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Iodine Deficiency in Pregnant Women despite Mandatory Bread Fortification

Despite the introduction of mandatory iodine fortification of bread since 2009, the iodine status in pregnant women in South Australia still falls within mild deficiency range.

Iodine deficiency affects nearly 2 billion people globally and is easily preventable with the use of iodized salt in the diet. Iodine deficiency during pregnancy is associated with increased rates of stillbirths, spontaneous abortions, and congenital anomalies and is the leading worldwide preventable cause of intellectual impairment in children. Even Mild iodine deficiency during pregnancy can have significant effects on fetal development and future cognitive function.

The iodine intake of pregnant women in Australia has been found to be inadequate in several studies over the past decade but has not been examined in the South Australian population. A recent Australia study was conducted to characterize the iodine status of South Australian women during pregnancy and relate it to the use of iodine-containing multivitamins. The impact of fortification of bread with iodized salt was also assessed.

196 Women were recruited prospectively at the beginning of pregnancy and urine collected at 12, 18, 30, 36 weeks gestation and 6 months postpartum. The use of a multivitamin supplement was recorded at each visit. Spot urinary iodine concentrations (UIC) were assessed.

The study found that median UICs were within the mildly deficient range in women not taking supplements (<90 μg/L). Among the women taking iodine-containing multivitamins, their UICs were higher than women who did not consume iodine-containing multivitamins, and were within WHO recommendations (150–249 μg/L) for sufficiency, and showed an increasing trend through gestation. The fortification of bread with iodized salt increased the median UIC from 68 μg/L to 84 μg/L, which was still in the deficient range.

These results indicates that pregnant women in this region of Australia were unlikely to reach recommended iodine levels without an iodine supplement, even after the mandatory iodine supplementation of bread was instituted in October 2009. Women should consider using an iodine-containing multivitamin during pregnancy to improve their iodine concentrations. This is in line with the NHMRC’s recommendation that all women who are pregnant, breastfeeding or considering pregnancy, with the exception of women with pre-existing thyroid conditions who should seek advice from their medical practitioner, are to take a daily iodine supplement of 150 micrograms per day.

Vicki L Clifton et al; Nutrition Journal 2013; 12:32; doi:10.1186/1475-2891-12-32

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