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Title: Effects of a single dose of oral iodised oil during pregnancy on thyroid & iodide status of women & children, pregnancy outcome, and infant mortality in a goitrous area of Bangladesh
Author: Anwar, Udoy Syeed
ISNI:       0000 0001 3425 5755
Awarding Body: University of London
Current Institution: University College London (University of London)
Date of Award: 2001
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Iodine deficiency disorders (IDDs) are a major public health problem of many less developed countries (LDCs) of the world including Bangladesh, especially affecting pregnant women and their children. A cross sectional study of 356 pregnant women in Madhupur revealed a high prevalence of goitre (98.6%) and hypothyroidism with a varying prevalence according to the test used (low TT4: 61.7%; high TSH: 18.7%; low TT4 & high TSH: 15.8%). Among goitrous pregnant women the risk of developing hypothyroidism, as defined by low levels of plasma TT4, increased as the pregnancy progressed. The prevalence of 'low TT4 hypothyroidism' rose from 19.6% (9/46) during early pregnancy (<15 weeks of gestation) to 68.9% > (186/270) during mid and late pregnancy (>15 weeks of gestation) [RR (CI95%) = 3.52 (1.95 - 6.36); χ2=38.4; p<0.001]. The study revealed that the size of goitre is not a good reflector of iodine status as measured by urinary iodine excretion (UIE). 98.4% of the pregnant women had goitre while 84% of them had varying degrees of iodine deficiency (UIE <0.78 μmol/L). Dietary thiocyanate producing goitrogens were not present and deficiencies of vitamin A and selenium were not associated with goitre. Pregnant women with moderate to severe iodine deficiency (UIE <0.39 μmol/L) had greater risks of reproductive loss. They had a RR of 1.44 (CI95% = 1.06 - 1.96; χ2 = 5.18; p = 0.023) for a combination of previous abortions, stillbirths and neonatal deaths and a RR of 1.33 (CI95% = 1.02 - 1.74; χ2 = 4.31; p = 0.038) for a combination of previous abortions, stillbirths and infant deaths when compared with those with mild or no iodine deficiency (UIE > 0.39 μmol/L). The effects of a single dose of 400 mg oral iodised poppy seed oil (IPSO) in two capsules administered to pregnant women on pregnancy outcome (spontaneous abortion, stillbirth, and birth weight), thyroid and iodide status of the women and their children, and childhood mortality until second year of life were investigated. Childhood mortality rates were similar. In 6.7% vs. 19.1% (RR = 0.35; CI95% = 0.11 - 1.15; χ2 = 2.51; p = NS) infants of the unsupplemented and IPSO supplemented women respectively, there was a transient 'biochemical hyperthyroidism' at 3 months post-partum without any evidence of clinical thyrotoxicosis. At 1 year no infant of the unsupplemented women and 4.4% infants of the IPSO supplemented women had 'biochemical hyperthyroidism' without any evidence of clinical thyrotoxicosis. The oral IPSO was protective from 'biochemical hypothyroidism' even among the shorter or thinner women. This study emphasises the importance of improving iodide and thyroid status by increasing iodine intake among pregnant and pre-pregnant women. Ideally this should be via the universal salt iodisation (USI) with proper monitoring and quality control. If USI is not locally available or the quality of iodisation is not up to the mark, a single dose of oral IPSO during pregnancy can be used for the benefit of both the women and their babies. Its protective effect lasts for at least a year.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Medicine