Impact of Dietary Habit, Iodine Supplementation and Smoking Habit on Urinary Iodine Concentration During Pregnancy in a Catalonia Population.

(1) Background: The nutritional status of women during pregnancy can have a considerable effect on maternal and fetal health, and on the perinatal outcome. Aim: to assess the changes occurring in dietary iodine intake, potassium iodide supplementation, and smoking habit, and the impact of these changes on the urinary iodine concentration (UIC) during pregnancy in a population of women in Catalonia (Spain). (2) Methods: Between 2009-2011, an observational study included a cohort of women whose pregnancies were monitored in the public health system in the Central and North Metropolitan areas of Catalonia. Women received individual educational counseling, a dietary questionnaire was completed, and a urine sample was collected for iodine determination at each trimester visit. (3) Results: 633 (67.9%) women answered the questionnaire at all 3 visits. The percentage of women with a desirable UIC (≥150 µg/L) increased from the first to the second trimester and remained stable in the third (57.3%, 68.9%, 68%; p < 0.001). Analysis of the relationship between UIC≥150 µg/L and the women's dietary habits showed that the percentage with UIC ≥150 µg/L increased with greater consumption of milk in the first trimester, and the same was true for iodized salt use in all three trimesters and iodine supplementation in all three. (4) Conclusion: During pregnancy, increased intake of milk, iodized salt, and iodine supplements were associated with an increase in the UIC.

Iodine nutritional status of women in their first trimester of pregnancy in Catalonia.

BACKGROUND: Sufficient iodine intake is needed during pregnancy to ensure proper fetal development. The iodine levels of women in their first trimester of pregnancy in Catalonia are currently unknown. This data would help to determine whether our public health services should establish recommendations or interventions in this line. The aim of this study was to investigate the iodine nutritional status, prevalence of urinary iodine <150 µg/L, and tobacco use in the first trimester of pregnancy in our setting. METHODS: Cross-sectional study. Data were collected during 2008-2009 from women in their first trimester at the primary care centers of the province of Barcelona (Spain). Pregnant women included in the study completed a questionnaire on eating habits and underwent urinary iodine concentration (UIC) assessment. RESULTS: Nine hundred forty five women completed the dietary questionnaire and urinary iodine testing. Median UIC was 172 µg/L, with 407 participants (43.1%) showing levels <150 µg/L. On multivariate logistic regression analysis, intake of 1-2 glasses of milk per day, OR = 0.636 95% CI (0.45-0.90) or >2 glasses, OR = 0.593 95% CI (0.37-0.95); iodized salt consumption, OR = 0.678 95% CI (0.51-0. 90); and use of iodine supplementation, OR = 0.410 95% CI (0.31-0.54), protected against the risk of UIC <150 µg/L. Simultaneous consumption of iodized salt and milk (≥1 glass/day) showed a larger protective effect: OR = 0.427, 95% CI (0.31-0.54). CONCLUSION: The median UIC of the pregnant women surveyed indicated an acceptable iodine nutritional status according to the criteria established by the WHO and ICCIDD. The risk of urinary iodine <150 µg/L decreased with simultaneous consumption of milk and iodized salt, similar to the decrease seen with iodine supplementation.

Nutritional status of iodine in pregnant women in Catalonia (Spain): study on hygiene-dietetic habits and iodine in urine.

BACKGROUND: It is a priority to achieve an adequate nutritional status of iodine during pregnancy since iodine deficiency in this population may have repercussions on the mother during both gestation and post partum as well as on the foetus, the neonate and the child at different ages. According to the WHO, iodine deficiency is the most frequent cause of mental retardation and irrreversible cerebral lesions around the world. However, few studies have been published on the nutritional status of iodine in the pregnant population within the Primary Care setting, a health care level which plays an essential role in the education and control of pregnant women. Therefore, the aim of the present study is: 1.- To know the hygiene-dietetic habits related to the intake of foods rich in iodine and smoking during pregnancy. 2.- To determine the prevalence of iodine deficiency and the factors associated with its appearance during pregnancy. METHODS/DESIGN: We will perform a cluster randomised, controlled, multicentre trial. Randomisation unit: Primary Care Team. STUDY POPULATION: 898 pregnant women over the age of 17 years attending consultation to a midwife during the first trimester of pregnancy in the participating primary care centres. OUTCOME MEASURES: consumption of iodine-rich foods and iodine deficiency. Points of assessment: each trimester of the gestation. INTERVENTION: group education during the first trimester of gestation on healthy hygiene-dietetic habits and the importance of an adequate iodine nutritional status. STATISTICAL ANALYSIS: descriptive analysis of all variables will be performed as well as multilevel logistic regression. All analyses will be done carried out on an intention to treat basis and will be fitted for potential confounding factors and variables of clinical importance. DISCUSSION: Evidence of generalised iodine deficiency during pregnancy could lead to the promotion of interventions of prevention such as how to improve and intensify health care educational programmes for pregnant women. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01301768.

Hábitos higiénico-dietéticos respecto alconsumo de alimentos ricos en yodo duranteel primer trimestre de la gestación / Hygiene and dietary habits with respect to the consumption of iodine-rich foods

Objetivo: Conocer los hábitos higiénico-dietéticos de las mujeresembarazadas respecto al consumo de alimentos ricos en yodo duranteel primer trimestre de la gestación.Material y método: Estudio observacional, descriptivo, transversaly multicéntrico. Se estudiaron las mujeres embarazadas en el primertrimestre de la gestación que acudieron a la consulta de control delembarazo del programa de atención a la salud sexual y reproductiva(ASSIR) de la Región Sanitaria del Ámbito Centro del Instituto Catalánde la Salud durante el año 2006. Para la recogida de datos se utilizóun cuestionario que cumplimentó la matrona en una entrevistaindividual en la primera visita de control de embarazo.Resultados: Se recogieron 823 cuestionarios cumplimentados. El 6%(50) de las gestantes no consumía pescado y el 83% (683) lo hacíamenos de cuatro veces por semana. El 17% (138) no consumía lechey el 39% (324) bebía un vaso al día. El 42% (342) de las gestantesutilizaba sal yodada para la preparación y condimentación de los alimentos,frente al 50% (412) que no la empleaba. El 22% (184) delas gestantes tomaba algún tipo de suplemento de yodo, y el 18%(148) de la muestra manifestó ser fumadora.Conclusiones: Las mujeres embarazadas de nuestro ámbito de estudiotienen un consumo reducido de alimentos ricos en yodo. Además, tantoel consumo de sal yodada como la utilización de suplementos que contenganyodo durante el embarazo resultan también insuficientes (AU)

Objective: To evaluate hygiene and dietary habits with respect to theconsumption of iodine-rich foods by pregnant women during the firsttrimester of pregnancy.Material and method: A cross-sectional, descriptive, observational,multicenter study was carried out. In 2006, we studied the women inthe first trimester of pregnancy who came to the clinics for pregnancymanagement pertaining to the sexual and reproductive health program(ASSIR) of the Central Health Region of Catalonia, Spain. Informationwas gathered by means of a questionnaire created by the research teamand completed by the midwife during the first visit to the pregnancymanagement clinic.Results: A total of 823 questionnaires were completed. Six percent(50) of those polled did not consume any fish and 83% (683) ate it lessthan four times a week. Seventeen percent (138) did not drink any milkand 39% (324) drank one glass per day. Forty-two percent (342) of thepregnant women used iodized salt for cooking while 50% (412) didnot. Twenty-two percent (184) of them were taking some kind of iodinesupplement and 18% (148) were smokers.Conclusions: The pregnant women included in our study consumedlow amounts of iodine-rich foods. Moreover, the consumption of bothiodized salt and iodine supplements was also insufficient (AU)

Modificaciones en el consumo de tabaco durante la gestación y el posparto / Changes in tobacco consumption during pregnancy and the postpartum period

Objetivo: Averiguar el consumo de tabaco y las modificaciones del hábito durante la gestación, y observar las recaídas después del parto. Personas y método: Estudio descriptivo transversal, realizado en el PASSIR «Casagemas», Badalona, desde febrero de 2006 a septiembre de 2007. Se incluyó a 115 gestantes que acudieron a la consulta de control prenatal en el tercer trimestre de gestación, y se excluyeron las que no fumaban al inicio de la gestación. Se recogieron variables sociodemográficas y las relacionadas con el hábito tabáquico a través de un cuestionario en la gestación y otro en el posparto. Resultados: Dejaron de fumar el 26% (30) de las gestantes, y las que continuaron fumando redujeron el consumo de una media de 19,2 (DE= 6,7) a 7,2 (DE= 6) cigarrillos/día. Se observaron diferencias en el abandono del tabaco en aquellas que fumaban un menor número de cigarrillos (p <0,001), en las que iniciaron el tabaquismo más tarde y en las de mayor edad (p= 0,013). Al año del parto, seguían fumando el 73% (70) de las mujeres, y habían recaído en el hábito el 39,2% (11) de las que lo habían abandonado en la gestación. Las mujeres que no fumaban lactaron a sus hijos un 76,9% (20), mientras que las que fumaban lo hicieron un 57,1% (40). La duración media de la lactancia fue inferior en las mujeres que fumaron en el posparto (2,81 meses [DE= 3,4]) en relación con las que no lo hicieron (4,96 meses [DE= 4,1]; p= 0,01). Conclusiones: La tasa de abandono del tabaco durante el embarazo es aún muy baja, y el índice de recaída del hábito tabáquico en el posparto, elevada (AU)

Objective: To find out more about tobacco consumption and the changes in the habit during pregnancy, and to observe the relapses after the delivery. Subjects and method: A cross-sectional descriptive study, carried out in the PASSIR (sexual and reproductive healthcare services) of Casagemas, Badalona, between February 2006 and September 2007. It included 115 pregnant women who attended the third trimester prenatal check-up, and those women who did not smoke at the start of the pregnancy were excluded. Socio-demographic variables as well as variables related to the tobacco habit were collected by means of a questionnaire during the pregnancy and another during the postpartum period. Results: Of the pregnant women 26% (30) stopped smoking, and those who continued to smoke reduced the consumption from an average of 19.2 (DE=6.7) to 7.2 (DE=6) cigarettes/day. Differences were observed in tobacco cessation among those who smoked a smaller number of cigarettes (p <0.001), those who started tobacco smoking later and among older pregnant women (p= 0.013). One year after giving birth, 73% (70) of the women continued to smoke, and 39.2% (11) of those who had stopped smoking during pregnancy had relapsed to smoking. Of the women who didn’t smoke 76.9% (20) Breastfed their babies, while among those who smoked 57.1% (40) breastfedtheir babies. The average duration of the breastfeeding was smaller in the case of the women who smoked during the postpartum period, 2.81 months (DE= 3.4), compared to 4.96 months (DE= 4.1) in the case of those who didn’t smoke; (p= 0.01). Conclusions: The rate of tobacco cessation during pregnancy is still very low, and the rate of relapse to tobacco smoking during the postpartum period is high (AU)

Monitorización biofísica intraparto / Intrapartum fetal biophysical monitoring

En este artículo se presenta la situación actual del control biofísico fetal intraparto, que comprende los siguientes aspectos: métodos de control de la frecuencia cardiaca fetal y de la dinámica uterina, los parámetros que hay que valorar y la relación entre ellos durante el parto. Se analizan los diferentes tipos de deceleraciones: precoces, tardías y variables, y se comentan otros métodos complementarios de control fetal intraparto

This article describes the current status of intrapartum fetal biophysical monitoring, including methods of monitoring the fetal heart rate and uterine dynamics, the parameters that should be assessed and the relationship among them during delivery. Early, late and variable decelerations are analyzed, and other complementary methods of intrapartum fetal monitoring are discussed