Abstract
BackgroundInsufficient iodine intake in pregnancy is associated with many adverse pregnancy outcomes. About 90% of African countries are at risk of iodine deficiency due to poor soils and dietary goitrogens. Pregnancy predisposes to insufficient iodine nutrition secondary to increased physiological demand and increased renal loss. Iodine deficiency is re-emerging in countries thought to be replete with pregnant women being the most affected. This review seeks to identify the degree of iodine nutrition in pregnancy on the entire African continent before and after the implementation of national iodization programmes.MethodsA systematic search of published literature will be conducted for observational studies that directly determined the prevalence of insufficient iodine intake among pregnant women in Africa. Electronic databases and grey literature will be searched for baseline data before the implementation of population-based iodine supplementation and for follow-up data up to December 2018. Screening of identified articles and data extraction will be conducted independently by two investigators. Risk of bias and methodological quality of the included studies will be assessed using a risk of bias tool. Appropriate meta-analytic techniques will be used to pool prevalence estimates from studies with similar features, overall and by major characteristics including the region of the study, time period (before and after implementation of iodization programmes), sample size and age. Heterogeneity of the estimates across studies will be quantified and publication bias investigated. This protocol is reported according to Preferred Reporting Items for Systematic reviews and Meta-Analysis protocols (PRISMA-P) 2015 guidelines.DiscussionThis review will help ascertain the impact of national iodization programmes on the iodine nutrition status in pregnancy in Africa and advise policy on the necessity for monitoring and mitigating iodine deficiency in pregnancy in Africa. This review is part of a thesis that will be submitted to the Faculty of Health Sciences, University of Cape Town, for the award of a PhD in Medicine whose protocol has been granted ethics approval (UCT HREC 135/2018). In addition, the results will be published in a peer-reviewed journal.Systematic review registrationPROSPERO CRD42018099434
Highlights
Insufficient iodine intake in pregnancy is associated with many adverse pregnancy outcomes
Chronic iodine deficiency among women in reproductive age will be exacerbated by the increased renal clearance and loss in urine which will predispose the foetus to defective neuronal migration, myelination and glial differentiation which are key features of brain central nervous system development [4, 5]
The aim of this systematic review and meta-analysis is to ascertain the trend in the prevalence of insufficient iodine nutrition status among pregnant women in Africa following the implementation of national iodization programmes and to establish if this has had a sustainable positive impact on the iodine nutrition status of pregnant women in Africa
Summary
Insufficient iodine intake in pregnancy is associated with many adverse pregnancy outcomes. Chronic iodine deficiency among women in reproductive age will be exacerbated by the increased renal clearance and loss in urine which will predispose the foetus to defective neuronal migration, myelination and glial differentiation which are key features of brain central nervous system development [4, 5]. This is the underlying cause of cretinism in severe cases and neurocognitive and psychomotor deficits. Data from a survey of 21 European countries in 2014 revealed that despite the iodine status of some countries being adequate across all age groups, 13/21 countries had inadequate iodine intake during pregnancy due to poor access to iodized foodstuffs and inadequate of monitoring of iodine nutrition status [9]
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