Iodine Status of Pregnant Women in Bulgaria

Anna-Maria Borissovа; Ludmila Ivanova; Boyana Trifonova; Lilia Dakovska; Eugenia Mihailova; Mircho Vukov

doi:doi:10.11648/j.ejpm.20200804.12

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Iodine Status of Pregnant Women in Bulgaria

Anna-Maria Borissovа, Ludmila Ivanova, Boyana Trifonova, Lilia Dakovska, Eugenia Mihailova, Mircho Vukov

Published in European Journal of Preventive Medicine (Volume 8, Issue 4)

Received: 6 June 2020 Accepted: 29 June 2020 Published: 4 August 2020

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Abstract

Universal iodization of salt on the whole territory in Bulgaria was introduced in 1994. The external evaluation of an International expert group conducted in 2005, placed the country among those who successfully overcame the problem of iodine deficiency. AIM of the present study is to update the data on iodine intake of pregnant women in Bulgaria, given that there have been no studies in the last 8 years. MATERIAL: A total number of 537 pregnant women were recruited in the study with an average age 30.49±5 y, distributed by gestational weeks and according to the intake of (vitamins and minerals preparations) preparations containing vitamins with minerals. The study was conducted as a cross-sectional, multicenter population-based in 10 regions of Bulgaria (a total of 84 settlements), without pre-selection and 98.3% of the examined pregnant women use Bulgarian iodized salt according to the data from the Questionnaire. METHOD: A spot morning urine samples were collected for determination of urinary iodine concentration. The frozen samples in a special container were transported to the accredited Limbach laboratory in Heidelberg, Germany. The iodine in urine was determined by inductively coupled plasma mass spectrometry (ICP-MS) method. The statistical analysis was performed using standard SPSS 13.0 for Windows. RESULTS: The median urinary iodine concentration (mUIC) for the whole group of pregnant women (n-537) was 170 µg/L (95% CI 161.00 - 177.00). Normal iodine excretion is present in 39.3%, low – in 41.2% and over-optimal – in 19.6% of pregnant women. Significantly lower levels of iodine in urine were found in the third trimester of pregnancy compared to the first trimester (P < 0.012) and compared to the second trimester (P < 0.001). The median iodine concentration in pregnant women from the group supplemented with combined vitamins with minerals was significantly higher compared to the group without supplementation – 175 (95% CI 166.00 - 199.00) against 149 (95% CI 123.00 - 168.00), P < 0.021. CONCLUSION: During pregnancy, additional supplementation with combined vitamins with minerals containing iodine is required, regardless of the universal iodization of salt, introduced in Bulgaria for more than twenty-five years.

Published in	European Journal of Preventive Medicine (Volume 8, Issue 4)
DOI	10.11648/j.ejpm.20200804.12
Page(s)	43-47
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Pregnant Women, Universal Salt Iodization, Urinary Iodine Concentration, Supplementation

References

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[2]	Skeaff SA. (2011). Iodine Deficiency in Pregnancy: The Effect on Neurodevelopment in the Child Nutrients 3 (2): 265–273. Published online 2011 Feb 18. doi: 10.3390/nu3020265.
[3]	Zimmermann MB. (2012). The Effects of Iodine Deficiency in Pregnancy and Infancy. Pediatric and Perinatal Epidemiology 26 (Suppl. 1), 108–117.
[4]	Andersson M1, de Benoist B, Rogers L. (2010). Epidemiology of iodine deficiency: Salt iodisation and iodine status. Best Pract Res Clin Endocrinol Metab 24 (1): 1-11. doi: 10.1016/j.beem.2009.08.005.
[5]	Iodine status worldwide: WHO global database on iodine deficiency. Geneva: World Health Organization; 2004. (http://whqlibdoc.who.int/publications/2004/9241592001.pdf, accessed 20 May 2020.
[6]	UNICEF. Guidance from Monitoring of Sal Iodization Programs and Determination of Population Iodine Status, 2015.
[7]	UNICEF, PAMM. Urinary Iodine Assessment: A Manual on Survey and Laboratory Methods. PAMM: Washington, DC; 2000.
[8]	WHO/UNICEF/ICCIDD. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers. 2007, 3rd ed.
[9]	WHO/UNICEF/ICCIDD. A practical guide to the correction of iodine deficiency. Wageningen: International Council for the Control of Iodine Deficiency Disorders; 1990.
[10]	Pallavi Panth, Gena Guerin and Nancy M. DiMarco. (2019). A Review of Iodine Status of Women of Reproductive Age in the USA. Biol Trace Elem Res 88 (1): 208–220. Published online 2019 Jan 7. doi: 10.1007/s12011-018-1606-5.
[11]	World Health Organization. Urinary iodine concentrations for determining iodine status in populations. VMNIS \| Vitamin and Mineral Nutrition Information System 2013.
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[13]	Review of Progress towards Sustained Optimal Iodine Nutrition in Bulgaria. Report by a team of experts on behalf of the Network for Sustained Elimination of Iodine Deficiency, ed by Tz. Timcheva, SMART Publ. 2006. pp32.
[14]	Zimmermann, MB. (2015). Iodine deficiency in pregnant women in Europe. Lancet Diabetes Endocrinol S2213-8587 (15) 00263-6. Published Online, August 10, 2015. http://dx.doi.org/10.1016/.
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[16]	Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejxzyk A, Negro R, Vaidya B. (2014). 2014 European Thyroid Association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J 3 (2): 76–94. https://doi.org/10.1159/00036 2597.
[17]	Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, and Sullivan S. (2017). 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 27 (3): 315–389. https://doi.org/10.1089/thy.2016.0457.
[18]	Soldin OP. (2002). Controversies in urinary iodine determinations. Clin Biochem 35: 575–579.
[19]	Joint strategies for salt iodization and salt reduction in public health. Excerpt from a report of a joint technical meeting convened by the World Health Organization and the George Institute for Global Health in collaboration with the ICCIDD Global Network in Sydney, Australia, 25–27 March 2013. IDD Newsletter, May 2014.
[20]	World Health Organization. Global status report on noncommunicable diseases. Geneva, 2010. http://www. who.int/nmh/publications/ ncd_report_full_en.pdf.

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APA Style

Anna-Maria Borissovа, Ludmila Ivanova, Boyana Trifonova, Lilia Dakovska, Eugenia Mihailova, et al. (2020). Iodine Status of Pregnant Women in Bulgaria. European Journal of Preventive Medicine, 8(4), 43-47. https://doi.org/10.11648/j.ejpm.20200804.12

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ACS Style

Anna-Maria Borissovа; Ludmila Ivanova; Boyana Trifonova; Lilia Dakovska; Eugenia Mihailova, et al. Iodine Status of Pregnant Women in Bulgaria. Eur. J. Prev. Med. 2020, 8(4), 43-47. doi: 10.11648/j.ejpm.20200804.12

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AMA Style

Anna-Maria Borissovа, Ludmila Ivanova, Boyana Trifonova, Lilia Dakovska, Eugenia Mihailova, et al. Iodine Status of Pregnant Women in Bulgaria. Eur J Prev Med. 2020;8(4):43-47. doi: 10.11648/j.ejpm.20200804.12

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@article{10.11648/j.ejpm.20200804.12,
  author = {Anna-Maria Borissovа and Ludmila Ivanova and Boyana Trifonova and Lilia Dakovska and Eugenia Mihailova and Mircho Vukov},
  title = {Iodine Status of Pregnant Women in Bulgaria},
  journal = {European Journal of Preventive Medicine},
  volume = {8},
  number = {4},
  pages = {43-47},
  doi = {10.11648/j.ejpm.20200804.12},
  url = {https://doi.org/10.11648/j.ejpm.20200804.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejpm.20200804.12},
  abstract = {Universal iodization of salt on the whole territory in Bulgaria was introduced in 1994. The external evaluation of an International expert group conducted in 2005, placed the country among those who successfully overcame the problem of iodine deficiency. AIM of the present study is to update the data on iodine intake of pregnant women in Bulgaria, given that there have been no studies in the last 8 years. MATERIAL: A total number of 537 pregnant women were recruited in the study with an average age 30.49±5 y, distributed by gestational weeks and according to the intake of (vitamins and minerals preparations) preparations containing vitamins with minerals. The study was conducted as a cross-sectional, multicenter population-based in 10 regions of Bulgaria (a total of 84 settlements), without pre-selection and 98.3% of the examined pregnant women use Bulgarian iodized salt according to the data from the Questionnaire. METHOD: A spot morning urine samples were collected for determination of urinary iodine concentration. The frozen samples in a special container were transported to the accredited Limbach laboratory in Heidelberg, Germany. The iodine in urine was determined by inductively coupled plasma mass spectrometry (ICP-MS) method. The statistical analysis was performed using standard SPSS 13.0 for Windows. RESULTS: The median urinary iodine concentration (mUIC) for the whole group of pregnant women (n-537) was 170 µg/L (95% CI 161.00 - 177.00). Normal iodine excretion is present in 39.3%, low – in 41.2% and over-optimal – in 19.6% of pregnant women. Significantly lower levels of iodine in urine were found in the third trimester of pregnancy compared to the first trimester (P < 0.012) and compared to the second trimester (P < 0.001). The median iodine concentration in pregnant women from the group supplemented with combined vitamins with minerals was significantly higher compared to the group without supplementation – 175 (95% CI 166.00 - 199.00) against 149 (95% CI 123.00 - 168.00), P < 0.021. CONCLUSION: During pregnancy, additional supplementation with combined vitamins with minerals containing iodine is required, regardless of the universal iodization of salt, introduced in Bulgaria for more than twenty-five years.},
 year = {2020}
}

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TY  - JOUR
T1  - Iodine Status of Pregnant Women in Bulgaria
AU  - Anna-Maria Borissovа
AU  - Ludmila Ivanova
AU  - Boyana Trifonova
AU  - Lilia Dakovska
AU  - Eugenia Mihailova
AU  - Mircho Vukov
Y1  - 2020/08/04
PY  - 2020
N1  - https://doi.org/10.11648/j.ejpm.20200804.12
DO  - 10.11648/j.ejpm.20200804.12
T2  - European Journal of Preventive Medicine
JF  - European Journal of Preventive Medicine
JO  - European Journal of Preventive Medicine
SP  - 43
EP  - 47
PB  - Science Publishing Group
SN  - 2330-8230
UR  - https://doi.org/10.11648/j.ejpm.20200804.12
AB  - Universal iodization of salt on the whole territory in Bulgaria was introduced in 1994. The external evaluation of an International expert group conducted in 2005, placed the country among those who successfully overcame the problem of iodine deficiency. AIM of the present study is to update the data on iodine intake of pregnant women in Bulgaria, given that there have been no studies in the last 8 years. MATERIAL: A total number of 537 pregnant women were recruited in the study with an average age 30.49±5 y, distributed by gestational weeks and according to the intake of (vitamins and minerals preparations) preparations containing vitamins with minerals. The study was conducted as a cross-sectional, multicenter population-based in 10 regions of Bulgaria (a total of 84 settlements), without pre-selection and 98.3% of the examined pregnant women use Bulgarian iodized salt according to the data from the Questionnaire. METHOD: A spot morning urine samples were collected for determination of urinary iodine concentration. The frozen samples in a special container were transported to the accredited Limbach laboratory in Heidelberg, Germany. The iodine in urine was determined by inductively coupled plasma mass spectrometry (ICP-MS) method. The statistical analysis was performed using standard SPSS 13.0 for Windows. RESULTS: The median urinary iodine concentration (mUIC) for the whole group of pregnant women (n-537) was 170 µg/L (95% CI 161.00 - 177.00). Normal iodine excretion is present in 39.3%, low – in 41.2% and over-optimal – in 19.6% of pregnant women. Significantly lower levels of iodine in urine were found in the third trimester of pregnancy compared to the first trimester (P < 0.012) and compared to the second trimester (P < 0.001). The median iodine concentration in pregnant women from the group supplemented with combined vitamins with minerals was significantly higher compared to the group without supplementation – 175 (95% CI 166.00 - 199.00) against 149 (95% CI 123.00 - 168.00), P < 0.021. CONCLUSION: During pregnancy, additional supplementation with combined vitamins with minerals containing iodine is required, regardless of the universal iodization of salt, introduced in Bulgaria for more than twenty-five years.
VL  - 8
IS  - 4
ER  -

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Author Information

Anna-Maria Borissovа

Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria
Ludmila Ivanova

Faculty of Medicine, Sofia University St. Kliment Ohridski, Sofia, Bulgaria
Boyana Trifonova

Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria
Lilia Dakovska

Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria
Eugenia Mihailova

Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria
Mircho Vukov

Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria

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APA Style

Anna-Maria Borissovа, Ludmila Ivanova, Boyana Trifonova, Lilia Dakovska, Eugenia Mihailova, et al. (2020). Iodine Status of Pregnant Women in Bulgaria. European Journal of Preventive Medicine, 8(4), 43-47. https://doi.org/10.11648/j.ejpm.20200804.12

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ACS Style

Anna-Maria Borissovа; Ludmila Ivanova; Boyana Trifonova; Lilia Dakovska; Eugenia Mihailova, et al. Iodine Status of Pregnant Women in Bulgaria. Eur. J. Prev. Med. 2020, 8(4), 43-47. doi: 10.11648/j.ejpm.20200804.12

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AMA Style

Anna-Maria Borissovа, Ludmila Ivanova, Boyana Trifonova, Lilia Dakovska, Eugenia Mihailova, et al. Iodine Status of Pregnant Women in Bulgaria. Eur J Prev Med. 2020;8(4):43-47. doi: 10.11648/j.ejpm.20200804.12

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@article{10.11648/j.ejpm.20200804.12,
  author = {Anna-Maria Borissovа and Ludmila Ivanova and Boyana Trifonova and Lilia Dakovska and Eugenia Mihailova and Mircho Vukov},
  title = {Iodine Status of Pregnant Women in Bulgaria},
  journal = {European Journal of Preventive Medicine},
  volume = {8},
  number = {4},
  pages = {43-47},
  doi = {10.11648/j.ejpm.20200804.12},
  url = {https://doi.org/10.11648/j.ejpm.20200804.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejpm.20200804.12},
  abstract = {Universal iodization of salt on the whole territory in Bulgaria was introduced in 1994. The external evaluation of an International expert group conducted in 2005, placed the country among those who successfully overcame the problem of iodine deficiency. AIM of the present study is to update the data on iodine intake of pregnant women in Bulgaria, given that there have been no studies in the last 8 years. MATERIAL: A total number of 537 pregnant women were recruited in the study with an average age 30.49±5 y, distributed by gestational weeks and according to the intake of (vitamins and minerals preparations) preparations containing vitamins with minerals. The study was conducted as a cross-sectional, multicenter population-based in 10 regions of Bulgaria (a total of 84 settlements), without pre-selection and 98.3% of the examined pregnant women use Bulgarian iodized salt according to the data from the Questionnaire. METHOD: A spot morning urine samples were collected for determination of urinary iodine concentration. The frozen samples in a special container were transported to the accredited Limbach laboratory in Heidelberg, Germany. The iodine in urine was determined by inductively coupled plasma mass spectrometry (ICP-MS) method. The statistical analysis was performed using standard SPSS 13.0 for Windows. RESULTS: The median urinary iodine concentration (mUIC) for the whole group of pregnant women (n-537) was 170 µg/L (95% CI 161.00 - 177.00). Normal iodine excretion is present in 39.3%, low – in 41.2% and over-optimal – in 19.6% of pregnant women. Significantly lower levels of iodine in urine were found in the third trimester of pregnancy compared to the first trimester (P < 0.012) and compared to the second trimester (P < 0.001). The median iodine concentration in pregnant women from the group supplemented with combined vitamins with minerals was significantly higher compared to the group without supplementation – 175 (95% CI 166.00 - 199.00) against 149 (95% CI 123.00 - 168.00), P < 0.021. CONCLUSION: During pregnancy, additional supplementation with combined vitamins with minerals containing iodine is required, regardless of the universal iodization of salt, introduced in Bulgaria for more than twenty-five years.},
 year = {2020}
}

Copy | Download

TY  - JOUR
T1  - Iodine Status of Pregnant Women in Bulgaria
AU  - Anna-Maria Borissovа
AU  - Ludmila Ivanova
AU  - Boyana Trifonova
AU  - Lilia Dakovska
AU  - Eugenia Mihailova
AU  - Mircho Vukov
Y1  - 2020/08/04
PY  - 2020
N1  - https://doi.org/10.11648/j.ejpm.20200804.12
DO  - 10.11648/j.ejpm.20200804.12
T2  - European Journal of Preventive Medicine
JF  - European Journal of Preventive Medicine
JO  - European Journal of Preventive Medicine
SP  - 43
EP  - 47
PB  - Science Publishing Group
SN  - 2330-8230
UR  - https://doi.org/10.11648/j.ejpm.20200804.12
AB  - Universal iodization of salt on the whole territory in Bulgaria was introduced in 1994. The external evaluation of an International expert group conducted in 2005, placed the country among those who successfully overcame the problem of iodine deficiency. AIM of the present study is to update the data on iodine intake of pregnant women in Bulgaria, given that there have been no studies in the last 8 years. MATERIAL: A total number of 537 pregnant women were recruited in the study with an average age 30.49±5 y, distributed by gestational weeks and according to the intake of (vitamins and minerals preparations) preparations containing vitamins with minerals. The study was conducted as a cross-sectional, multicenter population-based in 10 regions of Bulgaria (a total of 84 settlements), without pre-selection and 98.3% of the examined pregnant women use Bulgarian iodized salt according to the data from the Questionnaire. METHOD: A spot morning urine samples were collected for determination of urinary iodine concentration. The frozen samples in a special container were transported to the accredited Limbach laboratory in Heidelberg, Germany. The iodine in urine was determined by inductively coupled plasma mass spectrometry (ICP-MS) method. The statistical analysis was performed using standard SPSS 13.0 for Windows. RESULTS: The median urinary iodine concentration (mUIC) for the whole group of pregnant women (n-537) was 170 µg/L (95% CI 161.00 - 177.00). Normal iodine excretion is present in 39.3%, low – in 41.2% and over-optimal – in 19.6% of pregnant women. Significantly lower levels of iodine in urine were found in the third trimester of pregnancy compared to the first trimester (P < 0.012) and compared to the second trimester (P < 0.001). The median iodine concentration in pregnant women from the group supplemented with combined vitamins with minerals was significantly higher compared to the group without supplementation – 175 (95% CI 166.00 - 199.00) against 149 (95% CI 123.00 - 168.00), P < 0.021. CONCLUSION: During pregnancy, additional supplementation with combined vitamins with minerals containing iodine is required, regardless of the universal iodization of salt, introduced in Bulgaria for more than twenty-five years.
VL  - 8
IS  - 4
ER  -

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