Volume 8, Issue 4, July 2020, Page: 43-47
Iodine Status of Pregnant Women in Bulgaria
Anna-Maria Borissovа, Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria; Faculty of Medicine, Sofia University St. Kliment Ohridski, Sofia, Bulgaria
Ludmila Ivanova, Faculty of Medicine, Sofia University St. Kliment Ohridski, Sofia, Bulgaria
Boyana Trifonova, Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria; Faculty of Medicine, Sofia University St. Kliment Ohridski, 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
Received: Jun. 6, 2020;       Accepted: Jun. 29, 2020;       Published: Aug. 4, 2020
DOI: 10.11648/j.ejpm.20200804.12      View  159      Downloads  60
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.
Pregnant Women, Universal Salt Iodization, Urinary Iodine Concentration, Supplementation
To cite this article
Anna-Maria Borissovа, Ludmila Ivanova, Boyana Trifonova, Lilia Dakovska, Eugenia Mihailova, Mircho Vukov, Iodine Status of Pregnant Women in Bulgaria, European Journal of Preventive Medicine. Vol. 8, No. 4, 2020, pp. 43-47. doi: 10.11648/j.ejpm.20200804.12
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This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Bath SC. (2019). The effect of iodine deficiency during pregnancy on child development. Proc Nutr Soc 78 (2): 150-160. doi: 10.1017/S0029665118002835. Epub 2019 Jan 15.
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.
Zimmermann MB. (2012). The Effects of Iodine Deficiency in Pregnancy and Infancy. Pediatric and Perinatal Epidemiology 26 (Suppl. 1), 108–117.
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.
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.
UNICEF. Guidance from Monitoring of Sal Iodization Programs and Determination of Population Iodine Status, 2015.
UNICEF, PAMM. Urinary Iodine Assessment: A Manual on Survey and Laboratory Methods. PAMM: Washington, DC; 2000.
WHO/UNICEF/ICCIDD. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers. 2007, 3rd ed.
WHO/UNICEF/ICCIDD. A practical guide to the correction of iodine deficiency. Wageningen: International Council for the Control of Iodine Deficiency Disorders; 1990.
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.
World Health Organization. Urinary iodine concentrations for determining iodine status in populations. VMNIS | Vitamin and Mineral Nutrition Information System 2013.
Decree of the Council of Ministers 96/1994 on the introduction of universal iodization of salt in Bulgaria, State Gazette 43 of 1994.
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.
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/.
National Statistical Institute, Number of Live Births Children 2019.
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.
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.
Soldin OP. (2002). Controversies in urinary iodine determinations. Clin Biochem 35: 575–579.
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.
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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