Maternal obesity and first trimester iodine levels are associated with the risk of congenital malformations in Assam, Northeast India


Maternal obesity and first trimester iodine levels are associated with the risk of congenital malformations in Assam, Northeast India


Mauchumi Baruah1, Hemonta Kr. Dutta 2*,   Debasish Borbora3

1Department of Physiology, Assam Medical College & Hospital, Dibrugarh 786002, Assam, India. 2Department of Pediatric Surgery, Assam Medical College & Hospital, Dibrugarh 786002, Assam, India. 3Department of Biotechnology, Gauhati University, Guwahati 781014, Assam, India.


International journal of Pediatric research and reviews-2d

Purpose of the study: To assess body mass index (BMI) and trimester specific iodine status among pregnant women of Assam and study their association with congenital malformations (CM).

Methods: Anthropometric, obstetric and socioeconomic data was obtained from pregnant women and apparently healthy women attending Assam Medical College and Hospital, Dibrugarh. Urinary iodine (UI) level was estimated in each trimester. BMI was classified based on Asian criteria suggested by WHO and the iodine intake was classified using WHO reference medians. Student’s t-test and univariate logistic regression analysis were used to determine the risk factors.

Results: 156 pregnant women (age 18-35 years) and 160 controls were enrolled in the study. 55.8% pregnant women were underweight and 3.8% were overweight. Malformations were observed in 16 babies. The median urinary iodine concentration (MUIC) of pregnant women in their 1st trimester was 170 µg/l (IQR 100 µg/l) which increased to 275 µg/l (IQR 166 µg/l) during the 2nd trimester and decreased to 265 µg/l (IQR 160 µg/l) at the 3rd trimester. In the univariate analysis, maternal BMI > 23 kg/m2 (OR 3.67, 95% CI 0.20-67.65) and MUIC <150 µg/l during the 1st trimester (OR 3.59, 95% CI: 1.20-10.79) were associated with an increased risk of CM. Within the cohort, maternal BMI <18.5

(OR 2.68, CI: 1.25-5.74), age <20 years (OR 1.39, CI: 0.22-8.70), iodine unawareness (OR 1.68, CI: 0.72-3.95) and illiteracy (OR 1.12, CI: 0.55-2.30) elevate risk of having MUIC <150 µg/l during the 1st trimester.

Conclusions: As maternal BMI and iodine deficiency are modifiable risk factors of CM, state policies directed towards maternal healthcare should encourage preconception counseling regarding risk factors of CM and aim to address low maternal BMI and IDD.


Keywords: congenital malformations; BMI; iodine deficiency, pregnancy.

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How to cite this article:
Mauchumi Baruah, Hemonta Kr. Dutta, Debasish Borbora. Maternal obesity and first trimester iodine levels are associated with the risk of congenital malformations in Assam, Northeast India. International Journal of Pediatric Research and Reviews, 2020, 3:25.  DOI:10.28933/ijoprr-2020-05-1805


References

1. Bhide P, Sagoo GS, Moorthie S, Burton H, Kar A. Systematic review of birth prevalence of neural tube defects in India. Birth defects research Part A, Clinical and molecular teratology. 2013;97(7):437-43. doi: 10.1002/bdra.23153. PubMed PMID: 23873811.
2. Danzhen You PB, Jingxian Wu and Tessa Wardlaw. Levels & Trends in Child Mortality report 2013. United Nations Inter-agency Group for Child Mortality Estimation, 2013.
3. WHO. Congenital anomalies Fact sheet N°370: WHO; 2014. Available from: http://www.who.int/mediacentre/factsheets/fs370/en/.
4. Tanvig M, Wehberg S, Vinter CA, Joergensen JS, Ovesen PG, Beck-Nielsen H, et al. Pregestational body mass index is related to neonatal abdominal circumference at birth–a Danish population-based study. BJOG : an international journal of obstetrics and gynaecology. 2013;120(3):320-30. doi: 10.1111/1471-0528.12062. PubMed PMID: 23146023.
5. Sridhar P V, Kamala C S. Iodine status and prevalence of goitre in school going children in rural area. Journal of clinical and diagnostic research : JCDR. 2014;8(8):PC15-7. doi: 10.7860/JCDR/2013/6311.4732. PubMed PMID: 25302243; PubMed Central PMCID: PMC4190768.
6. ICMR. Epidemiological survey of Endemic goiter and Endemic cretinism. An ICMR TaskForce Study. . Indian Council of Medical Research, New Delhi. 1989.
7. Dutta HK, Bhattacharyya NC, Sarma JN, Giriraj K. Congenital malformations in Assam. Journal of Indian Association of Pediatric Surgeons. 2010;15(2):53-5. doi: 10.4103/0971-9261.70639. PubMed PMID: 20975782; PubMed Central PMCID: PMC2952776.
8. Consultation WHOE. Appropriate body-mass index for Asian populations and its implicationsfor policy and intervention strategies. Lancet. 2004;363(9403):157-63. doi: 10.1016/S01406736(03)15268-3. PubMed PMID: 14726171.
9. WHO U, ICCIDD. Assessment of iodine deficiency disorders and monitoring their elimination, A guide for programme managers. 2007 1st September 2008. Report No.
10. Pandav CS, Yadav K, Srivastava R, Pandav R, Karmarkar MG. Iodine deficiency disorders (IDD) control in India. The Indian journal of medical research. 2013;138(3):418-33. PubMed PMID: 24135192; PubMed Central PMCID: PMC3818611.
11. Dutta HK, Deori P. Anterior encephaloceles in children of Assamese tea workers. Journal of neurosurgery Pediatrics. 2010;5(1):80-4. Epub 2010/01/02. doi: 10.3171/2009.8.PEDS0912. PubMed PMID: 20043740.
12. Rydbeck F, Bottai M, Tofail F, Persson LA, Kippler M. Urinary iodine concentrations of pregnant women in rural Bangladesh: A longitudinal study. Journal of exposure science & environmental epidemiology. 2014;24(5):504-9. doi: 10.1038/jes.2013.79. PubMed PMID: 24220214.
13. Lean MI, Lean ME, Yajnik CS, Bhat DS, Joshi SM, Raut DA, et al. Iodine status during pregnancy in India and related neonatal and infant outcomes. Public health nutrition. 2014;17(6):1353-62. doi: 10.1017/S1368980013001201. PubMed PMID: 23659491.
14. Aguayo A, Grau G, Vela A, Aniel-Quiroga A, Espada M, Martul P, et al. Urinary iodine and thyroid function in a population of healthy pregnant women in the North of Spain. Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements. 2013;27(4):302-6. doi: 10.1016/j.jtemb.2013.07.002. PubMed PMID: 23992867.
15. Grewal E, Khadgawat R, Gupta N, Desai A, Tandon N. Assessment of iodine nutrition in pregnant north Indian subjects in three trimesters. Indian journal of endocrinology and metabolism. 2013;17(2):289-93. doi: 10.4103/2230-8210.109716. PubMed PMID: 23776905; PubMed Central PMCID: PMC3683207.
16. Majumder A, Jaiswal A, Chatterjee S. Prevalence of iodine deficiency among pregnant and lactating women: Experience in Kolkata. Indian journal of endocrinology and metabolism. 2014;18(4):486-90. doi: 10.4103/2230-8210.137491. PubMed PMID: 25143903; PubMed Central
1. PMCID: PMC4138902.
17. Habimana L, Twite KE, Wallemacq P, De Nayer P, Daumerie C, Donnen P, et al. Iodine and iron status of pregnant women in Lubumbashi, Democratic Republic of Congo. Public health nutrition. 2013;16(8):1362-70. doi: 10.1017/S1368980012005484. PubMed PMID: 23324455.
18. Menon KC, Skeaff SA, Thomson CD, Gray AR, Ferguson EL, Zodpey S, et al. The effect of maternal iodine status on infant outcomes in an iodine-deficient Indian population. Thyroid : official journal of the American Thyroid Association. 2011;21(12):1373-80. doi: 10.1089/thy.2011.0130. PubMed PMID: 22029720.
19. Henrichs J, Ghassabian A, Peeters RP, Tiemeier H. Maternal hypothyroxinemia and effects on cognitive functioning in childhood: how and why? Clinical endocrinology. 2013;79(2):152-62. doi: 10.1111/cen.12227. PubMed PMID: 23600900.
20. Bath SC, Steer CD, Golding J, Emmett P, Rayman MP. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet. 2013;382(9889):331-7. doi: 10.1016/S01406736(13)60436-5. PubMed PMID: 23706508.
21. Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA : the journal of the American Medical Association. 2009;301(6):636-50. doi: 10.1001/jama.2009.113. PubMed PMID: 19211471.
22. Al-Obaidly S, Parrish J, Murphy KE, Maxwell C. Maternal pre-gravid body mass index and obstetric outcomes in twin gestations. Journal of perinatology : official journal of the California Perinatal Association. 2014;34(6):425-8. doi: 10.1038/jp.2014.29. PubMed PMID: 24603456.
23. Mandal D, Manda S, Rakshi A, Dey RP, Biswas SC, Banerjee A. Maternal obesity and pregnancy outcome: a prospective analysis. The Journal of the Association of Physicians of India. 2011;59:486-9. PubMed PMID: 21887903.
24. Rankin J, Tennant PW, Stothard KJ, Bythell M, Summerbell CD, Bell R. Maternal body mass index and congenital anomaly risk: a cohort study. International journal of obesity. 2010;34(9):137180. doi: 10.1038/ijo.2010.66. PubMed PMID: 20368710.
25. Yadav K, Srivastava R, Badhal S, Palanivel C, Pandav CS, G KM. Iodine nutrition of pregnant women in India: evidence of significant iodine deficiency. Indian Journal of Medical Specialities. 2012;3(1):49-54.
26. Jaiswal N, Melse-Boonstra A, Sharma SK, Srinivasan K, Zimmermann MB. The iodized salt programme in Bangalore, India provides adequate iodine intakes in pregnant women and more-than adequate iodine intakes in their children. Public health nutrition. 2014:1-11. doi: 10.1017/S136898001400055X. PubMed PMID: 24762565.
27. Chakraborty I, Chatterjee S, Bhadra D, Mukhopadhyaya BB, Dasgupta A, Purkait B. Iodine deficiency disorders among the pregnant women in a rural hospital of West Bengal. The Indian journal of medical research. 2006;123(6):825-9. Epub 2006/08/04. PubMed PMID: 16885606.
28. Singh MB, Fotedar R, Lakshminarayana J. Micronutrient deficiency status among women of desert areas of western Rajasthan, India. Public health nutrition. 2009;12(5):624-9. doi: 10.1017/S1368980008002395. PubMed PMID: 18503719.
29. Joshi K, Nair S, Khade C, Rajan MG. Early gestation screening of pregnant women for iodine deficiency disorders and iron deficiency in urban centre in Vadodara, Gujarat, India. Journal of developmental origins of health and disease. 2014;5(1):63-8. doi: 10.1017/S2040174413000470. PubMed PMID: 24847692.
30. Chakraborty I, Mazumdar P, Chakraborty PS, Chattopadhyay G, Bhowmick K. Iodine deficiency disorder among pregnant women in a tertiary care hospital of Kolkata, India. The Southeast Asian journal of tropical medicine and public health. 2010;41(4):989-95. PubMed PMID: 21073075.