Skip to main content
    • Aa
    • Aa

The impact of iodised salt or iodine supplements on iodine status during pregnancy, lactation and infancy

  • Michael B Zimmermann (a1)

Objectives: Monitoring of iodine status during pregnancy, lactation and infancy is difficult as there are no established reference criteria for urinary iodine concentration (UI) for these groups; so it is uncertain whether iodized salt programs meet the needs of these life stages.

Design and Subjects: The method used in this paper was: 1) to estimate the median UI concentration that reflects adequate iodine intake during these life stages; and 2) to use these estimates in a review of the literature to assess whether salt iodisation can control iodine deficiency in pregnant and lactating women, and their infants.

Results: For pregnancy, recommended mean daily iodine intakes of 220-250 μg were estimated to correspond to a median UI concentration of about 150 μg l− 1, and larger surveys from the iodine sufficient countries have reported a median UI in pregnant women ≥ 140 μg l− 1. Iodine supplementation in pregnant women who are mild-to-moderately iodine deficient is beneficial, but there is no clear affect on maternal or newborn thyroid hormone levels. In countries where the iodine intake is sufficient, most mothers have median breast milk iodine concentration (BMIC) greater than the concentration (100-120 μg l− 1) required to meet an infant's needs. The median UI concentration during infancy that indicates optimal iodine nutrition is estimated to be ≥ 100 μg l− 1. In iodine-sufficient countries, the median UI concentration in infants ranges from 90-170 μg l− 1, suggesting adequate iodine intake in infancy.

Conclusions: These findings suggest pregnant and lactating women and their infants in countries with successful sustained iodised salt programs have adequate iodine status.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The impact of iodised salt or iodine supplements on iodine status during pregnancy, lactation and infancy
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      The impact of iodised salt or iodine supplements on iodine status during pregnancy, lactation and infancy
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      The impact of iodised salt or iodine supplements on iodine status during pregnancy, lactation and infancy
      Available formats
Corresponding author
*Corresponding author: Email
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

5JC Dillon , J Milliez . Reproductive failure in women living in iodine deficient areas of West Africa. British Journal of Obstetrics and Gynaecology 2000; 107: 631–6.

6R Fierro-Benitez , R Cazar , JB Stanbury , P Rodriguez , F Garces , F Fierro-Renoy , E Estrella . Effects on school children of prophylaxis of mothers with iodized oil in an area of iodine deficiency. Journal of Endocrinological Investigation 1988; 11: 327–35.

7POD Pharoah , KJ Connolly . A controlled trial of iodinated oil for the prevention of endemic cretinism: a long-term follow-up. International Journal of Epidemiology 1987; 16: 6873.

9KM Pedersen , P Laurberg , E Iversen , PR Knudsen , HE Gregersen , OS Rasmussen , KR Larsen , GM Eriksen , PL Johannesen . Amelioration of some pregnancy-associated variations in thyroid function by iodine supplementation. Journal of Clinical Endocrinology and Metabolism 1993; 77: 1078–83.

10D Glinoer , P De Nayer , F Delange , M Lemone , V Toppet , M Spehl , JP Grun , J Kinthaert , B Lejeune . A randomized trial for the treatment of mild iodine deficiency during pregnancy: maternal and neonatal effects. Journal of Clinical Endocrinology and Metabolism 1995; 80: 258–69.

11AWC Kung , TT Lao , LCK Low , RWC Pang , JD Robinson . Iodine insufficiency and neonatal hyperthyrotropinemia in Hong Kong. Clinical Endocrinology 1997; 46: 315–9.

13D Glinoer , F Delange . The potential repercussions of maternal, fetal and neonatal hypothyroxinemia on the progeny. Thyroid 2000; 10: 871–87.

16DA Fisher , TH Oddie . Thyroidal radioiodine clearance and thyroid iodine accumulation: Contrast between random daily variation and population data. Journal of Clinical Endocrinology and Metabolism 1969; 29: 111–5.

17DA Fisher , TH Oddie . Thyroid iodine content and turnover in euthyroid subjects: validity of estimation of thyroid iodine accumulation from short term clearance studies. Journal of Clinical Endocrinology and Metabolism 1969; 29: 721–7.

18TH Oddie , DA Fisher , JM Long . Factors affecting the estimation of iodine entering the normal thyroid gland using short-term clearance studies. Journal of Clinical Endocrinology and Metabolism 1964; 24: 924–33.

19HJ Dworkin , JA Jacquez , WH Beierwaltes . Relationship of iodine ingestion to iodine excretion in pregnancy. Journal of Clinical Endocrinology and Metabolism 1966; 26: 1329–42.

20MT Harrison . Iodine balance in man. Postgraduate Medical Journal 1968; 44: 6971.

21MT Harrison , R Harden , WD Alexander , E Wayne . Iodine balance studies in patients with normal and abnormal thyroid function. Journal of Clinical Endocrinology 1965; 25: 1077–84.

22B Malamos , DA Koutras , SG Marketos , GA Rigopoulos , XA Yataganas , D Binopoulos , J Sfontouris , AD Pharmakiotis , RL Vought , WT London . Endemic goiter in Greece: an iodine balance study in the field. Journal of Clinical Endocrinology and Metabolism 1967; 27: 1372–80.

23RL Vought , WT London . Iodine intake, excretion and thyroidal accumulation in healthy subjects. Journal of Clinical Endocrinology and Metabolism 1967; 27: 913–9.

27D Glinoer . The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocrine Reviews 1997; 18: 404–33.

28F Delange . Iodine nutrition and congenital hypothyroidism. In: F Delange , DA Fisher , D Glinoer , eds. Research in Congential Hypothyroidism. New York: Plenum Press, 1989.

31R Romano , EA Jannini , M Pepe , A Grimaldi , M Olivieri , P Spennati , F Cappa , M D'Armiento . The effects of iodoprophylaxis on thyroid size during pregnancy. American Journal of Obsterics and Gynecology 1991; 164: 482–5.

33JG Hollowell , NW Staehling , WH Hannon , DW Flanders , EW Gunter , GF Maberly , LE Braverman , S Pino , DT Miller , P Garbe . Iodine nutrition in the United States. Trends and public health implications: iodine excretion data from National Health and Nutrition Examination Surveys I and III (1971–1974 and 1988–1994). Journal of Clinical Endocrinology and Metabolism 1998; 83: 3401–8.

35S Mattsson , S Lindstrom . Diuresis and voiding pattern in healthy schoolchildren. British Journal of Urology 1995; 76: 783–9.

37E Dafnis , S Sabatini . The effect of pregnancy on renal function: physiology and pathophysiology. American Journal of Medical Science 1992; 303: 184205.

39CS Liberman , SC Pino , SL Fang , LE Braverman , CH Emerson . Circulating iodide concentrations during and after pregnancy. Journal of Clinical Endocrinology and Metabolism 1998; 83: 3545–9.

40P Bourdoux . Evaluation of the iodine intake: Problems of the iodine/creatinine ratio–comparison with iodine excretion and daily fluctuations of iodine concentration. Experimental Clinical Endocrinology and Diabetes 1998; 106: S17S20.

41PPA Smyth , AMT Hetherton , DF Smith , M Radcliff , C O'Herlihy . Maternal iodine status and thyroid volume during pregnancy: correlation with neonatal iodine intake. Journal of Clinical Endocrinology and Metabolism 1997; 82: 2840–3.

42PPA Smyth . Variation in iodine handling during normal pregnancy. Thyroid 1999; 9: 637–42.

43AWC Kung , TT Lao , MT Chau , SCF Tam , LCK Low . Goitrogenesis during pregnancy and neonatal hypothyroxinaemia in a borderline iodine sufficient area. Clinical Endocrinology 2000; 53: 725–31.

44SY Hess , MB Zimmermann , T Torresani , H Bürgi , RF Hurrell . Monitoring the adequacy of salt iodization in Switzerland: a national study of school children and pregnant women. European Journal of Clinical Nutrition 2001; 55: 162–6.

46A Berghout , W Wiersinga . Thyroid size and thyroid function during pregnancy: an analysis. European Journal of Endocrinology 1998; 138: 536–42.

47MB Zimmermann , F Delange . Iodine supplementation of pregnant women in Europe: a review and recommendations. European Journal of Clinical Nutrition 2004; 58: 979–84.

49SB Nohr , P Laurberg , KG Borlum , KM Pedersen , PL Johannesen , P Damm , E Fuglsang , A Johansen . Iodine deficiency in pregnancy in Denmark: regional variations and frequency of individual iodine supplementation. Acta Obsterica et Gynecologica Scandinavica 1993; 72: 350–3.

51E Mezosi , I Molnar , A Jakab , E Balogh , Z Karanyi , Z Pakozdy , P Nagy , F Gyory , J Szabo , L Bajnok , A Leovey , G Kakuk , EV Nagy . Prevalence of iodine deficiency and goitre during pregnancy in East Hungary. European Journal of Endocrinology 2000; 143: 479–83.

52SB Nohr , P Laurberg . Opposite variations in maternal and neonatal thyroid function induced by iodine supplementation during pregnancy. Journal of Clinical Endocrinology and Metabolism 2000; 85: 623–7.

53KP Liesenkötter , W Göpel , U Bogner , B Stach , A Grüters . Earliest prevention of endemic goiter by iodine supplementation during pregnancy. European Journal of Endocrinology 1996; 134: 443–8.

54SB Nohr , A Jorgensen , KM Pedersen , P Laurberg . Postpartum thyroid dysfunction in pregnant thyroid peroxidase antibody-positive women living in an area with mild to moderate iodine deficiency: is iodine supplementation safe? Journal of Clinical Endocrinology and Metabolism 2000; 85: 3191–8.

55L Antonangeli , D Maccherini , R Cavaliere , C Di Giulio , B Reinhardt , A Pinchera , F Aghini-Lombardi . Comparison of two different doses of iodide in the prevention of gestational goiter in marginal iodine deficiency: a longitudinal study. European Journal of Endocrinology 2002; 147: 2934.

56F Vermiglio , VP Lo Presti , MD Finocchiaro , S Battiato , L Grasso , FV Ardita , A Mancuso , F Trimarchi . Enhanced iodine concentration capacity by the mammary gland in iodine deficient lactating women of an endemic goiter region in Sicily. Journal of Endocrinological Investigation 1992; 15: 137–42.

57JG Dorea . Iodine nutrition and breast feeding. Journal of Trace Elements in Medicine and Biology 2002; 16: 207–20.

58S Kurtoglu , M Akcakus , C Kocaoglu , T Gunes , N Budak , M Emre Atabek , I Karakucuk , F Delange . Iodine status remains critical in mother and infant in Central Anatolia (Kayseri) of Turkey. European Journal of Nutrition 2004; 43: 297303.

60RD Semba , F Delange . Iodine in human milk: perspectives for human health. Nutrition Reviews 2001; 59: 269–78.

61EA Pretell , F Moncloa , R Salinas , A Kawano , R Guerra-Garcia , L Gutierrez , L Beteta , J Pretell , M Wan . Prophylaxis and treatment of endemic goiter in Peru with iodized oil. Journal of Clinical Endocrinology and Metabolism 1969; 29: 1586–95.

62ML Chaouki , M Benmiloud . Prevention of iodine deficiency disorders by oral administration of Lipiodol during pregnancy. European Journal of Endocrinology 1994; 130: 547–51.

63SB Nohr , P Laurberg , KG Bortum , KM Pedersen , PL Johannesen , P Damm , E Fuglsang , A Johansen . Iodine status in neonates in Denmark: regional variations and dependency on maternal iodine supplementation. Acta Paediatrica 1994; 83: 578–82.

69F Delange , P Wolff , D Gnat , M Dramaix , M Pilchen , F Vertongen . Iodine deficiency during infancy and early childhood in Belgium: does it pose a risk to brain development? European Journal of Pediatrics 2001; 160: 251–4.

70F Azizi , R Shaikholesmani , M Hedayati , P Mirmiran , H Malekafzali , M Kimiagar . Sustainable control of iodine deficiency in Iran. Journal of Endocrinological Investigation 2002; 25: 409–13.

71B Elnagar , A Eltom , L Wide , M Gebre-Medhin , FA Karlsson . Iodine status, thyroid function and pregnancy: study of Swedish and Sudanese women. European Journal of Nutrition 1998; 52: 351–5.

72L Brander , C Als , H Buess , F Haldimann , M Harder , W Hanggi , U Herrmann , K Lauber , U Niederer , T Zurcher , U Burgi , H Gerber . Urinary iodine concentration during pregnancy in an area of unstable dietary iodine intake in Switzerland. Journal of Endocrinological Investigation 2003; 26: 389–96.

73OP Soldin , SJ Soldin , JC Pezzullu . Urinary iodine percentile ranges in the United States. Clinica Chimica Acta 2003; 328: 185–90.

74D Glinoer , P de Nayer , P Bourdoux , M Lemone , C Robyn , A Van Steirteghem , . Regulation of maternal thyroid during pregnancy. Journal of Clinical Endocrinology and Metabolism 1990; 71: 276–87.

75P Caron , M Hoff , S Bazzi , A Dufor , G Faure , I Ghandour , P Lauzu , Y Lucas , D Maraval , F Mignot , P Ressigeac , F Vertongen , V Grange . Urinary iodine excretion during normal pregnancy in healthy women living in the Southwest of France: correlation with maternal thyroid parameters. Thyroid 1997; 7: 749–54.

76F Vermiglio , VP Lo Presti , MG Castagna , MA Violi , M Moleti , MD Finocchiaro , F Mattina , A Artemisia , F Trimarchi . Increased risk of maternal thyroid failure with pregnancy progression in an iodine deficient area with major iodine deficiency disorders. Thyroid 1999; 9: 1924.

77CD Thomson , MA Packer , JA Butler , AJ Duffield , KL O'Donaghue , PD Whanger . Urinary selenium and iodine during pregnancy and lactation. Journal of Trace Elements in Medicine and Biology 2001; 14: 210–7.

78KJ Schulze , KP West Jr, LA Gautschi , ML Dreyfuss , SC LeClerq , BR Dahal , LS Wu , SK Khatry . Seasonality in urinary and household salt iodine content among pregnant and lactating women of the plains of Nepal. European Journal of Clinical Nutrition 2003; 57: 969–76.

79A Eltom , M Eltom , B Elnagar , M Elbagir , M Gebre-Medhin . Changes in iodine metabolism during late pregnancy and lactation: a longitudinal study among Sudanese women. European Journal of Clinical Nutrition 2000; 54: 429–33.

81A Brander , L Kivisaari . Ultrasonography of the thyroid during pregnancy. Journal of Clinical Ultrasound 1989; 17: 403–6.

82A Berghout , E Endert , A Ross , HV Hogerzeil , NJ Smits , WM Wiersinga . Thyroid function and thyroid size in normal pregnant women living in an iodine replete area. Clinical Endocrinology (Oxford) 1994; 41: 375–9.

84NG Rasmussen , PJ Hornnes , L Hegedus . Ultrasonographically determined thyroid size in pregnancy and post partum: the goitrogenic effect of pregnancy. American Journal of Obstetrics and Gynecology 1989; 160: 1216–20.

86P Lahesmaa , P Vilkki . The iodine content of human milk in Finland. Acta Paediatrica 1960; 49: 371.

88M Chiba , R Ichikawa . Secretion rate of dietary iodine into human milk. Journal of Radiation Research 1968; 9: 1217.

90B Bakker , T Vulsma , J de Randamie , AM Achterhuis , B Wiedij , H Oosting , C Glas , JJ de Vijlder . A negative iodine balance is found in healthy neonates compared with neonates with thyroid agenesis. Journal of Endocrinology 1999; 161: 115–20.

91DM Trabzuni , HS Ibrahim , EH Ewaidah . An assessment of iodine status of Saudi lactating mothers and its relation to iodine intake in Riyadh City. Ecology of Food and Nutrition 1998; 37: 297307.

95RM Parr , EM DeMayer , VG Iyengar , AR Byrne , GF Kirkbright , G Schoch , L Niistro , O Pineda , HL Vis , Y Hofvander , A Omolulu . Minor and trace elements in human milk from Guatemala, Hungary, Nigeria, Phillipines, Sweden and Zaire. Results from a WHO/IAEA Joint Project. Biological Trace Element Research 1991; 29: 5175.

98JC Bruhn , AA Franke . Iodine in human milk. Journal of Dairy Science 1983; 66: 1396–8.

99L Jansson , S Ivarsson , I Larsson , R Ekman . Triiodothyronine and thyroxine in human milk. Acta Paediatrica Scandinavica 1983; 72: 703–5.

104N Etling , F Gehin-Fouque . Iodinated compounds and thyroxine binding to albumin in human breast milk. Pediatrics Research 1984; 18: 901–3.

108PH Heidemann , P Stubbe , K von Reuss , P Schurnbrand , A Larson , W von Petrykowski . Iodine excretion and dietary iodine supply in newborn infants in iodine-deficient regions of West Germany. Deutsche Medizinische Wochenschrift 1984; 109: 773–8.

109A Wiechen , M Kock . Routine determination of low iodine concentration in milk. Fresenius Zeitschrift Analytische Chemie 1984; 319: 569–72.

110R Chierici , D Saccomandi , V Vigi . Dietary supplements for the lactating mother: influence on the trace element content of milk. Acta Paediatrica Supplement 1999; 88: 713.

111N Etling , E Padovani , F Fouque , L Tato . First month variations in total iodine content of human breast milks. Early Human Development 1986; 13: 81–5.

112R Aquaron , K Zarrouck , M el Jarari , R Ababou , A Talibi , JP Ardissone . Endemic goiter in Morocco (Skoura-Toundoute areas in the high Atlas). Journal of Endocrinological Investigation 1993; 16: 914.

116S Ares , J Quero , S Duran , MJ Presas , R Herruzo , G Morreale de Escobar . Iodine content of infant formulas and iodine intake of premature babies: high risk of iodine deficiency. Archives of Disease in Childhood Fetal and Neonatal Edition 1994; 71: F18491.

117L Fernandez-Sanchez , J Szupnar . Speciation analysis for iodine in milk by size-exclusion chromatography with inductively coupled plasma mass spectrometry (SECICPMS). Journal of Analytical Atomic Spectrometry 1999; 14: 1697–702.

120IG Gokmen , G Dagli . Determination of iodine concentration in human-milk, cows milk and infant formula and estimation of daily iodine intake of infants. Analyst 1995; 120: 2005–8.

121F Delange , A Dalhem , P Bourdoux , R Lagasse , D Glinoer , DA Fisher , PG Walfish , AM Ermans . Increased risk of primary hypothyroidism in preterm infants. Journal of Pediatrics 1984; 105: 462–9.

122F Delange , P Heidemann , P Bourdoux , A Larsson , R Vigneri , M Klett , C Beckers , P Stubbe . Regional variations of iodine nutrition and thyroid function during the neonatal period in Europe. Biology of the Neonate 1986; 49: 322–30.

123R Ciardelli , D Haumont , D Gnat , F Vertongen , F Delange . The nutritional iodine supply of Belgian neonates is still insufficient. European Journal of Pediatrics 2002; 161: 519–23.

125A Grüters , KP Liesenkötter , H Willgerodt . Persistence of differences in iodine status in newborns after the reunification of Berlin. New England Journal of Medicine 1995; 333: 1429.

126C Roth , J Meller , S Bobrzik , H Thal , W Becker , D Kulenkampff , M Lakomek , H Zappel . The iodine status of newborns. Deutsche Medizinische Wochenschrift 2001; 126: 321–5.

129M Barakat , D Carson , AM Hetherton , P Smyth , H Leslie . Hypothyroidism secondary to topical iodine treatment in infants with spina bifida. Acta Paediatrica 1994; 83: 741–3.

131G Bona , E Chiorboli , A Rapa , G Weber , MC Vigone , G Chiumello . Measurement of urinary iodine excretion to reveal iodine excess in neonatal transient hypothyroidism. Journal of Pediatric Endocrinology and Metabolism 1998; 11: 739–43.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score