2018-2020年青岛市孕妇碘营养状况分析

Iodine nutrition status of pregnant women in Qingdao City from 2018 to 2020

目的了解青岛市孕妇碘营养状况及碘缺乏病防治效果,为居民科学补碘以及采取针对性防治措施和调整干预策略提供依据。方法按照《全国碘缺乏病监测方案(2016版)》和《山东省碘缺乏病监测方案》要求,2018-2020年,采用整群抽样法,在青岛市10个区(市)抽取孕妇,调查其基本信息及甲状腺疾病史,同时采集家中食用盐盐样及随机尿样,检测碘含量。结果2018-2020年,共监测孕妇3000人,年龄中位数为31岁,孕周中位数为18周。不同年份孕妇的年龄、孕周、是否高龄产妇、孕期分布比较,差异均有统计学意义(H/χ^(2)=29.35、81.03、65.62、77.34,均P<0.001)。孕妇家中食用盐(n=3000)和碘盐(n=2700)的盐碘中位数分别为23.02、23.70 mg/kg。碘盐合格率、碘盐覆盖率、合格碘盐食用率分别为89.59%(2419/2700)、90.00%(2700/3000)、80.63%(2419/3000)。不同年份间碘盐合格率、碘盐覆盖率、合格碘盐食用率比较,差异均有统计学意义(χ^(2)=48.09、36.62、61.08,均P<0.001),碘盐覆盖率和合格碘盐食用率均呈逐年下降趋势(χ^(2)趋势=35.54、29.50,均P<0.001)。共采集孕妇尿样3000份,尿碘中位数为147.85μg/L。孕晚期尿碘水平低于孕早期和孕中期(均P<0.001),非高龄产妇组尿碘水平高于高龄产妇组(Z=-6.66,P<0.001),无甲状腺疾病组尿碘水平高于有甲状腺疾病组(Z=-1.99,P=0.047),食用碘盐组尿碘水平高于食用非碘盐组(Z=-2.42,P=0.015)。结论青岛市孕妇碘营养总体处于不足水平,发生碘缺乏的风险较高,需引起重视。近年来青岛市碘盐覆盖率、合格碘盐食用率均呈下降趋势,且已达不到国家标准要求。今后应加强孕妇碘缺乏病监测和健康教育。

Objective To investigate the iodine nutritional status of pregnant women in Qingdao and the effect of prevention and treatment of iodine deficiency disorders(IDD),so as to provide a basis for residents to supplement iodine scientifically,and take targeted prevention measures and adjust intervention strategies.Methods In accordance with the requirements of the"National Iodine Deficiency Disorders Surveillance Program(2016 edition)"and"Shandong Iodine Deficiency Disorders Surveillance Program",the cluster sampling method was adopted to select pregnant women from 10 districts(cities)in Qingdao from 2018 to 2020,to investigate their basic information and thyroid disease history.Meanwhile,household edible salt samples and random urine samples were collected to detect iodine content.Results A total of 3000 pregnant women were monitored from 2018 to 2020,the median age was 31 years,and the median gestational age was 18 weeks.There were significant differences in the distribution of age,gestational age,whether senile puerpera,and pregnancy in different years(H/χ^(2)=29.35,81.03,65.62,77.34,P<0.001).The median salt iodine of edible salt(n=3000)and iodized salt(n=2700)in pregnant women's homes were 23.02 and 23.70 mg/kg,respectively.The qualified rate of iodized salt,the coverage rate of iodized salt and the consumption rate of qualified iodized salt were 89.59%(2419/2700),90.00%(2700/3000)and 80.63%(2419/3000).The comparison of qualified rate of iodized salt,coverage rate of iodized salt and consumption rate of qualified iodized salt among different years was statistically significant(χ^(2)=48.09,36.62,61.08,P<0.001),the coverage rate of iodized salt and the consumption rate of qualified iodized salt showed a downward trend year by year(χ^(2)trent=35.54,29.50,P<0.001).A total of 3000 urine samples were collected from pregnant women and the median urinary iodine of pregnant women was 147.85μg/L.The urinary iodine level in the third trimester was lower than that in the first and second trimesters(P<0.001).The urinary iodine level in the non elderly group was higher than that in the elderly group(Z=-6.66,P<0.001).The urinary iodine level in the group without thyroid disease was higher than that in the group with thyroid disease(Z=-1.99,P=0.047).The urinary iodine level in iodized salt group was higher than that in non-iodized salt group(Z=-2.42,P=0.015).Conclusions The iodine nutrition of pregnant women in Qingdao is generally at an insufficient level,and the risk of iodine deficiency is high,which needs attention.In recent years,the coverage rate of iodized salt and the consumption rate of qualified iodized salt in Qingdao have shown a downward trend,and have failed to meet the requirements of national standards.In the future,we should strengthen the monitoring and health education of IDD in pregnant women.