title: Universal salt iodization is successful in Kashmiri population as iodine deficiency no longer exists in pregnant mothers and their neonates: Data from a tertiary care hospital in North India.
abstract: BACKGROUND
  Normal pregnancy results in a number of important physiological and hormonal changes that alter thyroid function. In pregnancy, the thyroid gland being subjected to physiological stress undergoes several adaptations to maintain sufficient output of thyroid hormones for both mother and fetus. Consequently, pregnant women have been found to be particularly vulnerable to iodine deficiency disorders (IDD), and compromised iodine status during pregnancy has been found to affect the thyroid function and cognition in the neonates.
  
  
  OBJECTIVE
  Two decades after successful universal salt iodization (USI) in the country, there is scarce data on the iodine status of the pregnant women and their neonates. This is more relevant in areas like Kashmir valley part of sub-Himalayan belt, an endemic region for IDD in the past. The objective was to estimate Urinary Iodine status in pregnant women, the most vulnerable population.
  
  
  METHODS
  We studied thyroid function [free T3 (FT3), T3, free T4 (FT4), T4, thyroid stimulating hormone (TSH)] and urinary iodine excretion (UIE) in the 1(st), 2(nd), and 3(rd) trimesters and at early neonatal period in neonates in 81 mother-infant pairs (hypothyroid women on replacement) and compared them with 51 control mother-infant pairs (euthyroid).
  
  
  RESULTS
  Mean age of cases (29.42 + 3.56 years) was comparable to that of controls (29.87 + 3.37 years). The thyroid function evaluation done at baseline revealed the following: FT3 2.92 ± 0.76 versus 3.71 ± 0.54 pg/ml, T3 1.38 ± 0.37 versus 1.70 ± 0.35 ng/dl, FT4 1.22 ± 0.33 versus 1.52 ± 0.21 ng/dl, T4 9.54 ± 2.34 versus 13.55 ± 2.16 μg/dl, and TSH 7.92 ± 2.88 versus 4.14 ± 1.06 μIU/ml in cases versus controls (P > 0.01), respectively. The 2(nd) to 6(th) day thyroid function of neonates born to case and control mothers revealed T3 of 1.46 ± 0.44 versus 1.48 ± 0.36 ng/dl, T4 of 12.92 ± 2.57 versus 11.76 ± 1.78 μg/dl, and TSH of 3.64 ± 1.92 versus 3.82 ± 1.45 μIU/ml, respectively.
  
  
  CONCLUSIONS
  UIE was similar (139.12 ± 20.75 vs. 143.78 ± 17.65 μg/l; P = 0.8), but TSH values were higher in cases (7.92 ± 2.88) as compared to controls (4.14 ± 1.06). Although UIE gradually declined from 1(st) trimester to term, it remained in the sufficient range in both cases and controls. Thyroid function and UIE was similar in both case and control neonates.
  
  
  CONCLUSIONS
  We conclude that pregnant Kashmiri women and their neonates are iodine sufficient, indicating successful salt iodization in the community. Large community-based studies on thyroid function, autoimmunity, malignancies, etc., are needed to see the long-term impact of iodization.
authors.affiliation: Department of Endocrinology, SheriKashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
authors.forename: Bashir Ahmed
authors.initials: BA
authors.lastname: Charoo
authors.forename: Riyaz Ahmed
authors.initials: RA
authors.lastname: Sofi
authors.forename: Sobia
authors.initials: S
authors.lastname: Nisar
authors.forename: Parvaiz A
authors.initials: PA
authors.lastname: Shah
authors.forename: Shenaz
authors.initials: S
authors.lastname: Taing
authors.forename: Henaan
authors.initials: H
authors.lastname: Jeelani
authors.forename: Fayaz
authors.initials: F
authors.lastname: Ahmed
authors.forename: Shameem
authors.initials: S
authors.lastname: Parveen
authors.forename: Zaffar Amin
authors.initials: ZA
authors.lastname: Shah
authors.forename: Syed
authors.initials: S
authors.lastname: Mudasir
authors.forename: Masood
authors.initials: M
authors.lastname: Malik
authors.forename: Mohd Ashraf
authors.initials: MA
authors.lastname: Ganie
keywords: India; neonates; pregnancy; thyroid function; urinary iodine excretion