Abstract
In Australia, pregnant women are advised to take an iodine supplement (I-supp) (150 µg/day) to reduce risks to the foetus associated with iodine deficiency (ID). To examine the impact of this recommendation on iodine status, and to identify factors that contribute to adequacy during gestation, supplement use and Urinary Iodine Concentration (UIC) was measured in 255 pregnant women (gestation range 6 to 41 weeks) in Tasmania. The median UIC (MUIC) of 133 µg/L (Inter-quartile range 82–233) was indicative of ID, being below the 150–249 µg/L range for adequacy during pregnancy. Women taking an iodine-containing-supplement (I-supp) had a significantly higher MUIC (155 µg/L) (n = 171) compared to the combined MUIC (112.5 µg/L) (n = 84) of those who had never (120 µg/L) (n = 61) or were no longer taking an I-supp (90 µg/L) (n = 23) (p = 0.017). Among women reporting I-supp use, the MUIC of those commencing the recommended 150 µg/day prior to conception was significantly higher than those starting supplementation following pregnancy confirmation: 196 (98–315) µg/L (n = 45) versus 137.5 (82.5–233.5) µg/L (n = 124), p = 0.032. Despite recommendations for iodine supplementation pregnant Tasmanian women remain at risk of ID. Commencing an I-supp of 150 µg/day prior to conception and continuing throughout pregnancy is required to ensure adequacy. Timely advice regarding the importance of adequate iodine nutrition, including supplementation is needed to reduce the risk of irreversible in utero neurocognitive damage to the foetus.
Highlights
The risk of endemic iodine deficiency (ID) has been well characterised in the south-easternAustralian states of New South Wales (NSW), Victoria (VIC) and Tasmania (TAS) [1,2]
We report the iodine status of a group of pregnant Tasmanian women following the introduction of mandatory bread fortification and recommendations for iodine supplementation, and discuss factors contributing to adequate iodine nutrition during gestation
median urinary iodine concentrations (MUIC) was highest in the group of women who enrolled during the first trimester and lowest in the group of women who enrolled in the third trimester with the third trimester MUIC being significantly lower than the first (161 vs. 119 μg/L, p = 0.046)
Summary
The risk of endemic iodine deficiency (ID) has been well characterised in the south-easternAustralian states of New South Wales (NSW), Victoria (VIC) and Tasmania (TAS) [1,2]. The risk of endemic iodine deficiency (ID) has been well characterised in the south-eastern. To address public health concerns of inadequate iodine status in Australia and New Zealand mandatory replacement of salt with iodised salt in bread was introduced in 2009 [3]. A series of urinary iodine surveys of Tasmanian school-age children, who are used as a proxy for the general population, indicates that bread fortification has successfully increased iodine status from deficiency to adequacy [4]. Fortification has had little impact on the status of pregnant women, increasing the pre-fortification median urinary iodine concentrations (MUIC) from 76 μg/L to 86 μg/L [5], well below. Nutrients 2019, 11, 172 the World Health Organization (WHO) 150–249 μg/L range for adequacy in pregnancy [6]. The consequences of severe iodine deficiency (ID) include spontaneous abortion, stillbirth, congenital abnormalities and endemic cretinism [6]
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