Iodine deficiency linked to delayed conception

Women who have moderate to severe iodine deficiency have a 46% less chance of getting pregnant as compared to women who have normal iodine levels says the results of the Longitudinal Investigation of Fertility and the Environment (LIFE) study, a population-based prospective cohort study published in recent issue of Human Reproduction.

This is the first study to investigate a link between iodine levels and chances of conception in women desiring to start a family.

The researchers interviewed and enrolled 501 women over a period of 5 years.  Urine samples of all the participants were collected at the start of the study for measuring iodine levels and these women reported on risk factors for infertility during the interview. The women were advised timed intercourse according to ovulation monitoring by various fertility trackers for a period of 1 year.

Pregnancy was detected with digital home pregnancy test around menstruation.

At 1 year, 72% women (332) conceived while 42 women could not, and the rest decided to leave the study.

It was seen that nearly 56% of women had sufficient iodine levels, while 44% of women had iodine deficiency, of whom nearly 25% samples were in range of moderate to severe iodine deficiency.

The researchers used fecundability odds ratio (FOR) to measure a couple’s chance of getting pregnant in a menstrual cycle. A FOR of less than 1 suggests that the couple will take longer time to achieve pregnancy, while FOR ratio more than 1 indicate a shorter time to pregnancy.

In this study, women with moderate to severe iodine deficiency had a 46% reduction in odds of conception as compared to women with adequate levels. (Adjusted FOR = 0.54)

According to National Institute of Health (NIH), RDA of iodine for pregnant and lactating women are 220 mcg and 290 mcg respectively, but no specific recommendation is made for women trying to get pregnant.  

According to WHO, a urinary iodine levels less than 150 mcg/L are considered insufficient while levels between 150–249 mcg/L indicates adequate iodine nutrition during pregnancy. About 30% of US women of childbearing age have iodine deficiency.

In pregnant women, iodine is necessary for brain development and is the most common cause of preventable mental retardation worldwide. It also causes miscarriage and stillbirths. Chronic, severe iodine deficiency in utero causes cretinism, a condition characterized by mental retardation, deaf mutism, motor spasticity, stunted growth, delayed sexual maturation, and other physical and neurological abnormalities.

This study does not prove causality, future studies are needed to replicate the findings.

It is also difficult to test women for iodine levels and give advice on iodine levels. The issue of iodine deficiency has not yet been addressed in women who are trying to conceive. 

The authors conclude that choosing a diet adequate in iodine is the key to avoid deficiency and some experts believe that consuming prenatal vitamins with iodine can address the problem of iodine deficiency in pregnancy.

Abstract 

Media courtesy: Mercola.com

What is best for Cesarean Antisepsis? Chlorhexidine-Alcohol versus Povidone-Iodine.

Chlorhexidine-Alcohol is not superior to Povidone-Iodine in reducing the rate of surgical site infection in Cesarean section reports the results of Chlorhexidine-Alcohol Versus Povidone-Iodine for Cesarean Antisepsis (CAPICA) Trial published ahead of print in American Journal of Obstetrics and Gynecology.

Wound infection after a cesarean section (CS) is a major cause of maternal morbidity, lengthy hospital stays and increased medical cost. The rate of surgical site infection after cesarean section range from 3% to 15%.

Researchers and investigators are always looking at ways to minimize the surgical site infection in cesarean section. Numerous interventions have been proposed from changing gloves at timeof abdominal closure to preoperative antibiotic prophylaxis.

But, no previous randomized control trial has compared chlorhexidine-alcohol to povidone-iodine aqueous scrub and paint in reduction of cesarean-related surgical site infections (SSIs).

The CAPICA Trial is the first single center pragmatic randomized trial conducted at urban tertiary care center over a period of 3+ years. The trial compared efficacy of 26ml chlorhexidine-alcohol applied as single step versus 236mL povidone-iodine aqueous scrub as preoperative skin preparation in cesarean section in reducing the SSIs.

The trial recruited 932 study participants, who were 18 years or older, with no chorioamnionitis, non-allergic to povidone iodine or alcohol and who were ready to be compliant with the follow up protocols.

Women who had elective cesarean section as well as those who had emergency cesarean sections were included in the study. 

Statistical analysis was performed to look at categorical and continuous outcomes in comparing incidence of superficial or deep SSIs or endometritis as defined by CDC, including allergic skin reactions, hematomas, wound separation, dehiscence.

461 women were assigned to chlorhexidine-alcohol, and 471 assigned to povidone-iodine group. About 97% to 99% women came for follow up at 30 days. SSIs occurred in 7% of women in the povidone-iodine group vs 6.3% chlorhexidine-alcohol group(p=0.38).

Individually the difference in sub-component of infections are: superficial surgical site infection (4.6% v 5.5%, p=0.55), deep surgical site infection (0.0% v 0.4%; p=0.50), and endometritis (1.7% v 1.1%; p=0.42) in chlorhexidine-alcohol versus povidone-iodine arms respectively.

The authors concluded that use of chlorhexidine-alcohol does not results in less frequent infections as compared to using povidone-iodine.