), 74–87.
Henderson, L., Irving, K., Gregory, J., Bates, C., Prentice, A., & Perks, J. (2003). The national diet & nutrition survey: Adults aged 19 to 64 years. Volume 3: Vitamin and mineral intake and urinary analytes. London: HMSO.
Hynes, K. L., Otahal, P., Hay, I., & Burgess, J. R. (2013a). Mild iodine deficiency during pregnancy is associated with reduced educational outcomes in the offspring: 9-Year follow-up of the gestational iodine cohort. Journal of Clinical Endocrinology and Metabolism, 98(5), 1954–1962. doi:10.1210/jc.2012-4249.
Hynes, K. L., Otahal, P., Hay, I., & Burgess, J. R. (2013b). Mild iodine deficiency during pregnancy is associated with reduced educational outcomes in the offspring: 9-Year follow-up of the gestational iodine cohort. Journal of Clinical Endocrinology and Metabolism,. doi:10.1210/jc.2012-4249.
Kibirige, M. S., Hutchison, S., Owen, C. J., & Delves, H. T. (2004). Prevalence of maternal dietary iodine insufficiency in the north east of England: Implications for the fetus. Archives of Disease in Childhood. Fetal and Neonatal Edition, 89(5), F436–F439.
Knudsen, N., Christiansen, E., Brandt-Christensen, M., Nygaard, B., & Perrild, H. (2000). Age- and sex-adjusted iodine/creatinine ratio. A new standard in epidemiological surveys? Evaluation of three different estimates of iodine excretion based on casual urine samples and comparison to 24 h values. European Journal of Clinical Nutrition, 54(4), 361–363.
Konig, F., Andersson, M., Hotz, K., Aeberli, I., & Zimmermann, M. B. (2011). Ten repeat collections for urinary iodine from spot samples or 24-hour samples are needed to reliably estimate individual iodine status in women. Journal of Nutrition, 141(11), 2049–2054.
Lampropoulou, M., Lean, M., & Combet Aspray, E. (2012). Iodine status of women of childbearing age in Scotland. The Proceedings of the Nutrition Society, 71, E143.
Lazarus, J. H., Bestwick, J. P., Channon, S., Paradice, R., Maina, A., Rees, R., et al. (2012). Antenatal thyroid screening and childhood cognitive function. New England Journal of Medicine, 366(6), 493–501.
Melse-Boonstra, A., Gowachirapant, S., Jaiswal, N., Winichagoon, P., Srinivasan, K., & Zimmermann, M. B. (2012). Iodine supplementation in pregnancy and its effect on child cognition. Journal of Trace Elements in Medicine and Biology, 26(2–3), 134–136. doi:10.1016/j.jtemb.2012.03.005.
Melse-Boonstra, A., & Jaiswal, N. (2010). Iodine deficiency in pregnancy, infancy and childhood and its consequences for brain development. Best Practice & Research Clinical Endocrinology & Metabolism, 24(1), 29–38.
Moleti, M., Di Bella, B., Giorgianni, G., Mancuso, A., De Vivo, A., Alibrandi, A., et al. (2011). Maternal thyroid function in different conditions of iodine nutrition in pregnant women exposed to mild-moderate iodine deficiency: An observational study. Clinical Endocrinology (Oxford), 74(6), 762–768.
Murcia, M., Rebagliato, M., Iniguez, C., Lopez-Espinosa, M. J., Estarlich, M., Plaza, B., et al. (2011). Effect of iodine supplementation during pregnancy on infant neurodevelopment at 1 year of age. American Journal of Epidemiology, 173(7), 804–812.
National Health and Medical Research Council. (2010). Iodine supplementation for pregnant and breastfeeding women. January 2010. www.nhmrc.gov.au/guidelines/publications/new45. Accessed October 10, 2011.
Ovesen, L., & Boeing, H. (2002). The use of biomarkers in multicentric studies with particular consideration of iodine, sodium, iron, folate and vitamin D. European Journal of Clinical Nutrition, 56(Suppl 2), S12–S17.
Pearce, E. N., Lazarus, J. H., Smyth, P. P., He, X., Dall’amico, D., Parkes, A. B., et al. (2010). Perchlorate and thiocyanate exposure and thyroid function in first-trimester pregnant women. Journal of Clinical Endocrinology and Metabolism, 95(7), 3207–3215.
Pearce, E. N., Lazarus, J. H., Smyth, P. P., He, X., Smith, D. F., Pino, S., et al. (2009). Urine test strips as a source of iodine contamination. Thyroid, 19(8), 919.
Phillips, D. I. (1997). Iodine, milk, and the elimination of endemic goitre in Britain: The story of an accidental public health triumph. Journal of Epidemiology and Community Health, 51(4), 391–393.
Rasmussen, L. B., Ovesen, L., Bulow, I., Jorgensen, T., Knudsen, N., Laurberg, P., et al. (2002). Dietary iodine intake and urinary iodine excretion in a Danish population: Effect of geography, supplements and food choice. British Journal of Nutrition, 87(1), 61–69.
Rayman, M. P., Searle, E., Kelly, L., Johnson, S., Bodman-Smith, K., Bath, S. C., et al. (2014). Effect of selenium on markers of risk of pre-eclampsia in UK pregnant women: Randomised, controlled pilot trial. British Journal of Nutrition, 112(1), 99–111.
Rebagliato, M., Murcia, M., Alvarez-Pedrerol, M., Espada, M., Fernandez-Somoano, A., Lertxundi, N., et al. (2013). Iodine supplementation during pregnancy and infant neuropsychological development: INMA mother and child cohort study. American Journal of Epidemiology, 177(9), 944–953. doi:10.1093/aje/kws333.
Rebagliato, M., Murcia, M., Espada, M., Alvarez-Pedrerol, M., Bolumar, F., Vioque, J., et al. (2010). Iodine intake and maternal thyroid function during pregnancy. Epidemiology, 21(1), 62–69.
Santiago, P., Velasco, I., Muela, J. A., Sanchez, B., Martinez, J., Rodriguez, A., et al. (2013). Infant neurocognitive development is independent of the use of iodised salt or iodine supplements given during pregnancy. British Journal of Nutrition, 110(5), 831–839. doi:10.1017/s0007114512005880.
Scientific Advisory Committe on Nutrition. (2014). SACN statement on iodine and health. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/339439/SACN_Iodine_and_Health_2014.pdf. Accessed October 20, 2014.
Scientific Committee on Food. (2002). Opinion of the Scientific Committee on Food on the tolerable upper intake level of iodine. SCF/CS/NUT/UPPLEV/26 Final. http://ec.europa.eu/food/fs/sc/scf/out146_en.pdf. Accessed January 11, 2012. European Commission.
Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., et al. (2011). Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid, 21(10), 1081–1125.
Stagnaro-Green, A., & Pearce, E. N. (2013). Iodine and pregnancy: A call to action. Lancet,. doi:10.1016/s0140-6736(13)60717-5.
Stagnaro-Green, A., Sullivan, S., & Pearce, E. (2012). Iodine supplementation during pregnancy and lactation. JAMA, 308(23), 2463–2464.
van Mil, N. H., Tiemeier, H., Bongers-Schokking, J. J., Ghabassian, A., Hofman, A., Hooijkaas, H., et al. (2012). Low urinary iodine excretion during early pregnancy is associated with alterations in executive functioning in children. The Journal of Nutrition, 142, 2167–2174.
Vanderpump, M. P., Lazarus, J. H., Smyth, P. P., Laurberg, P., Holder, R. L., Boelaert, K., et al. (2011). Iodine status of UK schoolgirls: A cross-sectional survey. Lancet, 377(9782), 2007–2012.
Velasco, I., Carreira, M., Santiago, P., Muela, J. A., Garcia-Fuentes, E., Sanchez-Munoz, B., et al. (2009). Effect of iodine prophylaxis during pregnancy on neurocognitive development of children during the first two years of life. Journal of Clinical Endocrinology and Metabolism, 94(9), 3234–3241.
Wenlock, R. W., Buss, D. H., Moxon, R. E., & Bunton, N. G. (1982). Trace nutrients. 4. Iodine in British food. British Journal of Nutrition, 47(3), 381–390.
WHO, UNICEF, & ICCIDD. (2007). Assessment of iodine deficiency disorders and monitoring their elimination. Geneva: WHO.
Zimmermann, M. B. (2009). Iodine deficiency. Endocrine Reviews, 30(4), 376–408.
Zimmermann, M. B., & Melse-Boonstra, A. (2008). Maternal Iodine Supplementation and Effects on Thyroid Function and Child Development (MITCH). ClinicalTrials.gov Identifier: NCT00791466. http://clinicaltrials.gov/ct2/show/NCT00791466. Accessed March 25, 2012.
Acknowledgments
We are grateful for the advice and help of the co-authors on our own studies (listed in the reference list). We gratefully acknowledge the funding that has supported our studies, including a PhD studentship for SC Bath from Wassen International and the Waterloo Foundation, from The Wellcome Trust for the SPRINT study (Grant No. 083918/Z/07/Z) and from the European Community’s 7th Framework Programme (FP7/2008–2013) Grant Agreement No. 212652 (NUTRIMENTHE “The Effect of Diet on the Mental Performance of Children”). An MRC Population Health Scientist Fellowship (reference MR/K02132X/1) supported S.C. Bath during the writing of this review.
Conflict of interest
Prof. Rayman reported a grant to her institution from Wassen International which helped support Dr. Bath’s Ph.D. studentship; Dr. Bath reported receiving a small honorarium for a lecture from the Dairy Council Northern Ireland and a Ph.D. studentship, partly funded by Wassen International.
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Bath, S.C., Rayman, M.P. A review of the iodine status of UK pregnant women and its implications for the offspring. Environ Geochem Health 37, 619–629 (2015). https://doi.org/10.1007/s10653-015-9682-3
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DOI: https://doi.org/10.1007/s10653-015-9682-3
Keywords
- Iodine
- Nutrition
- Pregnancy
- UK
- Cognition