妊娠期孕妇隐匿性碘缺乏对子女脑发育影响的长期效果研究

Iodine deficiency is the most important and preventable factor which results in the brain development problems of children. Pregnant women are the key population to prevent their children from iodine deficiency. There is no agreement about hidden iodine deficiency among pregnant women, i.e. whether 100µg/L -150µg/L of urinary iodine during gestation, could results in delaying the brain development of their children after birth or not. The reasons include little research could follow up, observe more than years, and the method of brain evaluation in this kind of study was simple in domestic until now. Recently, conflict international studies were published. However, all of them were based on the countries without iodine deficient disorders. It will be possible that pregnant women will be exposed at the risk of hidden iodine deficiency because of the decrease of iodine concentration in edible salt, the physiological regulation during gestation, and the tendency of sodium reduction strategies movement...The main purpose of this study is to explore the impact of hidden iodine deficiency among pregnant women on their children’s brain development. Therefore, this study is designed as a longitudinal and cross-sectional study, with evaluation on children brain development by using standardized and quantitative psychological tests and the hearing ability test, which will provide more valid and reliable evidences...The whole study will be divided into two parts. Based on the data we have obtained before, Study One will track the population, re-evaluate the status of brain development with psychological tests and check the hearing ability which is more related to the thyroid hormone (TH) during gestation and maternal TH as well. Study Two will further focus on exploring the role of hidden iodine deficiency among pregnant women on children brain development, particularly considering those living in areas where has controlled or has not controlled iodine deficient disorders for continuously more than two years. ..The roles of variables will be involved, such as maternal iodine status and TH, gestational trimester, and other nutrition. The data of both sub-studies will provide evidence for the relationship between variables and children brain development, and will appear the sensitivity of pregnant women’ TH standard for diagnosis during gestation by Yan to predict the level of brain development of their infants...The results of this project will explain the mechanism about the role of iodine nutrition among pregnant women on their children’s brain development, and provide valuable evidence for adjusting the monitoring strategy of national control iodine deficient disorders program as well.

碘缺乏是导致儿童脑发育障碍的最大和可预防因素,孕妇是预防该问题关键人群。国内缺少对后代脑发育的长期追踪评估,国外研究仅针对碘充足地区,不同研究结论并不一致。随着食用盐碘含量下调、妊娠生理影响及未来减盐生活趋势,孕妇将面临隐匿性碘缺乏可能性。这对防治碘缺乏病(IDD)提出新课题。本研究将长期追踪与横断面研究设计结合,运用心理评估与听神经检查综合评估脑发育,充分利用前期数据和经验。研究1将再次评估幼儿脑发育、复诊生育后妇女甲功变化。研究2利用横断面对照设计,着重探讨持续或未持续消除IDD情况下,孕妇隐匿性碘缺乏对子女脑发育的影响。研究探讨的变量涉及孕妇不同碘营养、妊娠时期、甲状腺激素及其它因素对子女脑发育和孕妇甲功的影响。所获结果在理论上将为碘与脑发育关系及发病机理增加新的依据,并评估现有孕妇甲状腺激素参考值范围预测的准确性。也将为国家制订更科学合理的IDD监测方案提供支持。

碘缺乏是导致儿童脑发育障碍的最大和可预防因素,孕妇是预防该问题关键人群。国内缺少对后代脑发育的长期追踪评估,国外研究仅针对碘充足地区,不同研究结论并不一致。随着食用盐碘含量下调、妊娠生理影响及未来减盐生活趋势,孕妇将面临隐匿性碘缺乏可能性。这对防治碘缺乏病(IDD)提出新课题。.本研究按计划，全部完成了对阿克苏地区产后孕妇的回访,回访率在70%以上，完成对他们所育儿童的以智力为主的心理评估；也完成了汉族孕妇以及所生婴儿的观察。完成了躯体检查，采集计划中的生物样本，完成实验室检测，初步完成数据整理与分析，发表阶段性论文完成研究论文6篇（钱明为通讯作者），综述文章1篇，另外，合作发表1篇，待发表综述2篇。根据调整的计划，建立妊娠期不同甲状腺激素水平的动物模型，重点探讨亚临床甲状腺功能低下对神经细胞发育的调控和对学习能力的影响。在应用研究方面，将项目成果用于医护人员、医科大学生的碘缺乏病防治健康教育，主编2部教材，参编2部，为国内外政府提供咨询意见。.根据目前的初步分析结果，我们认为：暴露于隐匿性碘缺乏的孕妇，如果妊娠中期发生亚甲减时，所育子女可能存在智力低下的风险，这种现象没有在适碘的亚甲减孕妇和后代子女中发现。因此，为了保护儿童脑发育正常，采取目前以碘盐为核心的防治，防止孕妇暴露于碘缺乏非常必要，即使是隐匿性碘缺乏也必须引起高度重视。由于本研究涉及妊娠期因素多，现场工作结束时间晚，需要对数据做更进一步的分析。.本项目所获结果将在理论上为碘与脑发育关系及发病机理增加新依据,也将为国内外制订碘缺乏病防治策略提供科学依据，很有应用价值。.