povidone-iodine and Congenital-Hypothyroidism

The aim of the present study was to investigate the effect of povidone-iodine (PVP-I) application at delivery on maternal urinary iodine concentration (UIC) and neonatal thyrotropin concentration.. In this cross-sectional study, urine samples were collected from each pregnant woman after admission to the hospital and before routine application of the PVP-I for delivery preparation and after delivery at time of screening for congenital hypothyroidism. A heel-prick blood sample was taken from all newborns.. A total of 394 pregnant women at time of delivery participated in this study. Median (interquartile range [IQR]) maternal UIC values were 120 (105-157) and 253 (126-470) μg/L before and after delivery, respectively (p<0.001). No significant correlations were observed between maternal UIC before and after delivery and neonatal thyrotropin levels.. Application of PVP-I significantly increased UIC in postpartum mothers; however, thyrotropin concentration in neonates, whose mothers had adequate UIC, was within the normal range.

Topics: Adult; Anti-Infective Agents, Local; Congenital Hypothyroidism; Cross-Sectional Studies; Delivery, Obstetric; Female; Humans; Infant, Newborn; Iodine; Neonatal Screening; Nutritional Status; Povidone-Iodine; Pregnancy; Thyrotropin

The proportion of newborns recalled during neonatal screening programs for congenital hypothyroidism (CH) varies substantially by country and may be higher in settings where povodine iodine (PVP-I) is used during delivery. We assessed this hypothesis by substituting PVP-I for chlorhexidine (CHL) and evaluated the reduction in the recall rate of the Irainian newborn screening program.. This study investigated 2282 neonates of mothers admitted to a local hospital for delivery between December 2012 and October 2013. We measured thyorid stimulating hormone (TSH) levels in heel-prick blood specimens of infants, aged between 3 and 5 days, born to mothers who received PVP-I (phase I) and those who received CHL after withdrawal of PVP-I from obstetric procedures (phase II). Then we compared the median TSH levels and the recall rate based on a TSH level ≥5 mU/L.. Of 2282 cases, 1094 infants were born to mothers exposed to PVP-I during phase I (PVP-I group) and 1188 ones were born to mothers exposed to chlorhexidine in phase II (CHL group); 6.56% of the PVP-I group and 1.91% of the CHL group were recalled later during screening (p<0.001). The median TSH level was significantly higher in the PVP-I group compared to the CHL group (1.35 vs. 1.00, p<0.001).. Replacement of iodine-containing antiseptics by iodine-free ones, during delivery resulted in a significant reduction in the recall rate of the Iranian screening program for CH.

Topics: Adult; Anti-Infective Agents, Local; Chlorhexidine; Congenital Hypothyroidism; Delivery, Obstetric; Female; Humans; Infant, Newborn; Male; Neonatal Screening; Povidone-Iodine; Thyrotropin; Young Adult

To evaluate the effects of delivery type and of povidone-iodine disinfection at delivery on cord dried-blood-specimen (DBS) thyrotropin (TSH) concentrations.. From 1998 to 2005, cord DBSs were collected from live deliveries in Tehran and Damavand, and TSH was assayed by a two-site immunoradiometric assay. Hyperthyrotropinemia was defined as TSH > or =20 mU/L. Vaginal deliveries prepared with povidone-iodine (VGL-PVP-I) or chlorhexidine (VGL-CHL), and cesarean sections prepared with povidone-iodine (CS-PVP-I) disinfection were assessed. Full-term, normal-size newborns were included. Iodine concentrations were measured in urine samples collected from 132 pregnant women immediately prior to delivery.. Median (range) TSH was 5.3 (1.0 to >100) mU/L in VGL-PVP-I (n = 23,432), 5.3 (1.0 to >100) mU/L in VGL-CHL (n = 5658), and 5.0 (1.0 to >100) mU/L in CS-PVP-I (n = 19,016) (p < 0.0001). Median TSH was higher in VGL-PVP-I versus CS-PVP-I (p < 0.0001) and in VGL-CHL versus CS-PVP-I (p < 0.0001). Hyperthyrotropinemia was present in 1.4%, 1.2%, and 0.8% of VGL-PVP-I, VGL-CHL, and CS-PVP-I deliveries, respectively, and was significantly higher in VGL-PVP-I versus CS-PVP-I (p < 0.0001) and in VGL-CHL versus CS-PVP-I (p = 0.005). Median (range) urinary iodine concentration of pregnant women was 176 (20-4600) microg/L.. Cord DBS TSH and rates of hyperthyrotropinemia are lower in cesarean section than in vaginal deliveries. Povidone-iodine disinfection at delivery has an effect neither on DBS TSH concentrations nor on the rate of hyperthyrotropinemia in the iodine-replete area of Iran.

Topics: Blood Specimen Collection; Chlorhexidine; Congenital Hypothyroidism; Delivery, Obstetric; Disinfection; Female; Fetal Blood; Humans; Infant, Newborn; Iodine; Povidone-Iodine; Pregnancy; Thyrotropin

Topics: Administration, Intravaginal; Anti-Infective Agents, Local; Cesarean Section; Congenital Hypothyroidism; Endometritis; Female; Humans; Infant, Newborn; Povidone-Iodine; Pregnancy; Premedication

Skin disinfection with povidine-iodine (PVP-I) is widely used in obstetrics. We evaluated the influence of PVP-I in mothers at delivery on the serum thyroid stimulating hormone concentrations of their infants at the time of screening for congenital hypothyroidism. The study covered 4745 infants who were either breast fed (3659, 77%) or bottle fed (1086, 23%); 3086 (65%) of them were born to mothers with no iodine overload (controls) and 1659 (35%) to mothers with iodine overload. Compared with the control group, the breast and bottle fed infants born to mothers with iodide overload had a shift of neonatal thyroid stimulating hormone concentration towards high values. The shift was maximal in the breast fed infants with a 25 to 30 fold increase in the recall rate at screening for congenital hypothyroidism (serum thyroid stimulating hormone greater than 50 mU/l) while in the bottle fed infants, the recall rate was barely modified. In conclusion, the use of PVP-I in mothers at delivery induces a transient impairment of thyroid function in their infants, especially if breast fed. This situation is detrimental to screening for congenital hypothyroidism. Consequently PVP-I is not recommended in obstetrics.

Topics: Breast Feeding; Congenital Hypothyroidism; Delivery, Obstetric; Disinfection; False Positive Reactions; Female; Humans; Hypothyroidism; Infant, Newborn; Mass Screening; Povidone; Povidone-Iodine; Skin Absorption; Thyrotropin

Topics: Congenital Hypothyroidism; Disinfection; Humans; Infant, Newborn; Mass Screening; Povidone; Povidone-Iodine; Sterilization

While screening 30 000 children for congenital hypothyroidism by radioimmunological determination of thyroid stimulating hormone (TSH) in blood spotted on filter paper on the 5th day of life, 12 neonates were found with this condition. In addition 99 infants were found who showed temporarily elevated TSH levels (20-80 microU/ml). Seven of the transitory cases could be traced to a vaginal application of povidone-iodine in the mother. Alimentary iodine deficiency, which is known to exist in parts of Lower Saxony, may be another explanation for some of the others.

Topics: Congenital Hypothyroidism; Female; Humans; Hypothyroidism; Infant, Newborn; Infant, Newborn, Diseases; Iodine; Maternal-Fetal Exchange; Povidone-Iodine; Pregnancy; Surveys and Questionnaires; Thyrotropin