Abstract
Objective: Nearly two-thirds of the population of Western and Central Europe live in countries that are iodine deficient. Damage to reproductive function and to the development of the fetus and newborn is the most important consequence of iodine deficiency. The objective of this review was to examine the iodine status of pregnant women in Europe and the potential need for iodine supplementation.
Design: A MEDLINE/PubMed search and compilation of all published studies since 1990 of iodine nutrition and iodine supplementation of pregnant women in Europe, as well as an Internet-based search and review on availability and legislation of iodine supplements in the European Union.
Results: Although the data suggest most women in Europe are iodine deficient during pregnancy, less than 50% receive supplementation with iodine. Mild-to-moderate iodine deficiency during pregnancy adversely affects thyroid function of the mother and newborn and mental development of the offspring and these adverse effects can be prevented or minimized by supplementation. There are no published data on the effect of iodine supplementation on long-term maternal and child outcomes. The iodine content of prenatal supplements in Europe varies widely; many commonly used products contain no iodine. The European Union is developing legislation to establish permissible levels for iodine in food supplements.
Conclusions: In most European countries, pregnant women and women planning a pregnancy should receive an iodine-containing supplement (≈150 μg/day). Kelp and seaweed-based products, because of unacceptable variability in their iodine content, should be avoided. Prenatal supplement manufacturers should be encouraged to include adequate iodine in their products. Professional organizations should influence evolving EU legislation to ensure optimal doses for iodine in prenatal vitamin–mineral supplements.
Sponsorship: International Council for Control of Iodine Deficiency Disorders.
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References
Aboul-Khair SA, Crooks J, Turnbull AC & Hytten FE (1964): The physiological changes in thyroid function during pregnancy. Clin. Sci. 27, 195–207.
Antonangeli L, Maccherini D, Cavaliere R, Di Giulio C, Reinhardt B, Pinchera A & Aghini-Lombardi F (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, 29–34.
Berghout A & Wiersinga W (1998): Thyroid size and thyroid function during pregnancy: an analysis. Eur. J. Endocrinol. 138, 536–542.
Bergmann R, Huch R, Bergmann KE & Dudenhausen JW (1997): Nutrition and prevention during pregnancy (in German). Vitaminspur. 12, 173–178.
Bleichrodt N & Born MP (1994): A metaanalysis of research on iodine and its relationship to cognitive development. In The Damaged Brain of Iodine Deficiency ed. JB Stanbury, pp 195–200. New York: Cognizant Communication.
Brussaard JH, Brants HA, Hulshof KF, Kistemaker C & Lowik MR (1997): Iodine intake and urinary excretion among adults in the Netherlands. Eur. J. Clin. Nutr. 51 (Suppl 3), S59–62.
Cao XY, Jiang XM, Dou ZH, Rakeman MA, Zhang ML, O'Donnell K, Ma T, Amette K, DeLong N & DeLong GR (1994): Timing of vulnerability of the brain to iodine deficiency in endemic cretinism. N. Engl. J. Med. 331, 1739–1744.
Caron P, Hoff M, Bazzi S, Dufor A, Faure G, Ghandour I, Lauzu P, Lucas Y, Maraval D, Mignot F, Ressigeac P, Vertongen F & Grange V (1997): Urinary iodine excretion during normal pregnancy in healthy women living in the southwest of France: correlation with maternal thyroid parameters. Thyroid 7, 749–754.
Delange F (1996): Administration of iodized oil during pregnancy: a summary of the published evidence. Bull. WHO 74, 101–108.
Delange F (2001): Iodine deficiency as a cause of brain damage. Postgrad. Med. J. 77, 217–220.
Delange F (2002): Iodine deficiency in Europe. Thyroid Int. 5, 3–18.
Dunn JT & Delange F (2001): Damaged reproduction: the most important consequence of iodine deficiency. J. Clin. Endocrinol. Metab. 86, 2360–2363.
Elnagar B, Eltom A, Wide L, Gebre-Medhin M & Karlsson FA (1998): Iodine status, thyroid function and pregnancy: study of Swedish and Sudanese women. Eur. J. Nutr. 52, 351–355.
European Union website at: http://europa.eu.int/comm/food/fs/sfp/df/df_fs_en.html (accessed August 2003).
German Ministry of Health (1998): Iodine Monitoring 1996. In Vol. 110, Series of the German Ministry of Health (in German). Nomos: Baden-Baden.
Glinoer D (2003): The maternal handling of iodine and metabolism of thyroid hormone during pregnancy. In Thyroid and Brain eds G Morreale de Escobar, JJM de Vijlder, S Butz & V Hostalek pp 97–112. Stuttgart: Schattauer.
Glinoer D, de Nayer P, Bourdoux P, Lemone M, Robyn C, van Steirteghem A, Kinthaert J & Lejeune B (1990): Regulation of maternal thyroid during pregnancy. J. Clin. Endocrinol. Metab. 71, 276–287.
Glinoer D, de Nayer P, Delange F, Lemone M, Toppet V, Spehl M, Grun JP, Kinthaert J & Lejeune B (1995): A randomized trial for the treatment of mild iodine deficiency during pregnancy: maternal and neonatal effects. J. Clin. Endocrinol. Metab. 80, 258–269.
Glinoer D & Delange F (2000): The potential repercussions of maternal, fetal and neonatal hypothyroxinemia on the progeny. Thyroid 10, 871–887.
Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, O'Heir CE, Mitchell ML, Hermos RJ, Waisbren SE, Faix JD & Klein RZ (1999): Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N. Engl. J. Med. 341, 549–555.
Hess SY, Zimmermann MB, Torresani T, Burgi H & Hurrell RF (2001): Monitoring the adequacy of salt iodization in Switzerland: a national study of school children and pregnant women. Eur. J. Clin. Nutr. 55, 162–166.
Institute of Medicine (IOM), Food and Nutrition Board (2001): Iodine. In Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc pp 258–289. Washington, DC: National Academy Press.
Lee SM, Lewis J, Buss DH, Holcombe GD & Lawrance PR (1994): Iodine in British foods and diets. Br. J. Nutr. 72, 435–446.
Liesenkötter KP, Gopel W, Bogner U, Stach B & Grüters A (1996): Earliest prevention of endemic goiter by iodine supplementation during pregnancy. Eur. J. Endocrinol. 134, 443–448.
Mezosi E, Molnar I, Jakab A, Balogh E, Karanyi Z, Pakozdy Z, Nagy P, Gyory F, Szabo J, Bajnok L, Leovey A, Kakuk G & Nagy EV (2000): Prevalence of iodine deficiency and goitre during pregnancy in east Hungary. Eur. J. Endocrinol. 143, 479–483.
Mocan MZ, Erem C, Telatar M & Mocan H (1995): Urinary iodine levels in pregnant women with and without goiter in the Eastern Black Sea part of Turkey. Trace Element Electrolyte 12, 195–197.
Nohr SB, Jorgensen A, Pedersen KM & Laurberg P (2000): Postpartum thyroid dysfunction in pregnant thyroid peroxidase antibody-positive women living in an area with mild to moderate iodine deficiency: is iodine supplementation safe? J. Clin. Endocrinol. Metab. 85, 3191–3198.
Nohr SB & Laurberg P (2000): Opposite variations in maternal and neonatal thyroid function induced by iodine supplementation during pregnancy. J. Clin. Endocrinol. Metab. 85, 623–627.
Nohr SB, Laurberg P, Borlum KG, Pedersen KM, Johannesen PL, Damm P, Fuglsang E & Johansen A (1993): Iodine deficiency in pregnancy in Denmark. Regional variations and frequency of individual iodine supplementation. Acta Obstet. Gynecol. Scand. 72, 350–353.
Park YK, Kim I & Yetley EA (1991): Characteristics of vitamin and mineral supplement products in the United States. Am. J. Clin. Nutr. 54, 750–759.
Pedersen KM, Laurberg P, Iversen E, Knudsen PR, Gregersen HE, Rasmussen OS, Larsen KR, Eriksen GM & Johannesen PL (1993): Amelioration of some pregnancy-associated variations in thyroid function by iodine supplementation. J. Clin. Endocrinol. Metab. 77, 1078–1083.
Pharoah POD, Buttfield IH & Hetzel BS (1971): Neurological damage to the fetus resulting from severe iodine deficiency during pregnancy. Lancet i, 308–310.
Rasmussen LB, Ovesen L, Bulow I, Jorgensen T, Knudsen N, Laurberg P & Pertild H (2002): Dietary iodine intake and urinary iodine excretion in a Danish population: effect of geography, supplements and food choice. Br. J. Nutr. 87, 61–69.
Romano R, Jannini EA, Pepe M, Grimaldi A, Olivieri M, Spennati P, Cappa F & D'Armiento M (1991): The effects of iodoprophylaxis on thyroid size during pregnancy. Am. J. Obstet. Gynecol. 164, 482–485.
Smyth PPA (1999): Variation in iodine handling during normal pregnancy. Thyroid 9, 637–642.
Smyth PPA, Hetherto AMT, Smith DF, Radcliff M & O'Herlihy C (1997): Maternal iodine status and thyroid volume during pregnancy: correlation with neonatal iodine intake. J. Clin. Endocrinol. Metab. 82, 2840–2843.
Vitti P, Delange F, Pinchera A, Zimmermann M & Dunn JT (2003): Europe is iodine deficient. Lancet 361, 1226.
WHO/UNICEF/ICCIDD (2001): Assessment of Iodine Deficiency Disorders and Monitoring their Elimination WHO/NHD/01.1. Geneva: World Health Organization.
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Guarantor: M Zimmermann.
Contributors: Both MZ and FD gathered and analyzed the published data and each contributed to the interpretation and discussion. The main preparation of the manuscript was done by MZ with revisions and editing by FD.
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Zimmermann, M., Delange, F. Iodine supplementation of pregnant women in Europe: a review and recommendations. Eur J Clin Nutr 58, 979–984 (2004). https://doi.org/10.1038/sj.ejcn.1601933
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DOI: https://doi.org/10.1038/sj.ejcn.1601933
Keywords
- women
- pregnancy
- Europe
- iodine
- deficiency
- supplementation
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