Letters
Metabolic diseases Women's health Environmental health
Volume 199 - Issue 10

Reinforcing the iodine message for pregnant women in Australia

Authors:  Karen E Charlton and Creswell J Eastman AM

Med J Aust 2013; 199 (10): 660. || doi: 10.5694/mja13.10708
Published online: 18 November 2013
Not enough women are being informed about the need for supplementation with iodine by their antenatal care providers.
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To the Editor: The recently released clinical practice guidelines on antenatal care,1 which have been endorsed by the National Health and Medical Research Council, recommend nutritional supplementation with 500 μg/day of folic acid, from 12 weeks before conception and for the first trimester, and 150 μg/day of iodine throughout pregnancy. This recommendation recognises that, despite the introduction in 2009 of mandatory fortification of bread with both iodine and folic acid, fortification does not meet the increased needs of pregnant and lactating women. Urinary iodine concentrations of pregnant women improved after the introduction of the iodine fortification program; however, a study in regional New South Wales found that only those women who were taking iodine-containing supplements had urinary concentrations indicating sufficiency (≥ 150 μg/L).2

A series of cross-sectional studies of women attending a major public antenatal clinic in a regional area of NSW has consistently shown suboptimal dietary practices and knowledge, particularly with regard to the iodine requirements for optimal neurocognitive development of the fetus.2,3 While supplement use has increased from 59% in 2008 to 71%–77% in 2011–2012, only 20% of women in 2008 and 60%–66% in 2011–2012 were taking supplements containing iodine. We do not know why up to 40% of women are still not taking recommended iodine supplements, but we surmise that women are not being informed about the need for supplementation by their antenatal care providers, despite there being written advice on supplements in the publication from NSW Health, Having a baby, which is provided in public health facilities statewide.4

We acknowledge that data on nutritional supplementation in pregnancy may differ in other states, and that nationally representative data are required, but we are not aware of any state or national campaign to promote iodine supplementation during pregnancy and breastfeeding.

Clearly, better service delivery models are required to ensure consistent messages about nutritional supplements are provided by all health care professionials. New data from Tasmania have shown for the first time in Australia that mild iodine deficiency during pregnancy is associated with reduced educational outcomes in children born to mothers with this deficiency (decreased performance in the NAPLAN [National Assessment Program — Literacy and Numeracy] of up to 10%).5 Similarly, in the United Kingdom, mild maternal iodine deficiency has been shown to result in decreased IQ in the offspring.6 It is indefensible that women of reproductive age, and especially pregnant women, are not being adequately informed about the need for iodine supplementation to prevent irreversible neurodevelopmental effects in their children. The time has come for a national public health education and supplementation program to ensure iodine requirements are met for all, not just a few, women of childbearing age.

Authors

  • Karen E Charlton1
  • Creswell J Eastman AM2,3
  • 1. School of Health Sciences, University of Wollongong, Wollongong, NSW.
  • 2. Sydney Medical School, University of Sydney, Sydney, NSW.
  • 3. Sydney Thyroid Clinic, Westmead Specialist Centre, Sydney, NSW.

Correspondence: karenc@uow.edu.au

Competing interests

Creswell Eastman has received honoraria for lectures on women’s health sponsored by educational grants from Blackmores, a manufacturer of iodine-containing pregnancy-related supplements.

References

View this article on Wiley Online Library