Maternal Iodine Status and Birth Outcomes: A Systematic Literature Review and Meta-Analysis

Nutrients. 2023 Jan 12;15(2):387. doi: 10.3390/nu15020387.

Abstract

Background & aims: Iodine is important for thyroid function during pregnancy to support fetal growth, but studies of maternal iodine status and birth outcomes are conflicting. We aimed to quantify the association between iodine status and birth outcomes, including potential threshold effects using nonlinear dose−response curves. Methods: We systematically searched Medline and Embase to 10 October 2022 for relevant cohort studies. We conducted random-effects meta-analyses of urinary iodine concentration (UIC), iodine:creatinine ratio (I:Cr), and iodide intake for associations with birth weight, birth weight centile, small for gestational age (SGA), preterm delivery, and other birth outcomes. Study quality was assessed using the Newcastle-Ottawa scale. Results: Meta-analyses were conducted on 23 cohorts with 42269 participants. Birth weight was similar between UIC ≥ 150 μg/L and <150 μg/L (difference = 30 g, 95% CI −22 to 83, p = 0.3, n = 13, I2 = 89%) with no evidence of linear trend (4 g per 50 μg/L, −3 to 10, p = 0.2, n = 12, I2 = 80%). I:Cr was similar, but with nonlinear trend suggesting I:Cr up to 200 μg/g associated with increasing birthweight (p = 0.02, n = 5). Birthweight was 2.0 centiles (0.3 to 3.7, p = 0.02, n = 4, I2 = 0%) higher with UIC ≥ 150 μg/g, but not for I:Cr. UIC ≥ 150 μg/L was associated with lower risk of SGA (RR = 0.85, 0.75 to 0.96, p = 0.01, n = 13, I2 = 0%), but not with I:Cr. Conclusions: The main risk of bias was adjustment for confounding, with variation in urine sample collection and exposure definition. There were modest-sized associations between some measures of iodine status, birth weight, birth weight centile, and SGA. In pregnancy, we recommend that future studies report standardised measures of birth weight that take account of gestational age, such as birth weight centile and SGA. Whilst associations were modest-sized, we recommend maintaining iodine sufficiency in the population, especially for women of childbearing age on restricted diets low in iodide.

Keywords: Iodine; birth weight; infant; meta-analysis; small for gestational age.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Birth Weight / physiology
  • Female
  • Fetal Development
  • Fetal Growth Retardation
  • Humans
  • Infant, Newborn
  • Iodides
  • Iodine* / urine
  • Parturition
  • Pregnancy
  • Premature Birth* / epidemiology

Substances

  • Iodides
  • Iodine

Grants and funding

The authors received no specific funding for this work. JW is in receipt of a scholarship from the School of Food Science and Nutrition, University of Leeds; and Rank Prize Funds. DCG and LJH were joint principal investigators on previous work funded by the National Institute for Health Research (NIHR) Policy Research Programme (Assessing iodine status and associated health outcomes in British women during pregnancy, PR-R10-0514-11004). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. No funding bodies had any role in study design, data collection, analysis or interpretation, in the writing of the report or in the decision to submit the article for publication.