Are Pregnant Women Iodine Sufficient in Sri Lanka? An Assessment Using Urinary Iodine Concentration

Are Pregnant Women Iodine Sufficient in Sri Lanka? 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An Assessment Using Urinary Iodine Concentration Piyumi Weerawickrama, Darshana Hewage, Dulanji Madarasinghe, Gayathri Amarakoon, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9228138/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Adequate maternal iodine intake is essential for optimal foetal brain development, and even mild deficiency can impair cognitive outcomes. Sri Lanka introduced Universal Salt Iodisation (USI) in 1995, yet emerging evidence indicates possible gaps in iodine ststus among pregnant women. This study aimed to assess urinary iodine concentration (UIC) among first-trimester pregnant women to evaluate iodine sufficiency. Methods : Across-sectional study was conducted in three selected districts representing different geographic and demographic settings. Antenatal clinics were sampled using a stratified approach to capture sectoral variation. Spot urine samples were collected from 337 first-trimester pregnant women during routine clinic visits. Median urinary iodine concentration (mUIC) was used as the primary indicator of iodine status, following WHO criteria. Result: The overall mUIC was 135.9 µg/L, below the WHO-recommended range of 150–249 µg/L for pregnancy. District level variation was notable, with the highest mUIC in Colombo and the lowest in Kandy (168.1 vs 106.4 µg/L; p0.05). More than half of participants (52.8%) were iodine deficient (mUIC <150µg/L), while only 22.6% were within the adequate range. Conversely, 20.8% exhibited UIC levels “above requirements” and 3.9% had “excessive” levels (≥500 µg/L), with both categories higher in Colombo (26.0% and 8.0% respectively). Conclusion ; Nearly three decades after the implementation of USI, iodine insufficiency persists among pregnant women in Sri Lanka, with wide district disparities and emerging pockets of excess intake. These findings highlight the need for strengthened monitoring of iodine nutrition during pregnancy and periodic evaluation of the salt iodisation programme to prevent mild iodine deficiency during pregnancy to ensure optimal foetal development. Pregnant women Iodine Status Urine Iodine Maternal Nutrition Figures Figure 1 Figure 2 Introduction Iodine is an essential micronutrient required for thyroid hormones synthesis, which is critical for metabolic regulation and normal foetal brain development. During pregnancy, iodine requirements increase substantially to support maternal thyroid hormone production, placental transfer, and foetal neurodevelopment. Even mild moderate iodine deficiency has been linked to miscarriage, stillbirth, congenital anomalies, and measurable cognitive impairment in offspring (1–6). Although Universal Salt Iodisation (USI) has significantly reduced iodine deficiency disorders (IDDs) worldwide (7–9), pregnant women remain at increased risk. Variations in soil iodine content, environmental leaching, and dietary patterns influence iodine availability, In Sri Lanka, despite natural iodine sources in some regions, high rainfall and soil erosion- particularly in coastal and wet zones-contribute to geographic variability in iodine intake. Iodised salt is the primary dietary source, yet iodine content can fluctuate depending on salt quality, storage practices, and household consumption behaviours (10–14). International evidence highlights this vulnerability. The Avon Longitudinal Study of Parents and Children (ALSPAC) in the United Kingdom reported iodine insufficiency among pregnant women, with levels below the WHO-recommended adequate range, and mild deficiency associated with lower verbal IQ and reduced reading comprehension in their children (15, 16). Comparable findings have been reported in Italy, Kuwait, Thailand, and Armenia (17–19). Historically, iodine deficiency was a major public health concern in Sri Lanka, particularly in the wet zones where endemic goitre was prevalent. The national USI program launched in 1995 resulted in marked reduction in goitre and improved iodine status among school-aged children (20). By 2005, Sri Lanka was classified as iodine sufficient at the population level, and iodisation standards were adjusted to prevent excess intake (21,22). However, pregnancy-specific data reveal persistent gaps. The 2012-2013 national survey reported a mUIC of 113.7 μg/L among pregnant women, with more than 60% below the recommended sufficiency threshold and declining values with advancing gestation (23). A subsequent survey in 2015 showed only modest improvement, with nearly half of pregnant women remaining iodine insufficient (21,24). These findings indicate a disparity between population-level iodine sufficiency and maternal iodine adequacy. Given the heightened physiological demand in pregnancy and the consequences for foetal neurodevelopment, updated evidence is essential. This study therefore aimed to assess urinary iodine concentration as an indicator of iodine status among pregnant women attending antenatal clinics in Sri Lanka. Materials and Methods A cross-sectional study was conducted among pregnant women attending antenatal clinics (ANCs) in Sri Lanka. Three districts were purposively selected to represent distinct ecological zones and provincial diversity: Colombo (wet zone, Western Province), Kandy (intermediate zone/hill country, Central Province), and Anuradhapura (dry zone, North Central Province). The calculated sample size was 390, based on a 95% confidence interval, 5% margin of error, and an assumed 50% prevalence of iodine sufficiency. Within each district, ANCs were randomly selected, and participants were recruited from clinic registers after obtaining the informed consent from each individual. An equal number of urban and rural participants were targeted, with 65 pregnant women from each setting per district. Spot urine samples were obtained from consenting first-trimester pregnant women using sterile, leak-proof containers. Samples were collected by trained clinic staff as a routine clinic procedure, transported to the International Institute of Health Sciences (IIHS) laboratory in cool boxes at 4 0 C, and stored at -20 0 C until analysis. Urinary iodine concentration (UIC) was determined using the ammonium persulphate-modified microplate method. Quality Control (QC) procedures included both internal and external validation. Internal QC was maintained using urine samples with known iodine concentrations analysed alongside study samples. External QC was ensured through participation in the US Centres for Disease Control and Prevention (CDC), Atlanta, ensuring the Quality of Urinary Iodine Procedures (EQUIP) programme. Of the 390 samples collected, 337 (86.4%) met QC requirements and were included in the final analysis. Statistical analysis were performed using IBM SPSS ver.26 and Microsoft EXCEL. UIC values were categorized according to World Health Organisation (WHO) criteria for pregnant women: <150 μg/L (insufficient), 150–249 μg/L (adequate); 250–499 μg/L (above requirements); ≥500 μg/L (excessive). Differences in UIC between districts were assessed using the Kruskal–Wallis test, with statistically significance set at p <0.05. Results The overall mUIC of the study population was 135.9 µg/L (range: 10.2 -1148.6 µg/L), indicating insufficient iodine status among pregnant women (Table 01). Figure 01 illustrates, the distribution of UIC values, which was positively skewed (skewness = 2.60), reflecting a substantial proportion of participants with low iodine levels. Table 01 – Demographic data distribution among the pregnant women. Variable Total (n = 337) Dry Zone (n = 118) Intermediate Zone (n = 119) Wet Zone (n = 100) Age (years) Mean ± SD 29.06 ± 5.04 28.69 ± 4.64 28.92 ± 5.31 29.71 ± 5.14 Urinary Iodine (µg/L) Median (IQR) 135.9 (74.4-243.8) 131.9 (76.0-226.5) 106.4 (63.4-224.6) 168.1 (82.0-287.3) Only 22.6% of the total sample achieved the WHO-defined adequate iodine range (150–249 µg/L), while 52.8% were iodine sufficient (150 µg/L). Post-hoc pairwise comparisons with Bonferroni correction indicated that Colombo had significantly higher UIC values than Kandy (p = 0.003). Differences between Colombo and Anuradhapura (p = 0.075) and between Kandy and Anuradhapura (p = 0.842) were not statistically significant after adjustment. In contrast to the high proportion of deficiency, 20.8% of women had UIC in the “above requirement” range (250–449 µg/L), and 3.9% had “excessive” iodine levels (≥ 500 µg/L). Colombo recorded the highest prevalence in both categories, with 26.0% above requirements and 8.0% excessive. Overall, the findings highlight marked regional disparities in iodine intake, with the greatest gap observed between Colombo and Kandy, and demonstrate a coexistence of insufficient and excessive iodine levels among pregnant women (Fig. 02). Figure 2 illustrates iodine status across the three ecological zones represented by the selected districts. The district from the wet zone (Colombo) demonstrated overall iodine sufficiency, while both the dry zone (Anuradhapura) and the hill country/intermediate zone (Kandy) exhibited insufficient iodine levels. Among the three, the hill zone (Kandy) showed the lowest median urinary iodine concentration, indicating the most severe iodine deficiency within the study population. Discussion This study provides an updated assessment of iodine status among first-trimester pregnant women in three sentinel districts of Sri Lanka-Colombo, Kandy, and Anuradhapura. The findings highlight important geographic and sectoral disparities and underscore ongoing vulnerability to iodine insufficiency during pregnancy despite longstanding national iodisation efforts. The overall mUIc of 135.9 µg/L falls below the WHO-recommended range of 150–249 µg/L for pregnant women ( 11 ), indicating mild iodine deficiency in the study population. A considerable proportion of pregnant women had suboptimal iodine levels, including a small subset with moderate to severe deficiency. These results are consistent with national surveys conducted between 2012 and 2016, which documented persistent maternal iodine insufficiency despite population-level; improvements following the USI programme. District-level analysis revealed notable variations. Colombo recorded the highest mUIC (168.1 µg/L), while Kandy demonstrated the lowest (106.4 µg/L), a difference remained statistically significant after post-hoc testing. Urban-rural disparities were also evident, with urban women showed higher iodine levels. These variations likely reflect differences in food intake. The pattern observed in Anuradapura district- where rural women had higher UIC than their urban counterparts-warrants further exploration of district-specific dietary habits and salt procurement practices ( 14 , 23 ). Although iodised salt is the primary source of dietary iodine in Sri Lanka, this study did not explore the relationship between the iodine content of household salt and urinary iodine concentration. However, improper iodisation, iodine losses during storage and cooking, varying consumption of processed foods, and use of prenatal supplements may all contribute to the observed heterogeneity ( 26 ). Notably, 20.8% of women exhibited UIC values above requirements and 3.9% had excessive levels, most prominently in urban Colombo. Excess iodine intake, though less common, carries potential risks such as thyroid autoimmunity and warrants continued monitoring ( 1 ). The sentinel site surveillance approach was instrumental in detecting localised disparities that may be obscured in national averages. The findings reaffirm that population iodine sufficiency does not guarantee adequacy in physiologically vulnerable groups such as pregnant women, who have increased requirements driven by maternal thyroid hormone production, renal iodine clearance, and foetal needs ( 27 ). The limitations of this study are spot urine samples were used to assess iodine intake, although it is recommended for population-based assessment, it is subject to day-to-day variability. Additionally, the absence of detailed data on dietary intake, supplement use, and contributory factors on thyroid functions. Despite these limitations, the use of standardised laboratory methods and participation in external quality assurance strengthens confidence in the results. Conclusion While Sri Lanka’s USI programme has substantially reduced iodine deficiency at the population level, gaps remain among pregnant women, particularly in certain districts. Strengthening routine monitoring, ensuring availability of adequately iodise salts at household level, improving regulatory enforcement, and promoting appropriate prenatal iodine supplementation are essential steps to safe guard maternal thyroid health to optimise foetal neurodevelopment. Continued targeted interventions will be critical to sustaining Sri Lanka’s progress toward eliminating iodine deficiency disorders. Declarations Acknowledgement This study was conducted under the requirement of the Health Ministry Iodine Surveillance Program of Sri Lanka. The authors gratefully acknowledge the support of the all the antenatal clinic staff for their assistance with data collection, and sincerely thank all study participants for their valuable contribution. Funding. This research did not receive any specific grant from funding agencies in the public, commercial, or not‑for‑profit sectors. Laboratory facilities were provided by the International Institute of Health Sciences (IIHS), Walisara, Sri Lanka. Ethical Consideration Conflict of interest The authors declare that they have no conflict of interest Ethics approval This study was reviewed by the Ethics Review Committee of the International Institute of Health Sciences, Walisara, Sri Lanka (Application No.: BI_ERC_2026_019) and an ethical clearance waiver was granted. Informed consent was obtained from all the participants before recruitment and the study was conducted in accordance with national public health guidelines and the principles of the Declaration of Helsinki. Data availability The raw quantitative datasets used to support the findings of this study are deidentified participant data and are available from the corresponding authors upon reasonable request. Please contact Dr. Renuka Jayatissa or Ms. PK Weerawickrama. Corresponding authors Primary Corresponding author: Dr. Renuka Jayatissa – [email protected] Corresponding author : Ms. PK Weerawickrama – [email protected] / [email protected] Author Contribution RJ conceptualized and supervised the study. PK, SR, DH, and DM designed the study, and performed sample analysis, with quality control and validation. GA and HJ coordinated sample collection, logistics and overall project. The main manuscript was drafted by PK, DH, DM, GA and GG with contributions to writing and critical revisions from KJ AND RJ. Tables and figures were prepared by PK and reviewed by RJ. All authors reviewed and approved the final manuscript. References Zimmermann MB, Boelaert K. Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol. 2015;3(4):286–95. Daniel KS, Mangano KM. Resurgence of Iodine Deficiency in the United States During Pregnancy: Potential Implications for Cognitive Development in Children. Nutr Rev. 2025;83(10):1944–56. Grossklaus R, Liesenkötter KP, Doubek K, Völzke H, Gaertner R. Key Messages of the Iodine Deficiency Working Group (AKJ): Maternal Hypothyroxinemia Due to Iodine Deficiency and Endocrine Disruptors as Risks for Child Neurocognitive Development. Geburtshilfe Frauenheilkd. 2025;85(08):796–809. Abel MH, Caspersen IH, Sengpiel V, Jacobsson B, Meltzer HM, Magnus P, et al. Insufficient maternal iodine intake is associated with subfecundity, reduced foetal growth, and adverse pregnancy outcomes in the Norwegian Mother, Father and Child Cohort Study. BMC Med. 2020;18(1):211. Dineva M, Fishpool H, Rayman MP, Mendis J, Bath SC. Systematic review and meta-analysis of the effects of iodine supplementation on thyroid function and child neurodevelopment in mildly-to-moderately iodine-deficient pregnant women. Am J Clin Nutr. 2020;112(2):389–412. Nazeri P, Shariat M, Azizi F. Effects of iodine supplementation during pregnancy on pregnant women and their offspring: a systematic review and meta-analysis of trials over the past 3 decades. Eur J Endocrinol. 2021;184(1):91–106. Gorstein JL, Bagriansky J, Pearce EN, Kupka R, Zimmermann MB. Estimating the Health and Economic Benefits of Universal Salt Iodization Programs to Correct Iodine Deficiency Disorders. Thyroid. 2020;30(12):1802–9. Feyrer J, Politi D, Weil DN. The Cognitive Effects of Micronutrient Deficiency: Evidence from Salt Iodization in the United States. J Eur Econ Assoc. 2017;15(2):355–87. Zimmermann MB, Andersson M, GLOBAL ENDOCRINOLOGY. Global perspectives in endocrinology: coverage of iodized salt programs and iodine status in 2020. 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Available from: https://www.mri.gov.lk/units/nutrition/survey-reports/ Jayatissa DR, Fernando DN, Herath DH, IODINE DEFICIENCY STATUS IN, SRI LANKA 2016 FOURTH NATIONAL SURVEY [Internet]. Medical Research Institute of Sri Lanka; 2016 [cited 2025 Apr 19]. Available from: https://www.mri.gov.lk/units/nutrition/survey-reports/ Bath SC, Steer CD, Golding J, Emmett P, Rayman MP. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet. 2013 July;27(9889):331–7. Baldini E, Virili C, D’Armiento E, Centanni M, Ulisse S. Iodine Status in Schoolchildren and Pregnant Women of Lazio, a Central Region of Italy. Nutrients. 2019 July;11(7):1647. Al-Yatama FI, Al-Bader MD, Al-Mazidi ZM, Ali A, Al-Omair A, Al-Ajmi NH, et al. Iodine status among pregnant women in Kuwait. J Endocrinol Invest. 2007;30(11):914–9. Spina V, Baldini E, Cardarelli S, Oliva C, Venarubea S, Faraoni F, et al. Iodized Salt May Not Be Sufficient to Guarantee an Adequate Iodine Intake in Pregnant Women. Nutrients. 2023;15(19):4182. Aslanyan H, Gerasimov G, Parvanta I. Pilot implementation of USI FORTIMAS Methodology for Assessment and Tracking Effective Coverage of the National Salt lodization Program and iodine status of pregnant women in the Republic of Armenia [Internet]. National Institute of Health Named after Academician S. Avdalbekyan; 2024 [cited 2025 Apr 19]. Available from: https://www.nih.am/assets/pdf/atvk/f9af5d7698c330a7427a17fe5babb6e4.pdf Ratnatunga P, Amarasinghe S, Ratnatunga N. Changing patterns of thyroid cancer in Sri Lanka. Has the iodination programme helped? Ceylon Med J. 2011;48(4):125. Jayatissa R, Gorstein J, Okosieme OE, Lazarus JH, Premawardhana LD. Stable Iodine Nutrition During Two Decades of Continuous Universal Salt Iodisation in Sri Lanka. Nutrients. 2020;12(4):1109. Jayatissa R, Gunathilaka M, Fernando D. Iodine nutrition status among schoolchildren after salt iodisation. Ceylon Med J. 2009;50(4):144. Jayatisa R, Gunathilaka M, Ranbanda J, Peiris P, Jayasingha J, Ekanayaka P. Iodine status of pregnant women in Sri Lanka. Sri Lanka J Diabetes Endocrinol Metab. 2013;3(1):4. Jayatissa R, Haturusinghe C, Knowles J, Codling K, Gorstein J. Estimated contribution of most commonly consumed industrialized processed foods to salt intake and iodine intakes in Sri Lanka. PLOS ONE 2021 Sept 20;16(9):e0257488. Jayatissa R. Second National Iodine Survey: Iodine deficiency in Sri Lanka [Internet]. 2005 [cited 2025 Apr 28]. Available from: https://www.mri.gov.lk/assets/Nutrition/2005-Second-National-IDD-Survey-.pdf World Health Organization, Aburto NJ, Abudou M, Candeias V, Wu T. Effect and safety of salt iodization to prevent iodine deficiency disorders: a systematic review with meta-analyses [Internet]. Geneva: World Health Organization; 2014 [cited 2025 Apr 28]. 150 p. Available from: https://iris.who.int/handle/10665/148175 Delange F. Iodine requirements during pregnancy, lactation and the neonatal period and indicators of optimal iodine nutrition. Public Health Nutr. 2007;10(12A):1571–80. Table 2 Table 2 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table02.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9228138","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":621678197,"identity":"7a74c87c-bb06-4610-ae8f-a75dfdf0c510","order_by":0,"name":"Piyumi 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1","display":"","copyAsset":false,"role":"figure","size":27069,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of urine iodine concentration among the pregnantwomen\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9228138/v1/3fc58e1f52527116a0a1edd7.png"},{"id":106874750,"identity":"ec8f026d-db6d-424c-980d-4e31bc11d60e","added_by":"auto","created_at":"2026-04-14 10:20:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":337684,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGeographic Distribution of Median Urinary Iodine Concentration Among Pregnant Women.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eillustrates iodine status across the three ecological zones represented by the selected districts. The district from the wet zone (Colombo) demonstrated overall iodine sufficiency, while both the dry zone (Anuradhapura) and the hill country/intermediate zone (Kandy) exhibited insufficient iodine levels. Among the three, the hill zone (Kandy) showed the lowest median urinary iodine concentration, indicating the most severe iodine deficiency within the study population.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9228138/v1/4a865ae9f757edd6ff3d6cb2.png"},{"id":107898851,"identity":"42c190b6-85f8-4bff-9749-b477c88e5e92","added_by":"auto","created_at":"2026-04-27 11:12:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":537468,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9228138/v1/093e24c6-f655-49e7-8fa7-bf8304f6773c.pdf"},{"id":106874754,"identity":"0da94ceb-edae-4981-870b-2aff947b0e13","added_by":"auto","created_at":"2026-04-14 10:20:44","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21135,"visible":true,"origin":"","legend":"","description":"","filename":"Table02.docx","url":"https://assets-eu.researchsquare.com/files/rs-9228138/v1/ee2c09a329623a59b8d33bf0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Are Pregnant Women Iodine Sufficient in Sri Lanka? An Assessment Using Urinary Iodine Concentration","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIodine is an essential micronutrient required for thyroid hormones synthesis, which is critical \u0026nbsp;for metabolic regulation and normal foetal brain development. During pregnancy, iodine requirements increase substantially to support maternal thyroid hormone production, placental transfer, and foetal neurodevelopment. Even mild moderate iodine deficiency has been linked to miscarriage, stillbirth, congenital anomalies, and measurable cognitive impairment in offspring (1\u0026ndash;6).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough Universal Salt Iodisation (USI) has significantly reduced iodine deficiency disorders (IDDs) worldwide (7\u0026ndash;9), \u0026nbsp;pregnant women remain at increased risk. Variations in soil iodine content, environmental leaching, and dietary patterns influence iodine availability, In Sri Lanka, despite natural iodine sources in some regions, high rainfall and soil erosion- particularly in coastal and wet zones-contribute to geographic variability in iodine intake. \u0026nbsp;Iodised salt is the primary dietary source, yet iodine content can fluctuate depending on salt quality, storage practices, and household consumption behaviours (10\u0026ndash;14).\u003c/p\u003e\n\u003cp\u003eInternational evidence highlights this vulnerability. The Avon Longitudinal Study of Parents and Children (ALSPAC) in the United Kingdom reported iodine insufficiency among pregnant women, with levels below the WHO-recommended adequate range, and mild deficiency associated with lower verbal IQ and reduced reading comprehension in their children (15, 16). Comparable findings have been reported in Italy, Kuwait, Thailand, and Armenia (17\u0026ndash;19).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHistorically, iodine deficiency was a major public health concern in Sri Lanka, particularly in the wet zones where endemic goitre was prevalent. The national USI program launched in 1995 resulted in marked reduction in goitre and improved iodine status among school-aged children (20). By 2005, Sri Lanka was classified as iodine sufficient at the population level, and \u0026nbsp;iodisation standards were adjusted to prevent excess intake (21,22).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, pregnancy-specific data reveal persistent gaps. The 2012-2013 national survey reported a mUIC of 113.7 \u0026mu;g/L among pregnant women, with more than 60% below the recommended sufficiency threshold and declining values with advancing gestation (23). A subsequent survey in 2015 showed only modest improvement, with nearly half of pregnant women remaining iodine insufficient (21,24). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese findings indicate a disparity between population-level iodine sufficiency and maternal iodine adequacy. Given the heightened physiological demand in pregnancy and the consequences for foetal neurodevelopment, updated evidence is essential. This study therefore aimed to assess urinary iodine concentration as an indicator of iodine status among pregnant women attending antenatal clinics in Sri Lanka.\u0026nbsp;\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eA cross-sectional study was conducted among pregnant women attending antenatal clinics (ANCs) in Sri Lanka. Three districts were purposively selected to represent distinct ecological zones and provincial diversity: Colombo (wet zone, Western Province), Kandy (intermediate zone/hill country, Central Province), and Anuradhapura (dry zone, North Central Province).\u003c/p\u003e\n\u003cp\u003eThe calculated sample size was 390, based on a 95% confidence interval, 5% margin of error, and an assumed 50% prevalence of iodine sufficiency. Within each district, ANCs were randomly selected, and participants were recruited from clinic registers after obtaining the informed consent from each individual. An equal number of urban and rural participants were targeted, with 65 pregnant women from each setting per district.\u003c/p\u003e\n\u003cp\u003eSpot urine samples were obtained from consenting first-trimester pregnant women using sterile, leak-proof containers. Samples were collected by trained clinic staff as a routine clinic procedure, transported to the International Institute of Health Sciences (IIHS) laboratory in cool boxes at 4 \u003csup\u003e0\u003c/sup\u003eC, and stored at -20 \u003csup\u003e0\u003c/sup\u003eC until analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUrinary iodine concentration (UIC) was determined using the ammonium persulphate-modified microplate method. Quality Control (QC) procedures included both internal and external validation. Internal QC was maintained using urine samples with known iodine concentrations analysed alongside study samples. External QC was ensured through participation in the US Centres for Disease Control and Prevention (CDC), Atlanta, ensuring the Quality of Urinary Iodine Procedures (EQUIP) programme.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOf the 390 samples collected, 337 (86.4%) met QC requirements and were included in the final analysis. Statistical analysis were performed using IBM SPSS ver.26 and Microsoft EXCEL. UIC values were categorized \u0026nbsp; according to World Health Organisation (WHO) criteria for pregnant women: \u0026lt;150 \u0026mu;g/L (insufficient), 150\u0026ndash;249 \u0026mu;g/L (adequate); 250\u0026ndash;499 \u0026mu;g/L (above requirements); \u0026ge;500 \u0026mu;g/L (excessive). Differences in UIC between districts were assessed using the Kruskal\u0026ndash;Wallis test, with statistically significance set at p \u0026lt;0.05.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe overall mUIC of the study population was 135.9 µg/L (range: 10.2 -1148.6 µg/L), indicating insufficient iodine status among pregnant women (Table 01). Figure 01 illustrates, the distribution of UIC values, which was positively skewed (skewness = 2.60), reflecting a substantial proportion of participants with low iodine levels. \u0026nbsp;\u003c/p\u003e\n\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 01\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003e– Demographic data distribution among the pregnant women.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(n = 337)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eDry Zone\u003c/p\u003e\n \u003cp\u003e(n = 118)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eIntermediate Zone\u003c/p\u003e\n \u003cp\u003e(n = 119)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eWet Zone\u003c/p\u003e\n \u003cp\u003e(n = 100)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMean ± SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e29.06 ± 5.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e28.69 ± 4.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e28.92 ± 5.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e29.71 ± 5.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrinary Iodine (µg/L)\u003c/strong\u003e Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e135.9\u003c/p\u003e\n \u003cp\u003e(74.4-243.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e131.9\u003c/p\u003e\n \u003cp\u003e(76.0-226.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e106.4\u003c/p\u003e\n \u003cp\u003e(63.4-224.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e168.1\u003c/p\u003e\n \u003cp\u003e(82.0-287.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eOnly 22.6% of the total sample achieved the WHO-defined adequate iodine range (150–249 µg/L), while 52.8% were iodine sufficient (150 µg/L). Post-hoc pairwise comparisons with Bonferroni correction indicated that Colombo had significantly higher UIC values than Kandy (p = 0.003). Differences between Colombo and Anuradhapura (p = 0.075) and between Kandy and Anuradhapura (p = 0.842) were not statistically significant after adjustment.\u003c/p\u003e\n\u003cp\u003eIn contrast to the high proportion of deficiency, 20.8% of women had UIC in the “above requirement” range (250–449 µg/L), and 3.9% had “excessive” iodine levels (≥ 500 µg/L). Colombo recorded the highest prevalence in both categories, with 26.0% above requirements and 8.0% excessive.\u003c/p\u003e\n\u003cp\u003eOverall, the findings highlight marked regional disparities in iodine intake, with the greatest gap observed between Colombo and Kandy, and demonstrate a coexistence of insufficient and excessive iodine levels among pregnant women (Fig. 02).\u003c/p\u003e\n\u003cp\u003eFigure 2 \u003cem\u003eillustrates iodine status across the three ecological zones represented by the selected districts. The district from the wet zone (Colombo) demonstrated overall iodine sufficiency, while both the dry zone (Anuradhapura) and the hill country/intermediate zone (Kandy) exhibited insufficient iodine levels. Among the three, the hill zone (Kandy) showed the lowest median urinary iodine concentration, indicating the most severe iodine deficiency within the study population.\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides an updated assessment of iodine status among first-trimester pregnant women in three sentinel districts of Sri Lanka-Colombo, Kandy, and Anuradhapura. The findings highlight important geographic and sectoral disparities and underscore ongoing vulnerability to iodine insufficiency during pregnancy despite longstanding national iodisation efforts.\u003c/p\u003e \u003cp\u003eThe overall mUIc of 135.9 \u0026micro;g/L falls below the WHO-recommended range of 150\u0026ndash;249 \u0026micro;g/L for pregnant women (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), indicating mild iodine deficiency in the study population. A considerable proportion of pregnant women had suboptimal iodine levels, including a small subset with moderate to severe deficiency. These results are consistent with national surveys conducted between 2012 and 2016, which documented persistent maternal iodine insufficiency despite population-level; improvements following the USI programme.\u003c/p\u003e \u003cp\u003eDistrict-level analysis revealed notable variations. Colombo recorded the highest mUIC (168.1 \u0026micro;g/L), while Kandy demonstrated the lowest (106.4 \u0026micro;g/L), a difference remained statistically significant after post-hoc testing. Urban-rural disparities were also evident, with urban women showed higher iodine levels. These variations likely reflect differences in food intake. The pattern observed in Anuradapura district- where rural women had higher UIC than their urban counterparts-warrants further exploration of district-specific dietary habits and salt procurement practices (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough iodised salt is the primary source of dietary iodine in Sri Lanka, this study did not explore the relationship between the iodine content of household salt and urinary iodine concentration. However, improper iodisation, iodine losses during storage and cooking, varying consumption of processed foods, and use of prenatal supplements may all contribute to the observed heterogeneity (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Notably, 20.8% of women exhibited UIC values above requirements and 3.9% had excessive levels, most prominently in urban Colombo. Excess iodine intake, though less common, carries potential risks such as thyroid autoimmunity and warrants continued monitoring (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe sentinel site surveillance approach was instrumental in detecting localised disparities that may be obscured in national averages. The findings reaffirm that population iodine sufficiency does not guarantee adequacy in physiologically vulnerable groups such as pregnant women, who have increased requirements driven by maternal thyroid hormone production, renal iodine clearance, and foetal needs (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe limitations of this study are spot urine samples were used to assess iodine intake, although it is recommended for population-based assessment, it is subject to day-to-day variability. Additionally, the absence of detailed data on dietary intake, supplement use, and contributory factors on thyroid functions. Despite these limitations, the use of standardised laboratory methods and participation in external quality assurance strengthens confidence in the results.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWhile Sri Lanka\u0026rsquo;s USI programme has substantially reduced iodine deficiency at the population level, gaps remain among pregnant women, particularly in certain districts. Strengthening routine monitoring, ensuring availability of adequately iodise salts at household level, improving regulatory enforcement, and promoting appropriate prenatal iodine supplementation are essential steps to safe guard maternal thyroid health to optimise foetal neurodevelopment. Continued targeted interventions will be critical to sustaining Sri Lanka\u0026rsquo;s progress toward eliminating iodine deficiency disorders.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted under the requirement of the Health Ministry Iodine Surveillance Program of Sri Lanka.\u0026nbsp;The authors gratefully acknowledge the support of the all the antenatal clinic staff for their assistance with data collection, and sincerely thank all study participants for their valuable contribution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not‑for‑profit sectors. Laboratory facilities were provided by the International Institute of Health Sciences (IIHS), Walisara, Sri Lanka.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthical Consideration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed by the Ethics Review Committee of the International Institute of Health Sciences, Walisara, Sri Lanka (Application No.: BI_ERC_2026_019) and an ethical clearance waiver was granted. Informed consent was obtained from all the participants before recruitment and the study was conducted in accordance with national public health guidelines and the principles of the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe raw quantitative datasets used to support the findings of this study are deidentified participant data and are available from the corresponding authors upon reasonable request. Please contact Dr. Renuka Jayatissa or Ms. PK Weerawickrama.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding authors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrimary Corresponding author: Dr. Renuka Jayatissa \u0026ndash; [email protected]\u003c/p\u003e\n\u003cp\u003eCorresponding author : Ms. PK Weerawickrama \u0026ndash; [email protected] /[email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRJ conceptualized and supervised the study. PK, SR, DH, and DM designed the study, and performed sample analysis, with quality control and validation. GA and HJ coordinated sample collection, logistics and overall project. The main manuscript was drafted by PK, DH, DM, GA and GG with contributions to writing and critical revisions from KJ AND RJ. Tables and figures were prepared by PK and reviewed by RJ. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n"},{"header":"References ","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZimmermann MB, Boelaert K. Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol. 2015;3(4):286\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDaniel KS, Mangano KM. Resurgence of Iodine Deficiency in the United States During Pregnancy: Potential Implications for Cognitive Development in Children. Nutr Rev. 2025;83(10):1944\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrossklaus R, Liesenk\u0026ouml;tter KP, Doubek K, V\u0026ouml;lzke H, Gaertner R. Key Messages of the Iodine Deficiency Working Group (AKJ): Maternal Hypothyroxinemia Due to Iodine Deficiency and Endocrine Disruptors as Risks for Child Neurocognitive Development. 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Ceylon Med J. 2009;50(4):144.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJayatisa R, Gunathilaka M, Ranbanda J, Peiris P, Jayasingha J, Ekanayaka P. Iodine status of pregnant women in Sri Lanka. Sri Lanka J Diabetes Endocrinol Metab. 2013;3(1):4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJayatissa R, Haturusinghe C, Knowles J, Codling K, Gorstein J. Estimated contribution of most commonly consumed industrialized processed foods to salt intake and iodine intakes in Sri Lanka. PLOS ONE 2021 Sept 20;16(9):e0257488.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJayatissa R. Second National Iodine Survey: Iodine deficiency in Sri Lanka [Internet]. 2005 [cited 2025 Apr 28]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mri.gov.lk/assets/Nutrition/2005-Second-National-IDD-Survey-.pdf\u003c/span\u003e\u003cspan address=\"https://www.mri.gov.lk/assets/Nutrition/2005-Second-National-IDD-Survey-.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization, Aburto NJ, Abudou M, Candeias V, Wu T. Effect and safety of salt iodization to prevent iodine deficiency disorders: a systematic review with meta-analyses [Internet]. Geneva: World Health Organization; 2014 [cited 2025 Apr 28]. 150 p. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.who.int/handle/10665/148175\u003c/span\u003e\u003cspan address=\"https://iris.who.int/handle/10665/148175\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDelange F. Iodine requirements during pregnancy, lactation and the neonatal period and indicators of optimal iodine nutrition. Public Health Nutr. 2007;10(12A):1571\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 2","content":"\u003cp\u003eTable 2 is available in the Supplementary Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pregnant women, Iodine Status, Urine Iodine, Maternal Nutrition","lastPublishedDoi":"10.21203/rs.3.rs-9228138/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9228138/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Adequate maternal iodine intake is essential for optimal foetal brain development, and even mild deficiency can impair cognitive outcomes. Sri Lanka introduced Universal Salt Iodisation (USI) in 1995, yet emerging evidence indicates possible gaps in iodine ststus among pregnant women. This study aimed to assess urinary iodine concentration (UIC) among first-trimester pregnant women to evaluate iodine sufficiency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Across-sectional study was conducted in three selected districts representing different geographic and demographic settings. Antenatal clinics were sampled using a stratified approach to capture sectoral variation. Spot urine samples were collected from 337 first-trimester pregnant women during routine clinic visits. Median urinary iodine concentration (mUIC) was used as the primary indicator of iodine status, following WHO criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult: \u003c/strong\u003eThe overall mUIC was 135.9 µg/L, below the WHO-recommended range of 150–249 µg/L for pregnancy. District level variation was notable, with the highest mUIC in Colombo and the lowest in Kandy (168.1 vs 106.4 µg/L; p\u0026lt;0.01). Urban-rural differences were not statistically significant (p\u0026gt;0.05). More than half of participants (52.8%) were iodine deficient (mUIC \u0026lt;150µg/L), while only 22.6% were within the adequate range. Conversely, 20.8% exhibited UIC levels “above requirements” and 3.9% had “excessive” levels (≥500 µg/L), with both categories higher in Colombo (26.0% and 8.0% respectively).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e; Nearly three decades after the implementation of USI, iodine insufficiency persists among pregnant women in Sri Lanka, with wide district disparities and emerging pockets of excess intake. These findings highlight the need for strengthened monitoring of iodine nutrition during pregnancy and periodic evaluation of the salt iodisation programme to prevent mild iodine deficiency during pregnancy to ensure optimal foetal development.\u003c/p\u003e","manuscriptTitle":"Are Pregnant Women Iodine Sufficient in Sri Lanka? An Assessment Using Urinary Iodine Concentration","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 10:20:39","doi":"10.21203/rs.3.rs-9228138/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e2c68b15-20f7-4bba-847c-90c771523282","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T11:11:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 10:20:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9228138","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9228138","identity":"rs-9228138","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}