Objective Mild to moderate iodine deficiency during pregnancy has been associated with adverse neurodevelopmental outcomes in offspring. Few research studies to date combine assessment of urinary iodine (UIC and/or ICr), biomarkers that best reflect dietary intake, with reported dietary intake of iodine rich foods in their assessment of iodine deficiency. Thus, a systematic review was conducted to incorporate both these important measures. Design Using PRISMA guidelines, a comprehensive search was conducted in three electronic databases (EMBASE®, MedLine® and Web of Science®) from January 1970–March 2021. Quality assessment was undertaken using the Newcastle Ottawa Scale. Eligible studies included reported assessment of iodine status through urinary iodine (UIC and/or ICr) and/or dietary intake measures in pregnancy alongside neurodevelopmental outcomes measured in the children. Data extracted included study author, design, sample size, country, gestational age, child age at testing, cognitive tests, urinary iodine assessment (UIC in μg/L and/or ICr in μg/g), dietary iodine intake assessment and results of associations for the assessed cognitive outcomes. Results Twelve studies were included with nine reporting women as mild-moderately iodine deficient based on World Health Organization (WHO) cut-offs for urinary iodine measurements < 150 μg/l, as the median UIC value in pregnant women. Only four of the nine studies reported a negative association with child cognitive outcomes based on deficient urinary iodine measurements. Five studies reported urinary iodine measurements and dietary intakes with four of these studies reporting a negative association of lower urinary iodine measurements and dietary iodine intakes with adverse offspring neurodevelopment. Milk was identified as the main dietary source of iodine in these studies. Conclusion The majority of studies classified pregnant women to be mild-moderately iodine deficient based on urinary iodine assessment (UIC and/or ICr) and/or dietary intakes, with subsequent offspring neurodevelopment implications identified. Although a considerable number of studies did not report an adverse association with neurodevelopmental outcomes, these findings are still supportive of ensuring adequate dietary iodine intakes and urinary iodine monitoring throughout pregnancy due to the important role iodine plays within foetal neurodevelopment. This review suggests that dietary intake data may indicate a stronger association with cognitive outcomes than urinary iodine measurements alone. The strength of this review distinguishes results based on cognitive outcome per urinary iodine assessment strategy (UIC and/or ICr) with dietary data. Future work is needed respecting the usefulness of urinary iodine assessment (UIC and/or ICr) as an indicator of deficiency whilst also taking account of dietary intakes.
Maternal thyroid hormones facilitate optimal foetal neurodevelopment; however, the exact role of the thyroid hormones on specific cognitive outcomes is unknown. The present study aimed to investigate associations between maternal thyroid function and neurodevelopmental outcomes in the Seychelles Child Development Study (SCDS) Nutrition 2 cohort (n 1328). Maternal free thyroid hormones (fT3, fT4 and fTSH) were assessed at 28 weeks’ gestation with a range of child cognitive outcomes analysed at 20 months. Dietary iodine intake was analysed for a subset of women through a Food Frequency Questionnaire. Linear regression analysis was used to test associations between serum concentrations of maternal thyroid hormones and child neurodevelopment outcomes. Thyroid hormones were analysed as continuous data and categorised as quintiles. 95% of mothers had optimal thyroid function based on fTSH concentrations. Overall, the present study shows that maternal thyroid function is not associated with neurodevelopmental outcomes in this high fish-eating population. However, a positive association, using quintiles for fT3, was reported for the Mental Developmental Index, between Q3 v. Q4 (β 0⋅073; P 0⋅043) and for Q3 v. Q5 (β value 0⋅086; P 0⋅018). To conclude, mothers in our cohort, who largely have optimal thyroid function and iodine intakes, appear able to regulate thyroid function throughout pregnancy to meet neurodevelopmental needs. However, it is possible that minor imbalances of fT3, as indicated from our secondary analysis, may impact offspring neurodevelopment. Further investigation of the relationship between maternal thyroid function and infant neurodevelopment is warranted, particularly in populations with different dietary patterns and thereby iodine intakes.
standard paediatric head injury proforma, with an under 1 year old section, was introduced. This printed instead of patient notes. Local education and electronic prompts on the ED clinical system also occurred. Results There were 1240 infants <1 year with head/facial injury over the study period, 245 were selected with 238 analysed (7 discounted as not head/facial injury). From 2017-2021 SFT documentation increased from baseline median 0% to >80%, with a statistical change in practice after introduction of the proforma. SIF submission increased from baseline median 60% to >80%, with a statistical shift in practice from October 2017. It is unclear what caused this shift in practice but national case awareness including Child X & U may have impacted. Clerical issues identified in the original QIP led to SIFs not reaching the Safeguarding team (SIF scanned into notes only and not discussed) thus impacting on achieving a higher percentage of SIF submissions. Despite raising awareness in 2018-19 with our clerical staff, this issue remains and may not be correctable until a planned fully electronic system is introduced. Some infants had no SIF reflecting staff noncompliance with local policy suggesting on-going education and feedback is required. Conclusions Introduction of a standardised head injury proforma and electronic prompt has created a sustained and embedded practice within our PED of adequate SFT documentation. SIF submission is high and improved further, but a combination of clerical issues and policy non-compliance has currently limited further improvement. Continuous staff education, training and feedback is required to sustain high compliance levels.
Iodine status is associated with children's neurodevelopment. As a result, the World Health Organization (WHO) recommends the monitoring of children's iodine intakes to ensure the effective and sustainable prevention of deficiency, which is known to adversely affect child neurodevelopment (1,2) . Nevertheless, a limited amount of data on iodine status is available for developing countries, including that of the Seychelles, and as such it is imperative to evaluate child Urinary Iodine Concentrations (UIC) thus enabling monitoring of iodine status (3) . Iodine status was quantified in children from the Seychelles Child Development Study (SCDS) Nutrition Cohort 2. The Seychelles population have a high fish consumption and iodized salt is widely available4. The aim of this study was to evaluate iodine status of the Seychellois school aged children using Urinary Iodine Concentrations (UIC). We hypothesized that children in this cohort would have adequate, or even excess iodine intakes based on their dietary patterns (4) .A total of 603 children provided a spot, non-fasted, urine samples at 7 years of age (mean 7.36 years and range 7-8 years). A 1.5 ml aliquot was analysed at the ETH Laboratory, Zurich for UIC using the Pino modification of the standard Sandell-Kolthoff method (5) . We used the UIC data according to the WHO cut-offs for analysis5. WHO classifies I status as the following <20 μg/l severe; 20-49 μg/l moderate; 50-99 μg/l mild; 100-299 μg/l adequate and >300 μg/l as excessive (6) .Sufficient iodine status was observed in some 63.3% of children whereas 17.1% of children had intakes defined as mildly iodine deficient, 8.6% as moderately deficient and 2.7% as severely deficient. For 8.3% of children their UIC suggested iodine intakes were in the excessive range.The range of UIC observed were unexpected and may reflect changing dietary patterns in the Seychelles with a shift away from high fish consumption. These findings in an oceanic, high fish-eating population warrants further research to explore the determinants of any low iodine intakes and their associations with neurodevelopmental outcomes in the children at 7 years of age.
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