Immune-endocrine and Oxidative Stress Alterations Associated with Urinary Iodine Status in Hypertensive Disorders of Pregnancy
Abstract
Hypertensive disorders of pregnancy (HDP), particularly preeclampsia, involve immune-endocrine dysregulation, oxidative stress, and endothelial dysfunction. This systematic review and meta-analysis evaluated associations between urinary iodine concentration (UIC), HDP, and related biomarkers.
PubMed was searched from inception to February 2026, with additional manual screening.
Thirteen studies were included, and six underwent meta-analysis. Women with HDP/preeclampsia had lower UIC than controls (MD −143.647 μg/L; 95% CI −256.362 to −30.933; I²=97.8%). TSH and FT3 did not differ significantly, whereas FT4 was reduced in HDP (MD −1.007 pmol/L; 95% CI −1.660 to −0.354; I²=0%).
Qualitative evidence indicated alterations in TPOAb, TgAb, CRP, nitric oxide, TBARS, SOD, CAT, OxLDL/Alb, GGT, and lymphocyte percentage. Abnormal iodine status may contribute to HDP through thyroid dysfunction, immune imbalance, oxidative stress, and endothelial inflammation.
Reduced FT4 was the most consistent biochemical abnormality. Further standardized, large-scale studies are needed.
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2. Greenwood DC, Webster J, Keeble C, Taylor E, Hardie LJ. Maternal Iodine Status and Birth Outcomes: A Systematic Literature Review and Meta-Analysis. Nutrients. 2023;15(2):387.
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8. Silva de Morais N, Ayres Saraiva D, Corcino C, Berbara T, Schtscherbyna A, Moreira K, Vaisman M, et al. Consequences of Iodine Deficiency and Excess in Pregnancy and Neonatal Outcomes: A Prospective Cohort Study in Rio de Janeiro, Brazil. Thyroid. 2020;30(12):1792-1801.
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10. Cuellar-Rufino S, Navarro-Meza M, García-Solís P, Xochihua-Rosas I, Arroyo-Helguera O. Iodine levels are associated with oxidative stress and antioxidant status in pregnant women with hypertensive disease. Nutr Hosp. 2017;34(3):661-6.
11. Reische EC, Männistö T, Purdue-Smithe A, Kannan K, Kim UJ, Suvanto E, et al. The Joint Role of Iodine Status and Thyroid Function on Risk for Preeclampsia in Finnish Women: a Population-Based Nested Case-Control Study. Biol Trace Elem Res. 2021;199(6):2131-7.
12. Charoenratana C, Leelapat P, Traisrisilp K, Tongsong T. Maternal iodine insufficiency and adverse pregnancy outcomes. Matern Child Nutr. 2016;12(4):680-7.
13. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
14. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Europ J Epidemiol. 2010;25(9):603-05.
15. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135.
16. Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 2018;27(6):1785-1805.
17. Torlinska B, Bath SC, Janjua A, Boelaert K, Chan SY. Iodine Status during Pregnancy in a Region of Mild-to-Moderate Iodine Deficiency is not Associated with Adverse Obstetric Outcomes; Results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Nutrients. 2018;10(3):291.
18. Businge CB, Longo-Mbenza B, Kengne AP. Mildly elevated thyroid-stimulating hormone is associated with endothelial dysfunction and severe preeclampsia among pregnant women with insufficient iodine intake in Eastern Cape province, South Africa. Ann Med. 2021;53(1):1083-9.
19. Businge CB, Longo-Mbenza B, Kengne AP. Iodine deficiency in pregnancy along a concentration gradient is associated with increased severity of preeclampsia in rural Eastern Cape, South Africa. BMC Pregnancy Childbirth. 2022;22(1):98.
20. Businge CB, Phohlo K, Sewani-Rusike C. Thyroid peroxidase antibody titers, thyroid function, and iodine nutrition status of pregnant normotensive and preeclamptic women in Eastern Cape South Africa. AJOG Glob Rep. 2023;3(4):100267.
21. Queiroz ADM, Torres MRDS, Ratis LCF, Morais MCV, Figueiroa JN, Souza ASR. Urinary iodine concentration and thyroid function in pregnant women with hypertensive disorders. Front Endocrinol (Lausanne). 2025;16(8):1578597.
22. Businge CB, Longo-Mbenza B. The Pathophysiological Mechanisms and Pattern of Dyslipidemia Associated with Iodine Deficiency and Subclinical Hypothyroidism in Pregnant Normotensive and Preeclamptic Central African Women. Pathophysiology. 2025;32(2):18.
2. Greenwood DC, Webster J, Keeble C, Taylor E, Hardie LJ. Maternal Iodine Status and Birth Outcomes: A Systematic Literature Review and Meta-Analysis. Nutrients. 2023;15(2):387.
3. Toloza FJK, Derakhshan A, Männistö T, Bliddal S, Popova PV, Carty DM, et al. Association between maternal thyroid function and risk of gestational hypertension and pre-eclampsia: a systematic review and individual-participant data meta-analysis. Lancet Diabetes Endocrinol. 2022 Apr;10(4):243-52.
4. Zimmermann MB. Iodine deficiency in pregnancy and the effects of maternal iodine supplementation on the offspring: a review. Am J Clin Nutr. 2009 Feb;89(2):668S-72S.
5. Businge CB, Usenbo A, Longo-Mbenza B, Kengne AP. Insufficient iodine nutrition status and the risk of pre-eclampsia: a systemic review and meta-analysis. BMJ Open. 2021;11(2):e043505.
6. Yang J, Liu Y, Liu H, Zheng H, Li X, Zhu L, et al. Associations of maternal iodine status and thyroid function with adverse pregnancy outcomes in Henan Province of China. J Trace Elem Med Biol. 2018;47(3):104-10.
7. Xiao Y, Sun H, Li C, Li Y, Peng S, Fan C, et al. Effect of Iodine Nutrition on Pregnancy Outcomes in an Iodine-Sufficient Area in China. Biol Trace Elem Res. 2018 Apr;182(2):231-7.
8. Silva de Morais N, Ayres Saraiva D, Corcino C, Berbara T, Schtscherbyna A, Moreira K, Vaisman M, et al. Consequences of Iodine Deficiency and Excess in Pregnancy and Neonatal Outcomes: A Prospective Cohort Study in Rio de Janeiro, Brazil. Thyroid. 2020;30(12):1792-1801.
9. Gulaboglu M, Borekci B, Delibas I. Urine iodine levels in preeclamptic and normal pregnant women. Biol Trace Elem Res. 2010;136(3):249-57.
10. Cuellar-Rufino S, Navarro-Meza M, García-Solís P, Xochihua-Rosas I, Arroyo-Helguera O. Iodine levels are associated with oxidative stress and antioxidant status in pregnant women with hypertensive disease. Nutr Hosp. 2017;34(3):661-6.
11. Reische EC, Männistö T, Purdue-Smithe A, Kannan K, Kim UJ, Suvanto E, et al. The Joint Role of Iodine Status and Thyroid Function on Risk for Preeclampsia in Finnish Women: a Population-Based Nested Case-Control Study. Biol Trace Elem Res. 2021;199(6):2131-7.
12. Charoenratana C, Leelapat P, Traisrisilp K, Tongsong T. Maternal iodine insufficiency and adverse pregnancy outcomes. Matern Child Nutr. 2016;12(4):680-7.
13. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
14. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Europ J Epidemiol. 2010;25(9):603-05.
15. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135.
16. Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 2018;27(6):1785-1805.
17. Torlinska B, Bath SC, Janjua A, Boelaert K, Chan SY. Iodine Status during Pregnancy in a Region of Mild-to-Moderate Iodine Deficiency is not Associated with Adverse Obstetric Outcomes; Results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Nutrients. 2018;10(3):291.
18. Businge CB, Longo-Mbenza B, Kengne AP. Mildly elevated thyroid-stimulating hormone is associated with endothelial dysfunction and severe preeclampsia among pregnant women with insufficient iodine intake in Eastern Cape province, South Africa. Ann Med. 2021;53(1):1083-9.
19. Businge CB, Longo-Mbenza B, Kengne AP. Iodine deficiency in pregnancy along a concentration gradient is associated with increased severity of preeclampsia in rural Eastern Cape, South Africa. BMC Pregnancy Childbirth. 2022;22(1):98.
20. Businge CB, Phohlo K, Sewani-Rusike C. Thyroid peroxidase antibody titers, thyroid function, and iodine nutrition status of pregnant normotensive and preeclamptic women in Eastern Cape South Africa. AJOG Glob Rep. 2023;3(4):100267.
21. Queiroz ADM, Torres MRDS, Ratis LCF, Morais MCV, Figueiroa JN, Souza ASR. Urinary iodine concentration and thyroid function in pregnant women with hypertensive disorders. Front Endocrinol (Lausanne). 2025;16(8):1578597.
22. Businge CB, Longo-Mbenza B. The Pathophysiological Mechanisms and Pattern of Dyslipidemia Associated with Iodine Deficiency and Subclinical Hypothyroidism in Pregnant Normotensive and Preeclamptic Central African Women. Pathophysiology. 2025;32(2):18.
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| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| Hypertensive disorders of pregnancy Immune-endocrine dysregulation Oxidative stress Preeclampsia Pregnancy immunology Thyroid dysfunction Urinary iodine | ||
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How to Cite
1.
Liu N, long Y. Immune-endocrine and Oxidative Stress Alterations Associated with Urinary Iodine Status in Hypertensive Disorders of Pregnancy. Iran J Allergy Asthma Immunol. 2026;:1-21.
