ARTÍCULO 49. APERTURA DEL PROCESO DE
11. En general, tendrá atribuciones suficientes para dirigir el proceso y lograr que se cumplan las finalidades del mismo"[172]
Pregnant women living in areas of mild to moderate iodine deficiency and iodine sufficiency may need extra iodine, but we do not know exactly the benefits and risks involved in such supplementation. There are no randomized controlled trials on iodine supplementation with long term follow up that have been conducted in this important group. This thesis therefore aimed to fill the important gap that exists in the current literature regarding the effect of iodine supplementation during pregnancy on birth outcomes, maternal goiter, thyroid autoimmunity, infant growth and cognitive development in an RCT. The current study is the first multicenter randomized controlled trial of iodine supplementation to pregnant women in areas of mild to moderate iodine deficiency (India and Thailand) to see the effects of Maternal Iodine supplementation (200 µg) or placebo on Thyroid function and Child development (MITCH study). In this thesis, only data from the Indian site are presented. We conducted the study at the antenatal clinic of the Obstetrics and Gynecology Department of St Martha’s Hospital in Bangalore, India in accordance with the Declaration of Helsinki. Institutional ethical review boards at St. John’s National Academy of Health Sciences, St Martha’s Hospital, Bangalore, India and the Wageningen University, The Netherlands approved the study. We recruited pregnant women for the study between November 2008 to March 2011 and completed the data collection in November 2013. We recruited all women presenting to the antenatal clinic for potential inclusion in the study if they had a positive pregnancy test and were:
a) ≥18 and ≤40 years old b) ≤14 weeks gestational age
c) Planning to reside in the study area for the duration of the study (3 years)
Exclusion criteria were:
a) Chronic diseases including diabetes, heart, kidney and thyroid disease, cancer, hypertension, tuberculosis, asthma, epilepsy, jaundice
33
b) A positive test for HIV, HbSAg or venereal diseases c) TSH value outside the normal range (0.3- 7.5 mIU/l) d) Treatment for infertility
e) Previous repeated spontaneous abortions (4 or more) f) Current multiple pregnancy as detected by ultrasound g) Currently breastfeeding.
We randomized the subjects into groups to receive either a daily iodine supplement of 200µg iodine (as potassium iodide tablets, donated by Merck KGsA, Darmstadt, Germany) until delivery or an identical placebo (Merck KGsA, Darmstadt, Germany) until delivery. We kept the codes in a sealed envelope with one of the members of the Data Safety and Monitoring Board; the codes were broken after the data analysis was completed.
We followed pregnant women at each trimester as per their antenatal visits at the hospital, obtained information on morbidity, performed anthropometry and thyroid gland size measurement and collected biological samples. Post-delivery, we followed mother-child pairs at 72 hrs, 6 weeks, 6 months, 1 and 2 years.
In Chapter 2, we report the results of the randomized controlled trial of iodine supplementation in pregnant women to determine whether the daily oral administration of iodine (200 µg) to pregnant women improves maternal and newborn thyroid function, pregnancy outcome, birth weight, infant growth and cognitive performance. We also investigate new indicators for assessing iodine status in pregnancy and infancy: neonatal TSH and newborn median urinary iodine concentration.
In Chapter 3, we report a pilot study which aimed to assess iodine intake (based on UIC) and potential determinants of intake, in Indian pregnant women and their school aged children who were sharing all meals. Our hypotheses were: 1) effective USI can ensure adequate iodine intake in pregnant women; 2) but this may lead to more-than- adequate or excessive iodine intake in their school aged children.
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In Chapter 4, we aim to understand the pattern and prevalence of maternal thyroid dysfunction and its associated risk factors in the Indian pregnant population in a cross-sectional study, using the screening data of the randomized controlled trial. The aims were to a) measure thyroid status in first trimester pregnant women in southern India; and b) assess potential determinants of thyroid function in this population, including iodine status, thyroid autoimmunity, body weight and anemia.
In Chapter 5, we aim to assess the association of maternal depression, and thyroid function during pregnancy. We hypothesized that thyroid dysfunction would be associated with a higher prevalence of depressive symptoms.
In the concluding Chapter 6, we summarise the main findings of this thesis, and their implications for public health. We also discuss the methodological limitations and suggest directions for future research.
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