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  • Author: Margaret P. Rayman x
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Victor J. M. Pop V Pop, Medical and Clinical Pyschology, Tilburg University Tilburg School of Social and Behavioral Sciences, Tilburg, Netherlands

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Johannes G Krabbe J Krabbe, Clinical Chemistry Lab, Medisch Spectrum Twente, Enschede, Netherlands

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Maarten Broeren M Broeren, Clinical Chemistry Lab, Maxima Medical Centre, Veldhoven, Netherlands

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Wilmar Wiersinga W Wiersinga, endocrinology, Academic Medical Centre, Amsterdam, Netherlands

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Margaret P. Rayman M Rayman, Department of Nutritional Sciences, , University of Surrey, Guildford, United Kingdom of Great Britain and Northern Ireland

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Objective

Pregnancy is a state of inflammation facilitating implantation. Early isolated hypothyroxinaemia (IH) and increased inflammation (including obesity) have been associated with obstetric complications. The current study evaluated the association between IH, low ferritin and inflammation parameters (interleukin-6 (IL-6), C-reactive protein (CRP), human chorionic gonadotrophin (hCG) and obesity. Moreover, the course of these parameters throughout pregnancy was evaluated in relation to IH.

Methods

In the cross-sectional study (A) at 12 weeks, 2759 women participated and 2433 participated in the longitudinal study (B) with assessments at 12, 20 and 28 weeks gestation. At first trimester, 122 (4.4%) IH women (FT4 < 5th percentile, normal TSH levels) were compared with 2114 (76.6%) reference women (FT4 between 10 - 90th percentiles, normal TSH levels), in study B these figures were 99 (4.1%) and 1847 (75.9%), respectively.

Results

Cross-sectionally, compared to reference women, IH was independently associated with low ferritin (< 5th percentile, OR: 2.6, 95%CI: 1.4-4.9), high CRP (> 95th percentile: OR: 1.9, 95%CI: 1.04-3.7), low hCG (< median, OR: 2.1, 95%CI: 1.40-3.16), obesity (BMI>30, OR: 1.7, 95% CI: 1.1-2.9) and higher age (OR: 1.1, 95%CI: 1.04-1.15). Longitudinally, compared to reference women, women with first trimester IH, showed persistently and significantly lower ferritin and hCG levels, and persistently higher CRP and IL-6 levels throughout gestation.

Conclusions

Gestational IH could be viewed as a condition of increased inflammation, as reported in non-thyroidal illness syndrome. Less favorable inflammation parameters and low iron status during early gestation in IH women seem to persist throughout gestation.

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Henry Völzke Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

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Iris Erlund Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland

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Alicja Hubalewska-Dydejczyk Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland

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Till Ittermann Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

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Robin P. Peeters Department of Internal Medicine, Rotterdam Thyroid Centre, Erasmus Medical Centre, Rotterdam, The Netherlands

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Margaret Rayman University of Surrey, Surrey, United Kingdom

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Monika Buchberger Department of Public Health and Health Technology Assessment, UMIT, University for Health Science, Medical Informatics and Technology, Hall, Austria

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Uwe Siebert Department of Public Health and Health Technology Assessment, UMIT, University for Health Science, Medical Informatics and Technology, Hall, Austria

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Betina H. Thuesen Research Centre for Prevention and Health, Glostrup, Denmark

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Michael B. Zimmermann Swiss Federal Institute of Technology, Zürich Department of Health Sciences and Technology, Zürich, Switzerland

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Stefan Grünert Biolution GmbH, Vienna, Austria

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John H. Lazarus Institute of Molecular Medicine, Cardiff University, Cardiff, United Kingdom

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Background: Iodine deficiency disorders (IDD) represent a global health threat to individuals and societies. IDD prevention programmes have been introduced in many parts of the world. However, challenges remain, particularly in Europe due to fragmentation and diversity of approaches that are not harmonized. Objectives: This review is dedicated to the public-health impact of IDD prevention programmes. It sums up experiences collected by the EUthyroid consortium so far and provides information on stakeholders that should be involved in actions directed to improve the impact of IDD prevention. Methods: A joint European database for combining registry-based outcome and monitoring data as well as tools for harmonizing study methods were established. Methods for analyzing thyroglobulin from a dried blood spot are available for assessing the iodine status in the general population and at-risk groups. Mother-child cohorts are used for in-depth analysis of the potential impact of mild-to-moderate iodine deficiency on the neurocognitive development of the offspring. A decision-analytic model has been developed to evaluate the long-term effectiveness and cost effectiveness of IDD prevention programmes. Results: EUthyroid has produced tools and infrastructure to improve the quality of IDD monitoring and follows a dissemination strategy targeting policymakers and the general public. There are tight connections to major stakeholders in the field of IDD monitoring and prevention. Conclusions: EUthyroid has taken steps towards achieving a euthyroid Europe. Our challenge is to inspire a greater sense of urgency in both policymakers and the wider public to address this remediable deficit caused by IDD.

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