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La deficiencia de yodo grave y moderada durante la gestación y la lactancia afecta a la función tiroidea de la madre y del neonato, así como al desarrollo neuropsicológico del niño. En la mayoría de los países de Europa el estado nutricional de yodo de gestantes y recién nacidos es deficiente, pues las necesidades de yodo en las mujeres embarazadas y en las que amamantan a sus hijos son al menos el doble de las recomendadas para la población adulta. Estudios realizados en España confirman que la mayoría de las mujeres se encuentran en yododeficiencia durante la gestación y la lactancia y muestran que la ingesta de sal yodada no es suficiente para conseguir un estado nutricional de yodo óptimo en esta población. Varios estudios demuestran el efecto beneficioso de la suplementación de yodo de las embarazadas sobre el estado nutricional de yodo y la función tiroidea de la madre y el recién nacido. Las mujeres embarazadas, las que amamantan a sus hijos y las que planifican su gestación deberían recibir suplementos de yodo en forma de tabletas de yoduro potásico.
Palabras clave:
Deficiencia de yodo
Suplementación de yodo
Gestación
Lactancia
Severe and mild iodine deficiency during pregnancy and lactation affects thyroid function of the mother and neonate as well as the infant's neuropsychological development. In most European countries, maternal and neonatal iodine status is deficient, since iodine requirements in pregnant and lactating women are almost double those recommended for nonpregnant or non-lactating women. Studies performed in Spain confirm that most women are iodine deficient during pregnancy and lactation, and show that iodized salt intake is insufficient to achieve optimal iodine nutritional status in this population. Several studies have demonstrated the beneficial effect of iodine supplementation in pregnant women on the iodine and thyroid status of both mother and neonate. Pregnant and breast feeding women and women planning to become pregnant should take iodine supplements in the form of potassium iodide tablets.
Key words:
Iodine deficiency
Iodine supplementation
Pregnancy
Lactation
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Bibliografía
[1.]
J.T. Dunn, F. Delange.
Damaged reproduction: the most important consequence of iodine deficiency.
J Clin Endocrinol Metab, 86 (2001), pp. 2360-2363
[2.]
P.OD. Pharoah, I.H. Buttfield, B.S. Hetzel.
Neurological damage to the fetus resulting from severe iodine deficiency during pregnancy.
Lancet, 13 (1971), pp. 308-311
[3.]
C.H. Thilly, R. Lagasse, G. Roger, P. Bourdoux, A.M. Ermans.
Impaired fetal and postnatal development and high perinatal death-rate in a severe iodine deficient area.
Thyroid research VIII, pp. 20-23
[4.]
P.O.D. Pharoah, K.J. Connolly.
Iodine deficiency in Papua, New Guinea.
The damaged brain of iodine deficiency, pp. 299-305
[5.]
X.Y. Cao, X.M. Jiang, Z.H. Dou, M.A. Rakeman, M.L. Zhang, K. O’donell, et al.
Timing of vulnerability of the brain to iodine deficiency in endemic cretinism.
N Engl J Med, 331 (1994), pp. 1739-1744
[6.]
K. Mahomed, A.M. Gülmezoglu.
Maternal iodine supplements in areas of deficiency.
The Cochrane Library, Update Software, (2003),
[7.]
F. Delange.
Iodine deficiency as a cause of brain damage.
Postgrad Med J, 77 (2002), pp. 217-220
[8.]
G. Morreale, M.J. Obregón, F. Escobar del Rey.
Is neuropsychological development related to maternal hypothyroidism or to maternal hypothyroxinema?.
J Clin Endocrinol Metab, 85 (2000), pp. 3975-3987
[9.]
G. Morreale.
Yodo y embarazo.
Yodo y salud en el siglo XXI, European Pharmaceutical Group, (2004),
[10.]
E.B. Mann, R.H. Holdren, W.S. Jones.
Thyroid function in human pregnancy. VII: Development and retardation of 4-year-old progeny of euthyroid and of hypothyroxinemic women.
Am J Obstet Gynecol, 109 (1971), pp. 12-19
[11.]
N. Matsura, J. Konishi.
Transient hypothyroidism in infant born to mothers with chronic thyroiditis- A nationwide study of twenty-three cases. The Transient Hypothyroidism Study Group.
Endocrinol Jpn, 37 (1990), pp. 369-379
[12.]
V.J. Pop, E.P. Brouwers, H.L. Vader, J. De Vijlder, T. Vulsma.
Maternal thyroid function during early pregnancy and neurodevelopment of the offspring.
Proceedings of the 82nd Annual Meeting of The Endocrine Society, pp. 163
[13.]
J.E. Haddow, G.E. Palomaki, W.C. Allan, J.R. Williams, G.J. Knight, J. Gagnon, et al.
Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child.
N Engl J Med, 341 (1999), pp. 549-555
[14.]
N. Bleichrodt, F. Escobar del Rey, G. Morreale de Escobar, I. García, C. Rubio.
Iodine deficiency Implications for mental and psychomotor development in children.
Iodine and the brain, pp. 269-287
[15.]
F. Vermiglio, M. Sidoti, M.D. Finocchiaro, S. Battiati, V.P. Lo Presti, S. Benvenga, et al.
Defective neuromotor and cognitive ability in iodine-deficient schoolchildren of an endemic goiter region in Sicily.
J Clin Endocrinol Metab, 70 (1990), pp. 379-384
[16.]
G.F. Fenzi, L.F. Giusti, F. Aghini-Lombardi, L. Bartalena, C. Marcocci, F. Santini.
Neuropsychological assesment in schoolchildren from an area of moderate iodine deficiency.
J Endocrinol Invest, 13 (1990), pp. 427-431
[17.]
F. Vermiglio, V.P. Lo Presti, M. Moleti, M. Sidoti, G. Tortorella, G. Scaffidi, et al.
Attention deficit and hyperactivity disorders in the offspring of mothers exposed to mild-moderate iodine deficiency: A possible novel iodine deficiency disorder in developed countries.
J Clin Endocrinol Metab, 89 (2004), pp. 6054-6060
[18.]
J. Dobbing, J. Sands.
Quantitative growth and development of human brain.
Arch Dis Child, 48 (1973), pp. 757-767
[19.]
WHO, UNICEF, ICCIDD. Assesment of iodine deficiency disorders and monitoring their elimination. A guide for programme managers. 2.a ed. (WHO/NHD/01.1). Geneva: WHO; 2001. p. 1-107.
[20.]
D. Glinoer.
Pregnancy and iodine.
Thyroid, 11 (2001), pp. 471-481
[21.]
M. Zimmerman, F. Delange.
Iodine supplementation of pregnant women in Europe: a review and recommendations.
Eur J Clin Nutr, 58 (2004), pp. 979-984
[22.]
H.J. Dworkin, J.A. Jacquez, W.H. Beierrwaltes.
Relationship of iodine ingestion to iodine excretion in pregnancy.
J Clin Endocrinol Metab, 26 (1966), pp. 1329-1342
[23.]
A. Berghout, W.M. Wiersinga.
Thyroid size and thyroid function during pregnancy.
Iodine in pregnancy, pp. 35-53
[24.]
Food and Nutrition Board. Institute of Medicine. Dietary Reference Intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington: National Academy Press; 2000. p. 258-89.
[25.]
F. Delange, P. Lecomte.
Iodine supplementation: benefits outweigh risks.
Drug Saf, 22 (2000), pp. 89-95
[26.]
De Benoist B, Delange F. Report of a WHO technical consultation on prevention and control of iodine deficiency in pregnancy, lactation and in children, less than 2 years of age. J Public Health Nutrition. 2006 [en prensa].
[27.]
R. Utiger.
Iodine nutrition. More is better.
N Engl J Med, 354 (2006), pp. 2819-2821
[28.]
F. Vermiglio, V.P. Lo Presti, M.D. Finocchiaro, S. Battiato, L. Grasso, F.V. Ardita, et al.
Enhanced iodine concentrating capacity by the mammary gland in iodine deficient lactating women of an endemic goiter region in Sicily.
J Endocrinol Invest, 15 (1992), pp. 137-142
[29.]
J.J. Arrizabalaga.
Nutrición y yodo, prevención y control de los trastornos causados por la deficiencia de yodo.
Yodo y salud en el siglo XXI, European Pharmaceutical Group, (2004),
[30.]
Scientific Committee on Food of European Commission.
Opinion of the Scientific Committee on Food on the Tolerable Upper Intake Level of Iodine.
European Commission, (2002),
[31.]
F. Delange.
Iodine deficiency in Europe and its consequences:an update.
Eur J Nucl Med, 29 (2002), pp. S404-S416
[32.]
F.J. Díaz Cadórniga, E. Delgado Álvarez.
Défict de yodo en España: situación actual.
Endocrinol Nutr, 51 (2004), pp. 2-13
[33.]
F. Almodóvar, J.J. Gorgojo, M. Lahera, F. Cava, S. Valor, S. Donnay.
Défict de yodo en una población de mujeres embarazadas pertenecientes a un área con leve deficiencia de yodo.
Endocrinol Nutr, 53 (2006), pp. 579-583
[34.]
F. Delange.
Screening for congenital hypothyroidism used an indicator of the degree of iodine deficiency and its control.
Thyroid, 8 (1998), pp. 1185-1192
[35.]
WHO, UNICEF, ICCIDD. Indicators for assessing iodine deficiency disorders and their control through salt iodization (WHO/NUT/94.6). Geneva: WHO; 1994. p. 1-55.
[36.]
M. Espada, E. Chamorro, E. Carles, E. Dulin, I. Aguilera, T. Pompols, et al.
Monitorización del défict de yodo en España a través del Programa de Cribado Neonatal.
An Esp Pediatr, 57 (2002), pp. 66
[37.]
F.J. Díaz Cadórniga, E. Delgado Álvarez.
Implicaciones clinicoterapéuticas de la deficiencia de yodo en España.
Endocrinol Nutr, 53 (2006), pp. 101-112
[38.]
K.l. Cadwell, R. Jones, J.G. Hollowell.
Urinary iodine concentration: United States National Health and Nutrition Examination Survey 2001-2002.
Thyroid, 15 (2005), pp. 692-699
[39.]
K. Guttikonda, J. Burgess, H. Kristen, S. Boyages, K. Byth, V. Parameswaran.
Recurrent iodine deficiency in Tasmania, Australia: a salutary lesson in sustainable iodine prophylaxis and its monitoring.
J Clin Endocrinol Metab, 87 (2002), pp. 2809-2815
[40.]
B. Moinier.
Iodized salt consumption patterns in Europe: a perspective from the salt industry.
IDD Newsletter, 22 (2006), pp. 8-9
[41.]
M. Li, C. Eastman.
The re-emergence of iodine deficiency in Australia.
IDD Newsletter, 23 (2006), pp. 2-3
[42.]
Real Decreto 142/1983. BOE n.o 130. Madrid, 1 de junio de 1983.
[43.]
J. Díaz, E. Vázquez, G. Fernández, C. Colón, C. Bacariza, F. Piñón.
Impacto del uso de la sal yodada en los escolares de la provincia de Lugo: su repercusión sobre el grado de bocio y la yoduria.
Endocrinología, 40 (1993), pp. 284-288
[44.]
S. Donnay, A. Fernández, M. Abel, F. Escobar.
Disponiblidad de sal yodada y su contenido real de yodo.
Endocrinol Nutr, 46 (1999), pp. 224-227
[45.]
S. Donnay, M.A. Saavedra, J.J. Gorgojo, M. Brito, A. Fernández, F.J. Cañizo.
Consumo de sal yodada en pacientes de consultas de endocrinología de tres áreas sanitarias de la Comunidad de Madrid.
Endocrinol Nutr, 53 (2006), pp. 536-542
[46.]
J. De Santiago, I. Pastor, F. Escobar del Rey, G. Morreale de Escobar.
Thyroid function in pregnant women from an area with mild (Grade I) iodine deficiency.
J Endocrinol Inv, 22 (1999), pp. 68
[47.]
I. Rodríguez, R. Luna, M. Ríos, C. Fluiters, C. Páramo, R. García-Mayor.
Déficit de yodo en gestantes y mujeres en edad fértil pertenecientes a un área con consumo normal de yodo.
Med Clin (Barc), 118 (2002), pp. 217-218
[48.]
L. Antonangeli, D. Maccherini, R. Cavaliere, C. Di Giulio, B. Reinhardt, A. Pinchera, et al.
Comparison of two different doses of iodide in the prevention of gestational goiter in marginal iodine deficiency: a longitudinal study.
Eur J Endocrinol, 147 (2002), pp. 29-34
[49.]
C. García Delgado, E. Delgado, F. Díaz-Cadórniga, J.A. Álvarez, M. Valdés, A. Méndez, et al.
Estudio sobre nutrición de yodo en embarazadas asturianas.
Endocrinol Nutr, 50 (2003), pp. 5
[50.]
E. Delgado, C. García Delgado, F. Díaz-Cadórniga, J.A. Álvarez, M. Valdés, A. Méndez, et al.
Prevalencia de autoinmunidad tiroidea en gestantes asturianas.
Endocrinol Nutr, 50 (2003), pp. 6
[51.]
F. Escobar del Rey, G. Morreale de Escobar.
Yodación universal de la sal: un derecho humano de la infancia.
Endocrinología, 45 (1998), pp. 3-16
[52.]
Ficha Técnica de Yoduk® (Recordati España) Fecha de la primera autorización/renovación de la autorización: 28-5-04.
[53.]
D. Glinoer.
The regulation of thyroid function during normal pregnancy: Importance of the iodine nutrition status.
Best Pract Res Clin Endocrinol Metab, 18 (2004), pp. 133-152
[54.]
I. Del Cura, L. Arribas, A. Cortado, E. Bailón, J. Landa, A. López, et al.
Actividades preventivas en la mujer.
Aten Primaria, 36 (2005), pp. 102-130
[55.]
R. Romano, E.A. Jannini, M. Pepe, A. Grimaldi, M. Olivieri, P. Spennati, et al.
The effects of iodoprophylaxis on thyroid size during pregnancy.
Am J Obstet Gynecol, 164 (1991), pp. 482-485
[56.]
D. Glinoer, P. De Nayer, F. Delange, M. Lemone, V. Toppet, M. Spehl, et al.
A randomized trial for the treatment of mild iodine deficiency during pregnancy: maternal and neonatal effects.
J Clin Endocrinol Metab, 80 (1995), pp. 258-269
[57.]
K.P. Liesenkötter, W. Gopel, U. Bogner, B. Stach, A. Grüters.
Earliest prevention of endemic goiter by iodine supplementation during pregnancy.
Eur J Endocrinol, 134 (1996), pp. 443-448
[58.]
S. Niesert, C. Jakobi, K. Behrens, A. Von zur Mühlen.
Prospektive untersuchung der postpartalen schilddrüsendysfunktion bei gesunden frauen.
Medwelt, 42 (1991), pp. 48-51
[59.]
S. Nohr, A. Jorgensen, K.M. Pedersen, P. Laurberg.
Post-partum thyroid dysfunction in pregnant thyroid peroxidase antibody-positive women living in an area with mild to moderate iodine deficiency: is iodine supplementation safe?.
J Clin Endocrinol Metab, 85 (2003), pp. 3191-3198
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