a very interesting article<\/a> about it in a swiss primary care journal.<\/p>\nFurthermore, an issue that caught my eye thanks to a message posted by Dr G\u00e9rvas on the listservers were the recent findings from a Spanish research group that iodine supplements in pregnancy could be potentially harmful to both the mother and the fetus. I had the chance afterwards of debating this issue with him personally via email, and with his permission, I reproduce below the electronic discussion I had with him, and invite you to draw your own conclusions.<\/p>\n
Tiago<\/strong>: Juan, do you have any idea of how widespread the practice of recommending systematic iodine supplementation early in pregnancy is, even in areas\u00a0considered iodine sufficient for the general population such as the US? Textbooks,\u00a0 guidelines, and protocols concerning pre-natal care always mention the importance of supplements of folic acid, and eventually, iron, but there’s usually much less talk about iodine supplementation.<\/p>\nSo, are we actually talking about a \u201ccurrent common practice?\u201d Is this practice perfectly avoidable? If so, why?<\/p>\n
Juan<\/strong>: Supplements of folic acid might\u00a0make sense only in the first\u00a0stages of pregnancy, i.e. the first 21\u00a0days before the neural tube is closed. Even then, we do not know the exact mechanism of action (not excluding, teratogenia and\u00a0the increase of abortion of \u201cerrors\u201d). Supplements of iron are generally not indicated, and its use is not recommended. With supplements of iodine, just have a look on the internet and see how many \u201cadvocates\u201d are around the world, from New Zealand and Australia, to Poland and Spain. In Spain it\u00a0is common practice to recommend supplements of iodine to pregnant\u00a0women. It is a practice with no scientific basis in countries and regions that ensure sufficient iodine for the general population.<\/p>\nTiago<\/strong>: The author’s 2010 results show potential harm for the mother, [1]\u00a0while the 2011 results show\u00a0potential harm for the fetus. [2]\u00a0Is it still too early or premature to talk about disease mongering?<\/p>\nJuan<\/strong>: The first results of the Spanish group (Rebagliato et al) were published in 2009.\u00a0They confirm in 2010 the previous findings about worse outcomes in\u00a0pregnancy, [1]\u00a0 but their interest\u00a0in iodine supplements started in the early 2000 with the INMA project (Infancia and Medio Ambiente, Environment and Childhood) (3,4). In 2011 they confirm their previous findings about the potential harm of iodine supplements in\u00a0 pregnancy.[2] We can speak, no doubt of disease\u00a0mongering, in this case helping to transform \u201cnormal\u201d pregnancy into a \u201cdisease\u201d that should be under the care of specialists.<\/p>\nTiago<\/strong>: The authors (Rebagliato et al) have said that the 2011 results corresponded to \u201cthe first known report of a potentially deleterious effect of maternal consumption of multivitamins containing iodine during pregnancy\u00a0on psychomotor achievement in infants\u201d and that \u201cthese results should be evaluated with caution.\u201d [2]\u00a0In the meantime, what should we tell our patients at the practice?<\/p>\nJuan<\/strong>: Rebagliato et al indeed started their work to support the supplements of iodine. So their findings were a surprise,\u00a0even for them. They are scientific and ask for caution. They recommend that\u00a0women in general, and during pregnancy, eat\u00a0healthy\u00a0diet which help them to enjoy life and obtain the nutrients they need. Healthy means fruit, vegetables, fish, meat,\u00a0 olive oil and so on (the Mediterranean diet).<\/p>\nTiago<\/strong>: This is a cohort study, so we’re likely to see more results in 2012. In your opinion, what else could we still expect?<\/p>\nJuan<\/strong>: I guess we can expect confirmation of the previous findings.<\/p>\nTiago Villanueva<\/strong> is a newly qualified general practitioner and former BMJ Clegg Scholar and editor, studentBMJ<\/em><\/p>\nReferences:<\/strong><\/p>\n1. Iodine intake and maternal thyroid function during pregnancy.
\nRebagliato M, Murcia M, Espada M, Alvarez-Pedrerol M, Bol\u00famar F, Vioque J, Basterrechea M, Blarduni E, Ram\u00f3n R, Guxens M, Foradada CM, Ballester F, Ibarluzea J, Sunyer J. Epidemiology<\/em>. 2010 Jan;21(1):62-9.<\/p>\n2. Effect of Iodine Supplementation During Pregnancy on Infant Neurodevelopment at 1 Year of Age.
\nMurcia M, Rebagliato M, I\u00f1iguez C, Lopez-Espinosa MJ, Estarlich M, Plaza B, Barona-Vilar C, Espada M, Vioque J, Ballester F. Am J Epidemiol<\/em>. 2011 Mar 8. [Epub ahead of print]<\/p>\n3. Ribas-Fito N, Ramon R, Ballester F, et al. Child health and the environment: the
\nINMA Spanish Study. Paediatr Perinat Epidemiol<\/em> 2006;20:403e10.<\/p>\n4. Murcia M, Rebagliato M, Espada M, et al. Iodine intake in a population of pregnant women: INMA mother and child cohort study, Spain. J Epidemiol Community Health<\/em>. 2010;64:1094-99.<\/p>\n","protected":false},"excerpt":{"rendered":"One of the major advantages of being an active member of listservers, particularly international ones, is\u00a0that I am\u00a0in touch with leading colleagues around the world,\u00a0and also I can learn about issues and think in ways that\u00a0I would not otherwise have become aware of. I’ve had the chance to cross paths a few times with Dr […]<\/p>\n
Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[2246],"tags":[2293,997,274],"class_list":["post-8839","post","type-post","status-publish","format-standard","hentry","category-tiago-villanueva","tag-iodine-supplements","tag-pregnancy","tag-primary-care"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/8839","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=8839"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/8839\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=8839"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=8839"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=8839"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
![\"Tiago_Villanueva\"](\"http:\/\/www.bmj.com\/site\/blog\/icons\/tiago_villanueva.jpg\")
One of the major advantages of being an active member of listservers, particularly international ones, is\u00a0that I am\u00a0in touch with leading colleagues around the world,\u00a0and also I can learn about issues and think in ways that\u00a0I would not otherwise have become aware of. I’ve had the chance to cross paths a few times with Dr Juan G\u00e9rvas, a towering figure of international general practice based in Spain, and a professor of primary care, public health, and management at several Spanish universities.<\/p>\n