Iodine status remains critical in mother and infant in Central Anatolia (Kayseri) of Turkey.
BACKGROUND
Severe iodine deficiency disorders have been eradicated in many parts of the world, but milder forms still exist and may escape detection. Turkey has long been known to be a mild to moderate iodine deficiency area.


OBJECTIVE
The aim of this study was to assess the iodine nutritional status and the thyroid function of pregnant women and their neonates in the region of Kayseri (central Anatolia of Turkey) that appeared to be iodine deficient in previous studies performed before the introduction of mandatory salt iodization.


METHODS
A cross-sectional voluntary screening study was performed in the Maternity Unit of a university hospital. A total of 70 mothers and their healthy full-term neonates were included in this study. Urinary iodine concentration was estimated in spot urine samples obtained from mothers and their neonates on day 5. All the neonates were breastfed. The iodine content was determined in the breast milk of all mothers on day 5. Serum concentrations of TSH, thyroglobulin (Tg), free triiodothyronine (FT3) and free thyroxine (FT4) were investigated in the cord serum of neonates and compared to those of mothers immediately after parturition


RESULTS
The median urinary iodine on day 5 in mothers and their babies were 30.20 and 23.80 microg/l, respectively. These figures are much lower than normal for these age groups (150-200 microg/l). The median iodine content of breast-milk was 73 microg/l. It is again much lower than in iodine sufficient areas, indicating that the status of iodine nutrition of pregnant and lactating women is clearly insufficient. The median concentrations (and ranges) of neonatal TSH, Tg, FT3 and FT4 were 7.44 mU/l, 71.62 ng/ml, 1.30 pg/ml and 1.34 ng/dl respectively. The corresponding levels for the mothers during labor were 2.19 mU/l, 25.65 ng/ml, 1.31 pg/ml and 1.23 ng/dl respectively. The median neonatal serum concentrations of TSH and Tg were significantly higher than the corresponding maternal levels (P < 0.0001, P < 0.0001, respectively) and 27.1% of the neonates had serum TSH concentrations above 10 mU/l and 57.1 % had cord blood serum Tg concentrations above 54 ng/ml. None of the mothers showed TSH concentrations above 5 mU/l and 41.4% had serum Tg concentrations above 30 ng/ml.


CONCLUSIONS
Iodine deficiency with low urinary iodine excretion and high serum Tg and TSH concentrations were recognized among pregnant women and their babies in Kayseri in spite of the program of salt iodization. National measures are urgently required for improving the correction of iodine deficiency in Turkey. This includes regular supplementation with iodine, starting at preconception or in early pregnancy and continuing during the period of nursing in this region.
Erciyes University, School of Medicine, Dept. of Pediatrics Divisions of Endocrinology & Neonatology, 38039 Kayseri, Turkey. selimk@erciyes.edu.tr.
Selim
S
Kurtoglu
Mustafa
M
Akcakus
Celebi
C
Kocaoglu
Tamer
T
Gunes
Nurten
N
Budak
Mehmet Emre
ME
Atabek
Inci
I
Karakucuk
François
F
Delange
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006304:Health Status; D006801:Humans; D007231:Infant, Newborn / Q000097:blood*; D007455:Iodine / Q000097:blood / Q000172:deficiency* / Q000378:metabolism* / Q000652:urine; D008895:Milk, Human / Q000737:chemistry*; D009752:Nutritional Status; D011247:Pregnancy / Q000097:blood*; D011248:Pregnancy Complications / Q000097:blood / Q000453:epidemiology; D013961:Thyroid Gland / Q000502:physiology*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood; D014421:Turkey / Q000453:epidemiology
D014284:Triiodothyronine; D013972:Thyrotropin; D007455:Iodine; D013974:Thyroxine