Abstract
Inadequate iodine intake during pregnancy increases the risk of neonatal morbidity and mortality. We aimed to evaluate whether prenatal supplements containing iodine affect urinary iodine concentrations (UIC) of pregnant women in Malawi. A randomised controlled trial. Pregnant women (n 1391) were assigned to consume 60 mg/d Fe and 400 µg/d folic acid (IFA) or 18 vitamins and minerals including 250 µg/d iodine (MMN) or 20 g/d small-quantity lipid-based nutrient supplements (SQ-LNS) with similar nutrient contents as MMN group, plus macronutrients (LNS) until childbirth. In a sub-study (n 317), we evaluated group geometric mean urinary iodine concentration (UIC) (µg/L) at 36 weeks of gestation controlling for baseline UIC and compared median (baseline) and geometric mean (36 weeks) UIC with WHO cut-offs: UIC < 150, 150-249, 250-499 and ≥500 reflecting insufficient, adequate, above requirements and excessive iodine intakes, respectively. Mangochi District, Malawi. Women ≤20 weeks pregnant. Groups had comparable background characteristics. At baseline, overall median (Q1, Q3) UIC (319 (167, 559)) suggested iodine intakes above requirements. At 36 weeks, the geometric mean (95 % CI) UIC of the IFA (197 (171, 226)), MMN (212 (185, 243)) and LNS (220 (192, 253)) groups did not differ (P = 0·53) and reflected adequate intakes. In this setting, provision of supplements containing iodine at the recommended dose to pregnant women with relatively high iodine intakes at baseline, presumably from iodised salt, has no impact on the women's UIC. Regular monitoring of the iodine status of pregnant women in such settings is advisable. Clinicaltrials.gov identifier: NCT01239693.
Highlights
A total of 1391 pregnant women were enroled into the International Lipid-based Nutrient Supplements (iLiNS) DYAD-Malawi trial
In the Ghana trial[20], which had the same design as this trial in Malawi, women who received small-quantity lipid-based nutrient supplements (SQ-lipid-based nutrient supplements group (LNS)) or MMN from ≤ 20 weeks of pregnancy had greater geometric mean
Investigators speculated that the lack of impact of SQ-LNS consumption in the Bangladesh trial[36] on urinary iodine concentration (UIC) was due to the very low baseline median UIC (46–50 μg/L) in that setting (compared with 119–151 μg/L in Ghana[20]), which may have resulted in the supplemental iodine being taken up by maternal and possibly fetal iodine-deprived thyroid glands for thyroid hormones production, rather than being excreted in the women’s urine
Summary
Inadequate iodine intake during pregnancy increases the risk of neonatal morbidity and mortality. We aimed to evaluate whether prenatal supplements containing iodine affect urinary iodine concentrations (UIC) of pregnant women in Malawi. In a sub-study (n 317), we evaluated group geometric mean urinary iodine concentration (UIC) (μg/L) at 36 weeks of gestation controlling for baseline UIC and compared median (baseline) and geometric mean (36 weeks) UIC with WHO cut-offs: UIC < 150, 150–249, 250–499 and ≥500 reflecting insufficient, adequate, above requirements and excessive iodine intakes, respectively. At 36 weeks, the geometric mean (95 % CI) UIC of the IFA (197 [171, 226]), MMN (212 [185, 243]) and LNS (220 [192, 253]) groups did not differ (P = 0·53) and reflected adequate intakes. Conclusions: In this setting, provision of supplements containing iodine at the recommended dose to pregnant women with relatively high iodine intakes at baseline, presumably from iodised salt, has no impact on the women’s UIC.
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