A case for universal salt iodisation to correct iodine deficiency in pregnancy: another salutary lesson from Tasmania

John R Burgess, Judy A Seal, Georgina M Stilwell, Peter J Reynolds, E Roscoe Taylor and Venkat Parameswaran
Med J Aust 2007; 186 (11): 574-576.


Objective: To assess the impact of iodine fortification of bread on the iodine status of pregnant women, and to determine if studies of iodine levels in school-age children were indicative of women’s gestational iodine status.

Design: Urinary iodine surveys of pregnant Tasmanian women before and after bread was fortified with iodine in October 2001.

Participants and setting: 285 women attending the Royal Hobart Hospital (RHH) antenatal clinic from 1 October 2000 to 30 September 2001 and 517 women attending the RHH antenatal clinic or primary health care centres in 2003–2006.

Main outcome measures: Median urinary iodine concentration (UIC) for comparison against the World Health Organization recommendation of of 150–249 μg/L for pregnant women.

Results: Before supplementation, the median UIC of the 285 women attending the RHH antenatal clinic was 76 μg/L. After supplementation, median UICs were 81 μg/L for 288 women attending primary health care centres and 86 μg/L for 229 women attending the RHH antenatal clinic. Differences in mean UIC were not significant for either the antenatal clinic group (P = 0.237) or the primary health care group (P = 0.809) compared with the pre-supplementation group.

Conclusions: Iodine deficiency in pregnancy persists despite being corrected in Tasmanian children. Successful iodine supplementation must target reproductive-age and pregnant women and be substantiated by ongoing monitoring during pregnancy and lactation. A robust national program for correcting iodine deficiency is urgently needed. Mandatory universal salt iodisation has international endorsement, and should be considered the preferred strategy for eliminating iodine deficiency in Australia.

  • John R Burgess1
  • Judy A Seal2
  • Georgina M Stilwell1
  • Peter J Reynolds1
  • E Roscoe Taylor2
  • Venkat Parameswaran1

  • 1 Royal Hobart Hospital, Hobart, TAS.
  • 2 Department of Health and Human Services, Tasmania, Hobart, TAS.



Financial support for this study was provided by (i) the Tasmanian Government (Dick Buttfield Memorial Fellowship), (ii) the Royal Hobart Hospital Research Foundation, and (iii) the Department of Health and Human Services, Tasmania (the Tasmanian Iodine Monitoring Program). We thank Zelda Doyle of Broad Street Consultants, and staff at the Royal Hobart Hospital antenatal clinic for undertaking logistical activities in relation to sample collection. Preliminary data were presented at the 11th International Congress of Endocrinology, Sydney, 2000 (Abstract P778).

Competing interests:

None identified.

  • 1. Assessment of iodine deficiency disorders and monitoring their elimination. Geneva: World Health Organization, 2001. (WHO/NHD/01.1) (accessed May 2007).
  • 2. Becker DV, Braverman LE, Delange F, et al. Iodine supplementation for pregnancy and lactation — United States and Canada: recommendations of the American Thyroid Association. Thyroid 2006; 16: 949-951.
  • 3. Nutrient reference values for Australia and New Zealand including recommended dietary intakes. Canberra: National Health and Medical Research Council, 2006.
  • 4. Dunn JT, Delange F. Damaged reproduction: the most important consequence of iodine deficiency. J Clin Endocrinol Metab 2001; 86: 2360-2363.
  • 5. Li M, Eastman CJ, Waite KV, et al. Are Australian children iodine deficient? Results of the Australian National Iodine Nutrition Study. Med J Aust 2006; 184: 165-169. <MJA full text>
  • 6. Gunton JE, Hams G, Fiegert M, McElduff A. Iodine deficiency in ambulatory participants at a Sydney teaching hospital: is Australia truly iodine replete? Med J Aust 1999; 171: 467-470. <MJA full text>
  • 7. Hamrosi MA, Wallace EM, Riley MD. Iodine status in pregnant women living in Melbourne differs by ethnic group. Asia Pac J Clin Nutr 2005; 14: 27-31.
  • 8. Travers CA, Guttikonda K, Norton CA, et al. Iodine status in pregnant women and their newborns: are our babies at risk of iodine deficiency? Med J Aust 2006; 184: 617-620. <MJA full text>
  • 9. Gibson HB. Surveillance of iodine deficiency disorders in Tasmania 1949–1984. 2nd ed. Launceston: Myola House of Publishing, 2006.
  • 10. Tasmanian Thyroid Advisory Committee. Study in disease surveillance, 1950–1979. Med J Aust 1981; 2: 234-238.
  • 11. Guttikonda K, Burgess JR, Hynes K, et al. Recurrent iodine deficiency in Tasmania, Australia: a salutary lesson in sustainable iodine prophylaxis and its monitoring. J Clin Endocrinol Metab 2002; 87: 2809-2815.
  • 12. Seal JA, Johnson EM, Doyle Z, Shaw K. Tasmania: doing its wee bit for iodine nutrition. Med J Aust 2003; 179: 451-452. <MJA full text>
  • 13. Seal JA, Doyle Z, Burgess JR, et al. Iodine status of Tasmanians following voluntary fortification of bread with iodine. Med J Aust 2007; 186: 69-71. <MJA full text>
  • 14. Dunn JT. Seven deadly sins in confronting endemic iodine deficiency, and how to avoid them. J Clin Endocrinol Metab 1996; 81: 1332-1335.
  • 15. Food Standards Australia New Zealand. Proposal P230 — Iodine Fortification. 2802.cfm (accessed Nov 2006).


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