不同孕期孕妇尿碘水平的监测及分析

目的调查不同孕期孕妇的尿碘水平,探讨尿碘筛查的最佳时机,为科学指导碘摄入提供理论依据。方法利用碘催化砷铈反应原理,采用冷消解快速尿碘定量检测方法测定623例孕妇随意尿的尿碘含量。结果 623例孕妇尿碘中位数是183μg/L,其中尿碘≤100μg/L的比率为18.61%,尿碘50μg/L的比率为4.01%。而孕早、中、晚期孕妇尿碘中位数分别是143μg/L、149μg/L、312μg/L,其中尿碘150μg/L的比率分别为60.19%、50.26%、25.31%,尿碘≤100μg/L的比率分别为20.37%、24.10%、14.69%,尿碘50μg/L的比率分别为0%、6.15%、4.06%,孕早、中期尿碘水平低于孕晚期(P0.01),低尿碘率高于孕晚期(P0.01)。低尿碘组中孕晚期的尿碘水平低于孕早、中期(P0.05),高尿碘组中孕晚期的尿碘水平高于孕早、中期(P0.05)。结论本研究中的孕妇人群虽不存在碘缺乏,但孕早、中期孕妇尿碘水平偏低,因此孕早、中期是尿碘筛查、及时纠正碘营养状况的最佳时机,孕晚期孕妇碘的需求应随个体不同的碘营养状况而调整。     

我国部分地区孕妇和哺乳妇女适宜的尿碘参考值范围的制定

目的:对我国部分地区正常孕妇和哺乳妇女的尿碘值进行测定,以期对尿碘值范围提供一定的参考.方法:收集我国6个地区孕妇和哺乳妇女的尿碘和甲状腺功能数据,对甲状腺功能正常的141例孕妇和170例哺乳妇女的尿碘值进行统计分析.结果:我国部分地区孕妇和哺乳妇女适宜的尿碘值范围分别为90～500 μg/L和70～450μg/L.结论:本研究为孕妇和哺乳妇女碘营养状况的个体诊断提供了一种思考方法.     

淄博市不同孕期女性尿碘水平及甲状腺功能状况调查

目的:研究淄博市孕期女性碘营养状况、不同妊娠阶段甲状腺功能变化及妊娠期甲状腺疾病种类分布,制定淄博地区孕期女性特异的血清甲状腺功能指标参考值,为孕期实施碘营养监测及甲状腺功能筛查提供理论依据。方法:选取2013年3月至2014年2月在淄博市妇幼保健院门诊行产检的1268例孕妇。采用化学发光法测定妊娠早、中、晚期孕妇的血清促甲状腺素(TSH)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(即TPOAb)。采用酸消化砷一铈接触法测定尿碘水平。结果:1268例孕妇中,孕早、中、晚期尿碘中位数分别为100.3、110.5、105.2,孕早期尿碘水平最低,孕中期尿碘中位数高于孕晚期。孕期FT4参考值范围设定:孕早期12.50~25.10pmmol/L,孕中期12.10~23.10pmmol/L,孕晚期11.20~20.16pmmol/L;孕期TSH参考值范围设定:孕早期0.15~3.20m IU/L,孕中期0.40~3.90m IU/L,孕晚期0.50~4.12m IU/L。正常尿碘组、低尿碘组及高尿碘组的FT4、TSH均在正常范围,高尿碘组、低尿碘组的FT4均低于正常尿碘组(P0.05),3组的TSH值比较差异均无统计学意义(P0.05)。1268例孕妇中,甲状腺功能异常者368例(29.02%),孕早期的甲状腺功能异常发生率高于孕中期及孕晚期,甲状腺功能异常以亚临床型甲减为主,其次为单纯TPOAb阳性。结论:淄博市孕期女性碘营养缺乏严重,需定期监测尿碘水平。随着孕周的增加,FT4值逐渐下降,而TSH值则呈上升趋势;尿碘异常早期可引起FT4的改变,对TSH影响不大。建议在妊娠早期对有甲状腺疾病危险因素的女性积极筛查甲状腺功能。     

不同碘摄入量地区妇女产后甲状腺炎患病情况的调查

目的　了解不同碘摄入量地区妇女产后甲状腺炎 (PPT)的患病情况 ,探讨PPT的环境致病因素。方法　对不同碘摄入量地区 ,既往未诊断过甲状腺疾病的产后 1年内的妇女共 119例 (观察组 )及在相同地区居住 3年以上的育龄妇女 2 38例 (对照组 ) ,进行问卷调查 ,并测定其甲状腺自身抗体、甲状腺功能及尿碘水平。结果　 (1)PPT患病率为 11 8% ,其中 ,临床PPT占 1 7% ,亚临床PPT占10 1% ;对照组甲状腺功能异常发生率为 5 9%。缺碘地区经补碘 4年后 [尿碘中位数 (MUI)为 374 μg L],亚临床PPT的患病率为 2 1 0 % ,显著高于未补碘地区 (MUI为 10 3μg L)和水源性高碘地区 (MUI为 6 14 μg L) (P <0 0 5 ) ;(2 )甲状腺自身抗体阳性率为 8 4 % ,其中有 1 2妇女发展成PPT。适碘摄入量地区产后妇女亚临床PPT的患病率高于持续轻度低碘摄入量地区和持续高碘摄入量地区。结论　碘与PPT的发生有关 ,补碘剂量应个体化 ;在加强补碘效果的监测 ,纠正碘不足的同时 ,也应防止因补碘过量而诱发的PPT。     

妊娠期碘营养状况及其与甲状腺功能关系研究

目的探讨广州地区孕妇碘营养状况及其与甲状腺功能的关系。方法选择2012年3月至2014年2月在中山大学孙逸仙纪念医院产检的孕妇815为研究对象,进行甲状腺功能、抗甲状腺过氧化物酶抗体(TPO-Ab)和尿碘的检测,结果异常者定期复查,密切监测母胎情况,追踪至妊娠终止。结果 815例无甲状腺疾病史孕妇尿碘中位数(median urinary iodine,MUI)为197.0μg/L;其中碘缺乏者39.6%(323/815);碘适宜者20.9%(170/815);碘超足量者27.4%(223/815);碘过量者12.1%(99/815)。早中晚孕期MUI分别为208、182.5、174.5μg/L。不同碘营养状况下甲状腺功能、甲状腺疾病的患病率及TPO-Ab阳性率的差异无统计学意义,均P0.05。结论孕妇碘营养状态为碘适宜,但个体间差异较大。不同碘营养状况下甲状腺疾病的患病率无明显差异,即轻度碘缺乏或碘过量不增加甲状腺疾病的患病率。随着孕周的增加,尿碘值逐渐下降,但都在碘适宜的范围内。     

胎儿及新生儿甲状腺激素水平的变化及意义

目的　探讨不同胎龄的正常胎儿及新生儿甲状腺激素水平变化及意义。方法　对可疑有遗传、内分泌、感染、代谢性疾病的孕 16～ 3 6周胎儿 71例 (观察组 ) ,在B超引导下 ,行脐静脉穿刺 ,孕妇甲状腺功能均正常。选择同期孕足月自然分娩的 14 0例新生儿脐带血为对照组。测定两组甲状腺激素水平及甲状腺功能。并对孕 2 8周前后的胎儿甲状腺功能、胎儿与新生儿甲状腺激素水平进行比较。结果　自孕 16周起 ,胎儿甲状腺激素均可检测到 ,并随孕周增加而增加 ;游离甲状腺素 (FT4)在孕 16周时为 ( 5 8± 2 6)pmol L ,接近正常成人甲状腺素水平 ,以后持续上升 ;胎儿甲状腺素 (T4)、三碘甲状腺原氨酸 (T3)、FT4在 2 8孕周后较 2 8周前显著升高 ,即分别由 ( 2 8± 1 8)nmol L、( 3 7 2± 2 7 2 )nmol L、( 10 6± 3 1)pmol L增至 ( 5 8± 2 6)nmol L、( 55 9± 3 3 3 )nmol L( 13 0± 4 5)pmol L。孕 2 0周时 ,胎儿促甲状腺激素 (TSH)水平达到正常成人上限 ,为 ( 4 6± 1 4)mU L ,以后持续上升 ,分娩期达高峰 ,为 ( 9 2± 6 7)mU L。而T3 及游离三碘甲状腺原氨酸 (FT3)在整个孕期始终处于较低水平。结论　胎儿甲状腺激素水平随孕周增长而升高。孕中期以后 ,胎儿T4 、FT4 及TSH ,可作为判断胎儿甲状腺功能的主     

孕产妇碘营养状况调查

目的探索不同孕期、哺乳期妇女和新生儿是否存在碘缺乏和碘缺乏病（iodinedeficiencydisorder,IDD），为妊娠期和哺乳期是否需要补碘提供依据。方法对孕产妇尿碘水平及孕母、新生儿甲状腺功能进行测定。结果孕产妇缺碘发生率达24．48％，明显高于非妊娠妇女（714％），且多集中于34孕周后及哺乳期。缺碘孕妇血清TSH、脐血清TSH、T4水平均有改变，其中脐血清TSH≥10mU／L，提示甲状腺功能处于代偿性状态。结论上海杨浦地区孕产妇存在一定缺碘状况，因此孕期有必要作尿碘筛查，低者及时补碘，避免碘缺乏给母儿带来不良影响。     

孕妇碘营养水平与新生儿甲状腺功能及体格发育的相关性研究

目的为了解孕妇不同碘营养水平对胎儿甲状腺功能和体格发育的影响,并对昆明市市区孕妇碘营养状况作出初步评估,以便为临床是否需针对性补碘提供理论依据.方法本研究测定220例正常孕足月孕妇尿碘浓度,并对比分析孕妇相应新生儿的甲状腺功能和体格发育状况.结果①昆明市市区正常孕妇大部分已处于较好的碘营养状况,但仍有部分孕妇存在缺碘或碘摄入过量情况.②孕妇尿碘水平在一定的浓度范围内与新生儿脐血TSH值呈明显负相关,提示孕妇碘营养越好时,胎儿、新生儿甲状腺功能越完善.③碘影响新生儿体格发育,摄入过少或过多均可使低体重儿数目增多.④与剖宫产相比,阴道产可使新生儿脐血TSH值升高.     

泉州地区妊娠中期单纯性低甲状腺素血症危险因素分析

目的探讨泉州地区妊娠中期单纯性低甲状腺素血症的危险因素。方法选取563例妊娠中期妇女,检测尿碘浓度、FT、FT4、TSH和生化指标等。分别以孕中期特异性甲状腺激素参考值(地区范围)和非孕期甲状腺激素参考值(试剂范围)诊断单纯性低甲状腺素(低T4)血症,比较两种情况下低T4血症患者临床资料的差异。以Pearson相关分析及多元线性回归分析探讨低T4血症发病的危险因素。结果 (1)入组孕妇中位数尿碘132.6μg/L。碘缺乏327例(58.1%),碘充足161例(28.6%),碘超足量58例(10.3%),碘过量17例(3.0%);(2)两种参考范围诊断的低T4血症患病率比较有统计学差异(1.95%vs 12.08%, P 0.01);(3)多元线性逐步回归分析表明,BMI、FT3、TSH、TG、LDL-C、年龄与FT4有独立的相关关系(均P 0.01)。结论孕妇碘缺乏在食盐加碘的沿海城市泉州很常见;高龄、高BMI、高TG、高LDL-C水平增加孕中期低T4血症风险。     

北京1151例孕妇铅暴露水平流行病学调查

目的　了解目前北京城区孕妇血铅水平、脐带血铅水平及产妇乳汁铅水平 ,探讨三者之间的关系 ,并分析孕妇铅暴露的影响因素。　方法　将孕妇按不同孕周分为早孕、中孕和晚孕三组 ,收集孕妇静脉血 ,于胎儿娩出时收集脐带血 ,于产后 3d收集产妇乳汁。所有样本采用石墨炉原子吸收法进行铅含量的测定。采用自行编制的问卷对调查对象进行有关环境、生活方式、膳食情况的调查以分析孕妇铅暴露的影响因素。　结果　共收集孕产妇静脉血 115 1例 ,孕期血铅中位数为 4 3.4 0μg/L。孕期血铅呈动态变化 ,孕中期最低为 37.4 0 μg/L ,孕早、晚期较高 ,分别为 4 4 .5 0 μg/L和4 5 .10μg/L ,差异有显著性 ,P <0 .0 0 1。文化程度、家用燃料、乳制品摄入量这三个因素对血铅的影响具有统计学意义。收集脐带血 4 34例 ,铅中位数为 2 6 .4 0 μg/L ,与母体血铅呈正相关 ,r =0 .36 5 ,P <0 .0 0 1。收集乳汁 2 76例 ,铅水平 4 .4 8μg/L ,与母血铅无明显相关性。　 结论　目前北京城区孕妇血铅水平处于可接受范围。铅易于通过胎盘进入胎儿体内 ,但产妇早期乳汁中铅含量很低。另外 ,加强健康教育 ,大力治理环境 ,适当增加饮食中乳制品比例 ,采用天然气为家用燃料 ,是减少铅暴露的有效措施。     

Urinary iodine concentrations in mothers and their term newborns in country with sufficient iodine supply

Objective: The main aim of the study was to evaluate maternal and newborn urinary iodine concentrations according to the usage of iodine supplementation during pregnancy.

Methods: Thirty-seven women with singleton uncomplicated pregnancies and their newborns were included in this study. Maternal urine samples were obtained at the time of delivery and on the third day after delivery. Newborn urine samples were obtained on the third day after delivery. Urinary iodine concentrations were determined by the alkaline ashing of urine specimens followed by the Sandell–Kolthoff reaction using brucine as a colorimetric marker.

Result: The overall rate of the usage of iodine supplementation during pregnancy was 54% (20/37). Women who used the iodine supplementation during the pregnancy did not have different urinary iodine concentrations neither at the time of delivery (p?=?0.23), nor on the third day after delivery (p?=?0.65) in comparison to women without extra iodine supplementation. Newborns from pregnancies with regular iodine supplementation had higher urine iodine concentrations on the third day after delivery (p?=?0.02). When women were split into several subgroups based on the daily dosage of iodine supplementation (200, 150, and 50?μg daily and without iodine supplementation), no differences were found in maternal urine iodine concentrations at the time of delivery (p?=?0.51) and on the third day after delivery (p?=?0.63). Different levels were found in newborn urine iodine concentrations among the subgroups of newborns from pregnancies with different daily doses of iodine supplementation and from pregnancies without iodine supplementation during pregnancy (p?=?0.05).

Conclusions: Iodine supplementation during pregnancy affects newborn urine concentrations but not maternal urine concentrations.     

Use of povidone–iodine during the first trimester of pregnancy: a correct practice?

Povidone–iodine (PVP-I) has been widely used as an antiseptic agent during invasive procedures for prenatal diagnosis. Women have been reported of thyroid dysfunction after simple exposure to PVP-I. We studied the effect on thyroid function and urinary iodine excretion after a single topical application of PVP-I in 31 women who had a miscarriage during the first trimester of pregnancy. PVP-I is absorbed through the skin and the vaginal mucosa, resulting in a sudden increase in the urinary excretion of iodine and a short-term variation in concentrations of thyroid hormones in maternal serum. This metabolic effect could have consequences for the embryo and the fetus during crucial stages of development.     

Does vaginal preparation with povidone–iodine prior to caesarean delivery reduce the risk of endometritis? A randomized controlled trial

Objective: The purpose of the present study was to determine whether the vaginal preparation with povidone–iodine prior to caesarean delivery decreased the incidence of postpartum endometritis. Methods: The present study was a prospective randomized controlled trial in which subjects received a vaginal preparation with povidone–iodine solution immediately prior to caesarean delivery or received no vaginal preparation. The primary outcome measure was the rate of postpartum endometritis. Results: A significant decrease in post-caesarean endometritis was noted in the group that received the povidone–iodine vaginal preparation (n = 334) compared with the control group (n = 336) [6.9 vs. 11.6%; RR = 1.69; 95% CI = 1.03–2.76]. No statistically significant differences in the incidence of endometritis were noted between the experimental and control groups among women who were not in labor at the time of the caesarean delivery [9.2 vs. 8.6%; RR = 1.05; 95% CI = 0.58–1.90], and no differences were found between groups when women with ruptured membranes were excluded from the analysis [9.6 vs. 6.7%; RR = 1.39; 95% CI = 0.78–2.47]. Conclusions: Vaginal preparation with povidone–iodine solution immediately prior to a caesarean delivery reduces the risk of post-operative endometritis. This preemptive measure was only found to be beneficial in women whose membranes had ruptured and those who were in labor prior to caesarean surgery.     

Chlorhexidine gluconate versus povidone iodine at cesarean delivery: a randomized controlled trial

Background/Aims: To compare the prevalence of positive bacterial cultures at the cesarean delivery (CD) incision site in patients with pre-operative application of chlorhexidine gluconate (CG) versus povidone iodine (PI).

Methods: Women undergoing a scheduled CD at ≥36 gestational weeks were randomly assigned to receive CG or PI. A swab of the incision site was performed at 3?min after disinfectant application and at 18 post-operative hours, and the prevalence of cultures with any detected bacterial growth was compared for the two groups.

Results: Of the 60 participants, 33 (55.0%) were in the PI group. There were no differences detected at 3?min, with 9.1% positive in the PI group versus 0% positive in the CG group (p?=?0.2499). However, at 18?h, women in the PI group were seven times more likely than women in the CG group to have a positive culture (16/33 [48.5%] versus 3/27 [11.1%], OR?=?7.53 [95% CI 1.67–38.83], p?=?0.0023). Multivariate logistic regression demonstrated similar results: OR?=?7.33 (95% CI 1.77–30.35), p?=?0.0060.

Conclusion: The prevalence of positive bacterial cultures obtained at the site of the skin incision 18?h after CD was higher in the PI versus the CG group.     

Relationship between the body iodine status and menopausal symptoms during postmenopausal period

Abstract

Aim: The aim of this study was to assess the effect of body iodine status on hot flashes and cardiovascular disease risk in postmenopausal women.

Methods: Two hundred and ten consecutive postmenopausal women without known any risk factor for cardiovascular disease risk or systemic disorder were recruited for the study. All participants underwent serum screening consisted of lipid profile including lipoprotein-a (Lp(a)) and urinary iodine excretion. Participants were also asked for the frequency and the duration of hotflashes. All parameters were assessed for the association between urine iodine excretion and other parameters.

Results: Urine spot iodine level was significantly correlated with Lp(a) (r?=??0.287, p?<?0.001), low-density lipoprotein cholesterol (LDL-C) (r?=??0.187, p?=?0.006), cholesterol level (r?=??0.573, p?<?0.001), TG level (r?=??0.211, p?=?0.02), frequency of hot flashes per a day (r?=??0.467, p?<?0.001), durations of hot flashes (r?=??0.424, p?<?0.001), fasting glucose level (r?=?0.331, p?<?0.001), and fT3 level (r?=?0.475, p?<?0.001). In multivariate analysis, Lp(a) levels were significantly associated with the urine iodine level (beta coefficient?=??0.342, p?<?0.001) after adjustment for LDL-C (beta coefficient?=?0.225, p?<?0.001), glucose (beta coefficient?=?0.303, p?<?0.001), and age (beta coefficient?=?0.146, p?<?0.017).

Conclusion: Body iodine status during postmenopausal period is associated with the menopausal symptoms and lipid profile including Lp(a).     

妊娠期甲状腺功能保护

甲状腺疾病可以导致母儿不良妊娠结局,由于妊娠期甲状腺功能发生特异性变化,用非妊娠妇女的诊断标准评估妊娠期甲状腺功能可导致妊娠期甲状腺功能减退症漏诊、甲状腺功能亢进症误诊和药物治疗剂量不足。只有正确诊断妊娠期甲状腺疾病,合理保护妊娠期甲状腺功能,才能避免不良妊娠结局的发生和减少对新生儿远期生存质量的影响,对实现我国优生优育的国策具有非常重要的意义。     

Optimal skin antiseptic agents for prevention of surgical site infection in cesarean section: a meta-analysis with trial sequential analysis

Purpose: The best choice of antiseptic agent for skin preparation at cesarean section remains controversial. We performed this meta-analysis to assess whether chlorhexidine (CH)-based skin antisepsis was more effective than povidone iodine (PI)-based antisepsis for the prevention of surgical site infection (SSI) after cesarean section.

Methods: PubMed, EMBASE, and the Cochrane Library were systematically searched to identify English publications that compared chlorhexidine gluconate (CH) as a skin preparation agent with PI in cesarean section. The primary outcome was SSI rate. Review Manager 5.3 was used to analyze the collected data and trial sequential analysis (TSA) Software 0.9 (Cochrane Collaboration, Oxford, UK) beta was applied to estimate whether the overall pooled outcome was conclusive.

Results: Six articles involving 4385 participants were included in this study. The outcomes showed that CH-based skin antisepsis, compared with PI-based antisepsis, was not associated with a decreased overall rate of SSI (risk ratio [RR], 0.74; 95% confidence interval [CI], 0.54–1.02; p?=?.07). TSA indicated that the current available evidence was inconclusive. There were no differences in adverse skin reactions in the two groups.

Conclusions: This study provides evidence that CH-based antisepsis for skin preparation does not show an additional advantage in reducing risk of SSI after cesarean section. However, additional high-quality, randomized clinical trials are needed to confirm these findings.