Associação das concentrações de iodo urinário na gestação com os desfechos maternos e neonatais: revisão sistemática e meta-análise
Carregando...
Data
2022-09-29
Autores
Bolfi, Fernanda
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A concentração urinária de iodo é utilizada como indicador de deficiência de iodo em gestantes. Entretanto, não há evidência suficiente se esses resultados laboratoriais possuem relação com importantes desfechos maternos, neonatais e infantis. Objetivo: Este estudo buscou avaliar se baixos níveis de concentração urinária de iodo em gestantes, quando comparados a valores normais, estão associados a prejuízo nos desfechos maternos, neonatais e infantis. Metodologia: Foi realizada uma revisão sistemática de acordo com a metodologia do Joanna Briggs Institute (JBI), incluindo estudos observacionais em que gestantes com UIC < 150 μg/L foram comparadas com gestantes com UIC entre 150 μg/L e 249 μg/L. MEDLINE, EMBASE, LILACS, CENTRAL foram nossas bases de dados. Os desfechos maternos foram: aborto espontâneo, hipotireoidismo, hipotireoidismo subclínico, volume tireoidiano materno, valor médio do hormônio tireoestimulante (TSH); os desfechos neonatais foram: parto prematuro, natimorto, baixo peso ao nascer, pequeno para a idade gestacional, TSH neonatal elevado, comprimento ao nascer. O processo de seleção, avaliação de risco de viés e extração de dados foram realizados em pares e de forma independente. Para desfechos dicotômicos, o risco relativo (RR) com intervalo de confiança de 95% (IC) foi calculado como uma estimativa do efeito do iodo < 150 μg/L. O software STATA foi utilizado para realizar as meta-análises, utilizando o modelo randômico. A qualidade da evidência foi gerada de acordo com o sistema Grading of Recomendations Assessment, Development, and Evaluation (GRADE). Resultados: A estratégia de busca resultou em 6.472 artigos, dos quais 169 foram selecionados para leitura na íntegra e 57 foram incluídos nesta revisão. Não encontramos diferença entre UIC < 150 μg/L e UIC > 150 μg/L para os seguintes desfechos: aborto espontâneo (RR: 0,87, IC 95% 0,64 a 1,18, seis estudos, 4841 participantes, I2=0, baixa qualidade da evidência ); hipotireoidismo materno (RR: 1,19, IC 95% 0,84 a 1,69, sete estudos, 11.371 participantes, I2=0); hipotireoidismo subclínico materno (RR: 1,05, IC 95% 0,87 a 1,26, 13 estudos, 14.705 participantes, I2=7,7%, baixa qualidade da evidência); volume tireoidiano materno (RR: -0,50, IC 95% -1,02 a 0,02, quatro estudos, 620 participantes, I2=0); medição do TSH materno (RR: -0,01, IC 95% -0,06 a 0,05, 21 estudos, 15.438 participantes, I2=51,2%, baixa qualidade da evidência); parto prematuro (RR: 1,18, IC 95% 0,94 a 1,47, 11 estudos, 15.098 participantes, Resumo 2 I2=44,8%, qualidade de evidência muito baixa); natimorto (RR: 0,63, IC 95% 0,24 a 1,69, quatro estudos, 2.992 participantes, I2=13%, baixa qualidade de evidência); baixo peso ao nascer (RR: 1,08, IC 95% 0,86 a 1,36, nove estudos, 11.038 participantes, I2=37,2%, certeza de evidência muito baixa); pequeno para a idade gestacional (RR: 1,11, IC 95% 0,90 a 1,37, cinco estudos, 5230 participantes, I2=0); comprimento ao nascimento (RR: 0,13, IC 95% -0,12 a 0,37, cinco estudos, 4831 participantes, I2=64,4%) e TSH neonatal elevado (RR: 1,29, IC 95% 0,77 a 2,18, três estudos, 2233 participantes, I2= 52,2%). Os seguintes desfechos não puderam ser plotados em uma meta-análise: bócio neonatal, volume neonatal da tireoide, morte infantil, malformações congênitas, desenvolvimento neuromotor e escores de coeficiente de inteligência. Conclusão: em gestantes, não encontramos associação entre UIC < 150 μg/L e desfechos maternos e neonatais, porém a qualidade da evidência da maioria dos resultados foi baixa ou muito baixa.
Introduction: Urinary iodine concentration (UIC) is used as an indicator of iodine deficiency in pregnant women. However, there is no evidence synthesis showing whether these laboratory results are related to important maternal, neonatal and infant outcomes. Objective: to assess whether low levels of urinary iodine concentration in pregnant women are outcomes. Methods: associated with impaired maternal and neonatal A systematic review was performed according to the Joanna Briggs Institute (JBI) methodology, including observational studies in which pregnant women with UIC < 150 μg/L were compared to pre gnant women with UIC between 150 μg/L and 249 μg/L. MEDLINE, EMBASE, LILACS, CENTRAL were our source databases. The maternal outcomes were spontaneous miscarriage, hypothyroidism, subclinical hypothyroidism, maternal thyroid volume, mean thyroid stimulatin g hormone (TSH) measurement; the neonatal outcomes were preterm birth, stillbirth, low birthweight, small for gestational age, neonatal elevated TSH, birth length. The selection process, risk of bias assessment and data extraction were performed in pairs a nd independently. For dichotomous outcomes, the relative risk (RR) with the 95% confidence interval (CI) was calculated as an estimate of the effect of iodine < 150 μg/L. The STATA software was used to perform the meta model. Theanalyses, using the random quality of evidence was generated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: The search strategy resulted in 6472 articles, of which 169 were selected for full reading and 57 were included in this review. We found no difference between UIC < 150 μg/L and UIC >150 μg/L for the following outcomes: miscarriage (RR: 0.87, IC 95% 0.64 to 1.18, six studies, 4841 participants, I2=0, low certainty of evidence); maternal hypothyroidism (RR: 1.19, IC 95% 0.84 to 1.69, seven studies, 11371 participants, I2=0); maternal subclinical hypothyroidism (RR: 1.05, IC 95% 0.87 to 1.26, 13 studies, 14705 participants, I2=7.7%, low certainty of evidence); maternal thyroid volume (RR: 0.50, IC 95% maternal TSH measurement (RR: 1.02 to 0.02, four studies, 620 participants, I2=0); 0.01, IC 95% 0.06 to 0.05, 21 studies, 15438 5 abstractparticipants, I2=51.2%, low certainty of evidence); preterm birth (RR: 1.18, IC 95% 0.94 a 1.47, 11 studies, 15098 participants, I2=44.8%, v ery low certainty of evidence); stillbirth (RR: 0.63, IC 95% 0.24 to 1.69, four studies, 2992 participants, I2=13%, low certainty of evidence); low birth weight (RR: 1.08, IC 95% 0.86 to 1.36, nine studies, 11038 participants, I2=37.2%, very low certainty of evidence); small for gestational age (RR: 1.11, IC 95% 0.90 to 1.37, five studies, 5230 participants, I2=0); birth length (RR: 0.13, IC 95% 0.12 to 0.37, five studies, 4831 participants, I2=64.4%) and elevated neonatal TSH (RR: 1.29, IC 95% 0.77 to 2.1 I2=52.2%). 8, three studies, 2233 participants, The following outcomes could not be plotted in a metaanalysis: neonatal goiter, neonatal thyroid volume, infant death, congenital malformations, neuromotor development and IQ scores. Conclusion: in pregnant women, we did not find an association between UIC < 150 μg/L and maternal and neonatal outcomes, however the certainty of evidence of most results were low or very low. 6 abstract
Introduction: Urinary iodine concentration (UIC) is used as an indicator of iodine deficiency in pregnant women. However, there is no evidence synthesis showing whether these laboratory results are related to important maternal, neonatal and infant outcomes. Objective: to assess whether low levels of urinary iodine concentration in pregnant women are outcomes. Methods: associated with impaired maternal and neonatal A systematic review was performed according to the Joanna Briggs Institute (JBI) methodology, including observational studies in which pregnant women with UIC < 150 μg/L were compared to pre gnant women with UIC between 150 μg/L and 249 μg/L. MEDLINE, EMBASE, LILACS, CENTRAL were our source databases. The maternal outcomes were spontaneous miscarriage, hypothyroidism, subclinical hypothyroidism, maternal thyroid volume, mean thyroid stimulatin g hormone (TSH) measurement; the neonatal outcomes were preterm birth, stillbirth, low birthweight, small for gestational age, neonatal elevated TSH, birth length. The selection process, risk of bias assessment and data extraction were performed in pairs a nd independently. For dichotomous outcomes, the relative risk (RR) with the 95% confidence interval (CI) was calculated as an estimate of the effect of iodine < 150 μg/L. The STATA software was used to perform the meta model. Theanalyses, using the random quality of evidence was generated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: The search strategy resulted in 6472 articles, of which 169 were selected for full reading and 57 were included in this review. We found no difference between UIC < 150 μg/L and UIC >150 μg/L for the following outcomes: miscarriage (RR: 0.87, IC 95% 0.64 to 1.18, six studies, 4841 participants, I2=0, low certainty of evidence); maternal hypothyroidism (RR: 1.19, IC 95% 0.84 to 1.69, seven studies, 11371 participants, I2=0); maternal subclinical hypothyroidism (RR: 1.05, IC 95% 0.87 to 1.26, 13 studies, 14705 participants, I2=7.7%, low certainty of evidence); maternal thyroid volume (RR: 0.50, IC 95% maternal TSH measurement (RR: 1.02 to 0.02, four studies, 620 participants, I2=0); 0.01, IC 95% 0.06 to 0.05, 21 studies, 15438 5 abstractparticipants, I2=51.2%, low certainty of evidence); preterm birth (RR: 1.18, IC 95% 0.94 a 1.47, 11 studies, 15098 participants, I2=44.8%, v ery low certainty of evidence); stillbirth (RR: 0.63, IC 95% 0.24 to 1.69, four studies, 2992 participants, I2=13%, low certainty of evidence); low birth weight (RR: 1.08, IC 95% 0.86 to 1.36, nine studies, 11038 participants, I2=37.2%, very low certainty of evidence); small for gestational age (RR: 1.11, IC 95% 0.90 to 1.37, five studies, 5230 participants, I2=0); birth length (RR: 0.13, IC 95% 0.12 to 0.37, five studies, 4831 participants, I2=64.4%) and elevated neonatal TSH (RR: 1.29, IC 95% 0.77 to 2.1 I2=52.2%). 8, three studies, 2233 participants, The following outcomes could not be plotted in a metaanalysis: neonatal goiter, neonatal thyroid volume, infant death, congenital malformations, neuromotor development and IQ scores. Conclusion: in pregnant women, we did not find an association between UIC < 150 μg/L and maternal and neonatal outcomes, however the certainty of evidence of most results were low or very low. 6 abstract
Descrição
Palavras-chave
Iodo, Gravidez, Tireoide, Revisão sistematica