Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the “SERENA study”, a randomized, double-blind, placebo-controlled trial

Abstract

Purpose Selenium is frequently in nutraceuticals for pregnancy, given its role on fertility and thyroid metabolism. However, most evidence rise from non-controlled studies. We aimed to evaluate the protective effect of selenium against thyroid autoimmunity during and after pregnancy. Methods A multicenter, randomized, double-blind, placebo-controlled trial was performed and promoted by the Young Italian Endocrinologists Group (EnGioI)-Italian Society of Endocrinology. Forty-five women with thyroiditis in pregnancy were enrolled and randomly assigned to L-selenomethionine (L-Se-Met) 83 mcg/day or placebo (PLB) and evaluated at 10 ± 2 (T1), 36 ± 2 weeks of gestation (T2) and 6 months after delivery (postpartum, PP). Results We measured a significant reduction of autoantibodies after pregnancy in L-Se-Met group [at PP: TgAb 19.86 (11.59-52.60), p < 0.01; TPOAb 255.00 (79.00-292.00), p < 0.01], and an antibodies titer's rebound in PLB group (TgAb 151.03 ± 182.9, p < 0.01; TPOAb 441.28 ± 512.18, p < 0.01). A significant increase in selenemia was measured in L-Se-Met group at T2 (91.33 ± 25.49; p < 0.01) and PP (93.55 ± 23.53; p = 0.02). Two miscarriage occurred in PLB. No differences were found in thyroid volume, echogenicity, quality of life, maternal/fetal complications. Conclusions SERENA study demonstrated a beneficial effect of L-Se-Met supplementation on autoantibody titer during pregnancy and on postpartum thyroiditis recurrence.

Maternal selenium deficiency during pregnancy in mice increases thyroid hormone concentrations, alters placental function and reduces fetal growth

“…A number of recent clinical trials have demonstrated that selenium supplementation can reduce thyroid autoimmunity (Mantovani et al . ) and improve thyroid function (Negro et al . ; Mao et al .…”

“…A number of recent clinical trials have demonstrated that selenium supplementation can reduce thyroid autoimmunity (Mantovani et al 2019) and improve thyroid function (Negro et al 2007;Mao et al 2016) in pregnancy although the sample sizes have been perhaps too small to identify any significant reductions in pregnancy complication risk. Thus, additional studies are required to interrogate the relationship between selenium intake and complications of thyroid dysfunction in pregnancy.…”

Selenium and at-risk pregnancy: challenges and controversies

“…The SERENA study, a multicenter, randomized, double-blind, placebo-controlled trial, organized and promoted by the Young Italian Endocrinologists Group (EnGioI)-Italian Society of Endocrinology, aimed to evaluate the effect of Se supplementation on AIT during and after pregnancy [65]. A significant reduction of TPOAb and thyroglobulin antibodies (TGAb) postpartum titer was observed in patients treated with SeMet (83 μg/day) [at PP: TGAb 20 IU/ml (11.59-52.60), p < 0.01; TPOAb 255.00 IU/ml (79.00-292.00), p < 0.01], while antibody titer rebound was reported in the placebo group.…”

Dietary Selenium Supplementation Ameliorates Female Reproductive Efficiency in Aging Mice

“…There is still a comparative dearth of adequately powered mechanistic and functional studies elucidating the wider implications of Se and selenoproteins in female fertility and reproduction [9,28]. Available evidence highlights that studies focusing on role of Se as an essential trace element in female reproduction are mainly focused on human pregnancy [30] and related complications such as pre-eclampsia [31], miscarriage and preterm birth [9,32], intrauterine growth restriction [33], small-for-gestational age newborns [34], pregnancy-induced hypertension [35], and pregnancy-related autoimmune thyroid disease [36]. Lower Se status and glutathione peroxidase 3 (GPX3) activity are shown to contribute in the progression of neoplastic diseases of female reproductive system including endometrial and ovarian cancers [37][38][39][40].…”