Avaliação do estado nutricional de iodo em gestantes de alto risco da Maternidade de Referência Professor José Maria de Magalhães Netto

Abstract

During the pregnancy, due to several physiological questions, it occurs an increase of 50-70% in the daily iodine nutritional demand. Low iodine ingestion during pregnancy might cause goiter, cretinism, intellectual disorder, growth retardation, neonatal hypothyroidism and increase of abortion risk. In Brazil, the level of salt iodization for human consumption was reduced to 15-45mg/kg in 2013 and scarses analysis indicate a prevalence between 20-57% of iodine deficiency (ID) in the pregnant women population. Disorders related to the nutritional iodine status could highly contribute to the additional increment in the risk of health problems related to high risk pregnancy. Objective: to analyse the iodine nutritional status of in high risk pregnancy women (HRPW) assisted at Reference Maternity Professor José Maria de Magalhães Netto, Salvador, Bahia. Methods: transversal study of 241 HRPW and 50 low risk pregnancy women (LRPW) as a group of control. Some aspects were evaluated: urine iodine concentration (UIC), socioeconomic, demographic, anthropometric and health data. Results: in the HRPW, the average age was 28,66±7,15 years old, 68,5% were in the third quarter of pregnancy, furthermore 77,241(32,5%) had high blood pressure and 41/241 (17 %) had diabetes; Indeed, 53% (n=128) were on a salt/iodine restriction diet (IRD) and 41,9% (n=101) had overweight or obesity before pregnancy. The median UIC was 119μg/L (percentile 25-75 th: 58,7-200,4μg/L),with mean of 140,6±104μg/L. indicating insufficient iodine ingestion. 61,8% (n=149) presented UIC below 150μg/L. The prevalence of slight, moderate and severe ID were 18,3%, 24,5% e 19,15, respectively. None of HRPW showed excess of iodine ingestion. The mean UIC in first trimester was 164,62±103,29μg/L (adequate), while pregnant women on second and third trimester presented mean UIC of 140,5±98,84μg/L and 139,14±107,07μg/L, respectively., indicating ID. Hypertensive HRPW (n=77) showed mean UIC of 122,93 ±111,80μg/L vs. 149,90±100,39μg/L in non hypertensive women (p=0,011). Family income superior to two minimum salary lead to protection against ID [OR 2,142 (0,990-4,634)], (p=0,009). There was an eminent risk of ID in patients under IRD [OR=1,82 ;IC:(1,073-0,88)], (p=0,026); and twice higher risk in hypertensive HRPW [OR=2,127(1,178-3,829); p=0,011)]. Conclusion: We observed a high prevalence of ID (61,8%) in HRPW analysed at Maternity José Maria de Magalhães Netto, with median UIC of 119μg/L, indicating ID. 19,1% of the HRPW presented severe ID. High blood pressure and iodine restriction diet were important risk factors associated to ID. These data alert to the urgent need for a national and detailed Brazilian pregnant women's iodine nutritional status evaluation.