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Hormones

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Iodine nutrition in pregnant and breastfeeding women: sufficiency, deficiency, and supplementation

  • Hossein DelshadEmail author
  • Fereidoun Azizi
Review Article
  • 20 Downloads

Abstract

Iodine is a micronutrient used by the thyroid gland to produce thyroid hormones, which manage different aspects of body metabolism. Humans depend on exogenous sources of iodine to maintain the normal concentration of thyroid hormones. Pregnancy alters iodine turnover and is associated with significant changes in thyroid function. Daily iodine requirement during pregnancy increases to 250 μg, compared with 150 μg for nonpregnant women. According to recent guidelines of scientific organizations, to improve maternal thyroid status and to prevent child neurocognitive defects, all pregnant and breastfeeding women should take 150 μg of iodine supplementation, not only in iodine-deficient regions but also in iodine-sufficient areas. However, some recent studies have confirmed that iodine supplementation of mildly iodine-deficient pregnant women has no clear benefits as concerns maternal thyroid function or child neurodevelopment.

Keywords

Iodine supplementation Pregnancy Lactation Iodine deficiency Iodine status 

Notes

Acknowledgments

The authors wish to acknowledge Ms. Niloofar Shiva for her critical editing of the English grammar and syntax of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Zimmermann MB (2012) The effects of iodine deficiency in pregnancy and infancy. Paediatr Perinat Epidemiol 26(supp 1):108–117PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Zimmermann MB, Gizak M, Abbott K et al (2015) Iodine deficiency in pregnant women in Europe. Lancet Diabetes Endocrinol 3:672–674PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Clar C, Wu T, Liu G, Li P (2002) Iodized salt for iodine deficiency disorders. A systematic review. Endocrinol Metab Clin N Am 31(3):681–698CrossRefGoogle Scholar
  4. 4.
    Vought R, London W (1967) Iodine intake, excretion and thyroidal accumulation in healthy subjects. J Clin Endocrinol Metab 27(7):913–919PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Zimmermann MB, Jooste PL, Pandav CS (2008) Iodine-deficiency disorders. Lancet 372(9645):1251–1262PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Fisher DA, Oddie TH (1969) Thyroid iodine content and turnover in euthyroid subjects: validity of estimation of thyroid iodine accumulation from short-term clearance studies. J Clin Endocrinol Metab 29(5):721–727PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Azizi F, Smyth P (2009) Breastfeeding and maternal and infant iodine nutrition. Clin Endocrinol 70(5):803–809CrossRefGoogle Scholar
  8. 8.
    Bruhn JC, Franke AA (1983) Iodine in human milk. J Dairy Sci 66(6):1396–1398PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Cavalieri RR (1997) Iodine metabolism and thyroid physiology: current concepts. Thyroid. 7(2):177–181PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    World Health Organization. United Nations Children’s Fund & International Council for the Control of Iodine Deficiency Disorders (2007) Assessment of iodine deficiency disorders and monitoring their elimination. 3rd ed. WHO, GenevaGoogle Scholar
  11. 11.
    Glinoer D (1997) The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev 18(3):404–433CrossRefGoogle Scholar
  12. 12.
    Krassas G, Poppe K, Glinoer D (2010) Thyroid function and human reproductive health. Endocr Rev 31(5):702–755PubMedCrossRefGoogle Scholar
  13. 13.
    Roti E, Fang SL, Emerson CH, Braverman LE (1981) Placental inner ring iodothyronine deiodination: a mechanism for decreased passage of T4 and T3 from mother to fetus. Trans Assoc Am Phys 94:183–189PubMedGoogle Scholar
  14. 14.
    Stulc J (1997) Placental transfer of inorganic ions and water. Physiol Rev 77:805–836PubMedCrossRefGoogle Scholar
  15. 15.
    Di Cosmo C, Fanelli G, Tonacchera M et al (2006) The sodium-iodide symporter expression in placental tissue at different gestational age: an immunohistochemical study. Clin Endocrinol 65:544–548CrossRefGoogle Scholar
  16. 16.
    Bizhanova A, Kopp P (2009) Minireview: the sodium-iodide symporter NIS and pendrin in iodide homeostasis of the thyroid. Endocrinology 150:1084–1090PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Glinoer D (2004) The regulation of thyroid function during normal pregnancy: importance of the iodine nutrition status. Best Pract Res Clin Endocrinol Metab 18(2):133–152PubMedCrossRefGoogle Scholar
  18. 18.
    Smyth PP (1999) Variation in iodine handling during normal pregnancy. Thyroid 9(7):637–642PubMedCrossRefGoogle Scholar
  19. 19.
    Bath SC, Steer CD, Golding J et al (2013) Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet 382:331–337PubMedCrossRefGoogle Scholar
  20. 20.
    Pop VJ, Kuijpens JL, van Baar AL et al (1999) Low maternal free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy. Clin Endocrinol 50(2):149–155CrossRefGoogle Scholar
  21. 21.
    Zimmermann MB, Andersson M (2012) Update on iodine status worldwide. Curr Opin Endocrinol Diabetes Obes 19(5):382–387CrossRefGoogle Scholar
  22. 22.
    Hetzel B (1983) Iodine deficiency disorders (IDD) and their eradication. Clin Obstet Gynecol 322(8359):1126–1129Google Scholar
  23. 23.
    Glinoer D (2007) The importance of iodine nutrition during pregnancy. Public Health Nutr 10(12A):1542–1546PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Haddow JE, Palomaki GE, Allan WC et al (1999) Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 341(8):549–555PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Stagnaro-Green A (2011) Overt hyperthyroidism and hypothyroidism during pregnancy. ClinObstet Gynecol 54:478–487Google Scholar
  26. 26.
    Mannisto T, Mendola P, Grewal J et al (2013) Thyroid diseases and adverse pregnancy outcomes in a contemporary US cohort. J Clin Endocrinol Metab 98:2725–2733PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Karakosta P, Alegakis D, Georgiou V et al (2012) Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes. J Clin Endocrinol Metab 97:4464–4447PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Toulis KA, Stagnaro-Green A, Negro R (2014) Maternal subclinical hypothyroidsm and gestational diabetes mellitus: a meta-analysis. Endocr Pract 20(7):703–714PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Jia M, Wu Y, Lin B et al (2019) Meta-analysis of the association between maternal subclinical hypothyroidism and gestational diabetes mellitus. J Gynaecol Obstet 144(3):239–247Google Scholar
  30. 30.
    Allan WC, Haddow JE, Palomaki GE et al (2000) Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen 7:127–130PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Benhadi N, Wiersinga WM, Reitsma JB et al (2009) Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death. Eur J Endocrinol 160:985–991PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Negro R, Schwartz A, Gismondi R et al (2010) Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy. J Clin Endocrinol Metab 95:E44–E48PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Cleary-Goldman J, Malone FD, Lambert-Messerlian G et al (2008) Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol 112:85–92PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Zoeller R, Rovet J (2004) Timing of thyroid hormone action in the developing brain: clinical observations and experimental findings. J Neuroendocrinol 16(10):809–818PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Glinoer D (2001) Pregnancy and iodine. Thyroid. 11(5):471–481PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Hynes KL, Otahal P, Hay I et al (2013) Mild iodine deficiency during pregnancy is associated with reduced educational outcomes in the offspring: 9-year follow-up of the gestational iodine cohort. J Clin Endocrinol Metab 98(5):1954–1962PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    van Mil NH, Tiemeier H, Bongers-Schokking JJ et al (2012) Low urinary iodine excretion during early pregnancy is associated with alterations in executive functioning in children–3. J Nutr 142(12):2167–2174PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Ghassabian A, Steenweg-de Graaff J, Peeters RP et al (2014) Maternal urinary iodine concentration in pregnancy and children’s cognition: results from a population-based birth cohort in an iodine-sufficient area. BMJ Open 4:e005520PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Oken E, Braverman LE, Platek D et al (2009) Neonatal thyroxine, maternal thyroid function, and child cognition. J Clin Endocrinol Metab 94:497–503PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Murcia M, Rebagliato M, Iñiguez C et al (2011) Effect of iodine supplementation during pregnancy on infant neurodevelopment at 1 year of age. Am J Epidemiol 173:804–812PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Vermiglio F, Lo Presti V, Moleti M et al (2004) Attention deficit and hyperactivity disorders in the offspring of mothers exposed to mild-moderate iodine deficiency: a possible novel iodine deficiency disorder in developed countries. J Clin Endocrinol Metab 89(12):6054–6060PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Rebagliato M, Murcia M, Alvarez-Pedrerol M et al (2013) Iodine supplementation during pregnancy and infant neuropsychological development. INMA Mother and Child Cohort Study. Am J Epidemiol 177:944–953PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Taylor PN, Okosieme OE, Dayan CM et al (2014) Therapy of endocrine disease: impact of iodine supplementation in mild-to-moderate iodine deficiency: systematic review and meta-analysis. Eur J Endocrinol 170(1):R1–R15PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Azizi F, Kalani H, Kimiagar M et al (1995) Physical, neuromotor and intellectual impairment in non-cretinous schoolchildren with iodine deficiency. Int J Vitam Nutr Res 65(3):199–205PubMedPubMedCentralGoogle Scholar
  45. 45.
    Oken E, Braverman LE, Platek D (2009) Neonatal thyroxin, maternal thyroid function, and child cognition. J Clin Endocrinol Metab 94:497–503PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Abel MH, Caspersen IH, Meltzer HM et al (2017) Suboptimal maternal iodine intake is associated with impaired child neurodevelopment at 3 years of age in the Norwegian Mother and Child Cohort Study. J Nutr 147:1314–1324PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Levie D, Korevaar TIM, Bath SC. et al. (2019) Association of maternal iodine status with child IQ: a meta-analysis of individual-participant data. J Clin Endocrinol MetabGoogle Scholar
  48. 48.
    Gushurst CA, Mueller JA, Green JA et al (1984) Breast milk iodide: reassessment in the 1980s. Pediatrics. 73(3):354–357PubMedPubMedCentralGoogle Scholar
  49. 49.
    Zimmermann MB (2008) Iodine deficiency in pregnancy and the effects of maternal iodine supplementation on the offspring: a review. Am J Clin Nutr 89(2):668S–672SPubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Liesenkötter KP, Göpel W, Bogner U et al (1996) Earliest prevention of endemic goiter by iodine supplementation during pregnancy. Eur J Endocrinol 134(4):443–448PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Pedersen K, Laurberg P, Iversen E et al (1993) Amelioration of some pregnancy-associated variations in thyroid function by iodine supplementation. J Clin Endocrinol Metab. 77(4):1078–1083PubMedPubMedCentralGoogle Scholar
  52. 52.
    Pastorelli AA, Stacchini P, Olivieri A (2015) Daily iodine intake and the impact of salt reduction on iodine prophylaxis in the Italian population. Eur J Clin Nutr 69(2):211–215PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Dold S, Zimmermann MB, Jukic T et al (2018) Universal salt iodization provides sufficient dietary iodine to achieve adequate iodine nutrition during the first 1000 days: a cross-sectional multicenter study. J Nutr 148(4):587–598PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Gowachirapant S, Winichagoon P, Wyss L et al (2009) Urinary iodine concentrations indicate iodine deficiency in pregnant Thai women but iodine sufficiency in their school-aged children. J Nutr 139:1169–1172PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Wong EM, Sullivan KM, Perrine CG et al (2011) Comparison of median urinary iodine concentration as an indicator of iodine status among pregnant women, school-age children, and nonpregnant women. Food Nutr Bull 32:206–212PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Vandevijvere S, Mourri AB, Amsalkhir S et al (2012) Fortification of bread with iodized salt corrected iodine deficiency in school-aged children, but not in their mothers: a national cross-sectional survey in Belgium. Thyroid 22:1046–1053PubMedCrossRefGoogle Scholar
  57. 57.
    Delshad H, Touhidi M, Abdollahi Z et al (2016) Inadequate iodine nutrition of pregnant women in an area of iodine sufficiency. J Endocrinol Investig 39(7):755–762CrossRefGoogle Scholar
  58. 58.
    Dahl L, Wik Markhus M, Sanchez PVR et al (2018) Iodine deficiency in a study population of Norwegian pregnant women—results from the little in Norway Study (LiN). Nutrients. 10(4):513PubMedCentralCrossRefPubMedGoogle Scholar
  59. 59.
    Yan YQ, Chen Z-P, Yang XM et al (2005) Attention to the hiding iodine deficiency in pregnant and lactating women after universal salt iodization: a multi-community study in China. J Endocrinol Investig 28(8):547–553CrossRefGoogle Scholar
  60. 60.
    Caldwell KL, Makhmudov A, Ely E et al (2011) Iodine status of the US population, National Health and Nutrition Examination Survey, 2005–2006 and 2007–2008. Thyroid. 21(4):419–427PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Pearce EN, Bazrafshan HR, He X et al (2004) Dietary iodine in pregnant women from the Boston, Massachusetts area. Thyroid. 14(4):327–328PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Nazeri P, Mirmiran P, Shiva N et al (2015) Iodine nutrition status in lactating mothers residing in countries with mandatory and voluntary iodine fortification programs: an updated systematic review. Thyroid. 25(6):611–620PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Bath SC, Rayman MP (2015) A review of the iodine status of UK pregnant women and its implications for the offspring. Environ Geochem Health 37(4):619–629PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Condo D, Huyhn D, Anderson AJ et al (2017) Iodine status of pregnant women in South Australia after mandatory iodine fortification of bread and the recommendation for iodine supplementation. Mater Child Nutr 13(4):e12410Google Scholar
  65. 65.
    World Health Organisation. United Nations Children’s Fund. International Council for the Control of Iodine Deficiency Disorders. (2007) Assessment of iodine deficiency disorders and monitoring their elimination. A guide for programme managers. World Health Organisation; Geneva, SwitzerlandGoogle Scholar
  66. 66.
    Institute of Medicine, Food and Nutrition Board (2001) Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy PressGoogle Scholar
  67. 67.
    Markou K, Georgopoulos N, Kyriazopoulou V et al (2001) Iodine-induced hypothyroidism. Thyroid. 11(5):501–510PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Secretariat W, Andersson M, De Benoist B et al (2007) Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old: conclusions and recommendations of the technical consultation. Public Health Nutr 10(12A):1606–1611CrossRefGoogle Scholar
  69. 69.
    Scientific Opinion on Dietary Reference Values for iodine. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) European Food Safety Authority (EFSA), Parma, Italy EFGoogle Scholar
  70. 70.
    Organization WH. Guideline (2014): fortification of food-grade salt with iodine for the prevention and control of iodine deficiency disordersGoogle Scholar
  71. 71.
    Harding KB, Pena-Rosas JP, Webster AC et al (2017) Iodine supplementation for women during the preconception, pregnancy and postpartum period. Cochrane Database Syst Rev 3:CD011761PubMedPubMedCentralGoogle Scholar
  72. 72.
    Pharoah PO, Connolly KJ (1991) Effects of maternal iodine supplementation during pregnancy. Arch Dis Child 66:145–147PubMedPubMedCentralCrossRefGoogle Scholar
  73. 73.
    Pharoah PO, Connolly KJ (1987) A controlled trial of iodinated oil for the prevention of endemic cretinism: a long-term follow-up. Int J Epidemiol 16:68–73PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Velasco I, Carreira M, Santiago P et al (2009) Effect of iodine prophylaxis during pregnancy on neurocognitive development of children during the first two years of life. J Clin Endocrinol Metab 94(9):3234–3241PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Antonangeli L, Maccherini D, Cavaliere R et al (2002) Comparison of two different doses of iodide in the prevention of gestational goiter in marginal iodine deficiency: a longitudinal study. Eur J Endocrinol 147(1):29–34PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Glinoer D, De Nayer P, Delange F et al (1995) A randomized trial for the treatment of mild iodine deficiency during pregnancy: maternal and neonatal effects. The Journal of Clinical Endocrinology & Metabolism 80(1):258–269Google Scholar
  77. 77.
    Nøhr SB, Laurberg P (2000) Opposite variations in maternal and neonatal thyroid function induced by iodine supplementation during pregnancy. The Journal of Clinical Endocrinology & Metabolism. 85(2):623–627Google Scholar
  78. 78.
    Berbel P, Mestre JL, Santamaría A et al (2009) Delayed neurobehavioral development in children born to pregnant women with mild hypothyroxinemia during the first month of gestation: the importance of early iodine supplementation. Thyroid. 19:511–519PubMedCrossRefPubMedCentralGoogle Scholar
  79. 79.
    Romano R, Jannini EA, Pepe M et al (1991) The effects of iodoprophylaxis on thyroid size during pregnancy. Am J Obstet Gynecol 164(2):482–485PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Murcia M, Espada M, Julvez J et al (2018) Iodine intake from supplements and diet during pregnancy and child cognitive and motor development: the INMA Mother and Child Cohort Study. J Epidemiol Community Health 72:216–222PubMedCrossRefGoogle Scholar
  81. 81.
    Zhou SJ, Anderson AJ, Gibson RA et al (2013) Effect of iodine supplementation in pregnancy on child development and other clinical outcomes: a systematic review of randomized controlled trials. Am J Clin Nutr 98(5):1241–1254PubMedCrossRefGoogle Scholar
  82. 82.
    Andersson M, De Benoist B, Delange F. et al. (2007) WHO Secretariat on behalf of the participants to the consultation. Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2:1606–11Google Scholar
  83. 83.
    Gowachirapan S, Jaiswal N, Melse-boonstra A et al (2017) Effect of iodine supplementation in pregnant women on child neurodevelopment: a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol 5:853–863CrossRefGoogle Scholar
  84. 84.
    Zimmermann MB (2007) The adverse effects of mild-to-moderate iodine deficiency during pregnancy and childhood: a review. Thyroid. 17(9):829–835PubMedCrossRefPubMedCentralGoogle Scholar
  85. 85.
    Kirk AB, Kroll M, Dyke JV et al (2012) Perchlorate, iodine supplements, iodized salt and breast milk iodine content. Sci Total Environ 420:73–78PubMedCrossRefPubMedCentralGoogle Scholar
  86. 86.
    Mulrine HM, Skeaff SA, Ferguson EL et al (2010) Breast-milk iodine concentration declines over the first 6 months postpartum in iodine-deficient women. Am J Clin Nutr 92:849–856PubMedCrossRefPubMedCentralGoogle Scholar
  87. 87.
    Bouhouch RR, Bouhouch S, Cherkaoui M et al (2014) Direct iodine supplementation of infants versus supplementation of their breastfeeding mothers: a double-blind, randomized, placebo-controlled trial. Lancet Diabetes Endocrinol 2:197–209PubMedCrossRefPubMedCentralGoogle Scholar

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© Hellenic Endocrine Society 2019

Authors and Affiliations

  1. 1.Micronutrient Research Office, Endocrine Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIslamic Republic of Iran
  2. 2.Endocrine Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIslamic Republic of Iran

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