however, are euthyroid. That said, such women carry a two-to ivefold increased risk for early pregnancy loss (Stagnaro-Green, 2004; hangaratinam, 2011). he presence of thyroid antibodies has also been associated with preterm birth (Stagnaro-Green, 2009). In a randomized treatment trial of 115 euthyroid women with TPO antibodies, Negro and coworkers (2006) reported that treatment with levothyroxine astoundingly reduced the preterm birth rate from 22 to 7 percent. Contrarily, AbbassiGhanavati and associates (2010) evaluated pregnancy outcomes in more than 1000 untreated women with TPO antibodies and did not ind an increased risk for preterm birth compared with the risk in 16,000 euthyroid women without antibodies. hese investigators, however, did find a threefold greater risk of placental abruption in these women.
As with nonpregnant subjects with TPO antibodies, these women are also at increased risk for progression of thyroid disease and postpartum thyroiditis (Jameson, 2015; StagnaroGreen, 2012a). Currently, universal screening for the thyroid autoantibodies is not recommended by any professional organization (De Groot, 2012; Stagnaro-Green, 20lla, 2012a).
Decreasing iodide fortification of table salt and bread products in the United States during the past 25 years has led to occasional iodide deficiency (Caldwell, 2005; Hollowell, 1998). Importantly, the most recent National Health and Nutrition Examination Survey indicated that, overall, the United States population remains iodine suicient (Caldwell, 201l). Even so, experts agree that iodine nutrition in vulnerable populations, such as pregnant women, requires continued monitoring. In 2011, the Oice of Dietary Supplements of the National Institutes of Health sponsored a workshop to prioritize iodine research. Participants emphasized the decline in median urinary iodine levels to 125 Lg/L in pregnant women and the serious potential efects on developing fetuses (Swanson, 2012).
Dietary iodine requirements are higher during pregnancy due to augmented thyroid hormone production, increased renal losses, and fetal iodine requirements. Adequate iodine is requisite for fetal neurological development beginning soon after conception, and abnormalities are dependent on the degree of deficiency. he World Health Organization (WHO) has estimated that 38 million children are born every year at risk of lifelong brain damage associated with iodine deiciency (Alipui, 2008).