January 05, 2017
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Guidelines needed to address iodine supplementation in pregnancy

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Despite routine recommendation of prenatal multivitamins before conception, pregnancy and lactation, many obstetricians and midwives fail to recommend iodine supplementation or to recommend an adequate amount.

“This failure to recommend iodine supplementation routinely may be due to the absence of specific guidelines of some obstetrical and midwifery societies, including the American Congress of Obstetricians and Gynecologists and the [American College of Nurse-Midwives], and to a lack of knowledge about the iodine status of U.S. pregnant women,” the researchers wrote.

Lewis E. Braverman, MD, professor of medicine in the section of endocrinology, diabetes and nutrition, Boston University School of Medicine, evaluated 199 midwives who were members of the American College of Nurse-Midwives and 277 obstetricians who were members of the AMA to determine their awareness of iodine nutrition and clinical practice regarding iodine supplementation.

Lewis Braverman
Lewis E. Braverman

“There is evidence that the major cause worldwide of a decrease in IQ is a lack of iodine during pregnancy,” Braverman told Endocrine Today. “The societies that are most involved with the care of pregnant women should emphasize that vitamins should be prescribed that contain iodine.”

Among obstetricians, 34.8% believed the iodine status of U.S. pregnant women was deficient, 46.7% believed it was adequate and 13% did not know. Results among midwives were similar, with 43.4% reporting iodine status as deficient, 32.1% as adequate and 15.3% did not know. Two-thirds of both groups reported that inadequate iodine status may result in adverse effects in the fetus; 60% of both groups reported iodine supplementation was useful for pregnant women and women of childbearing age.

More than 90% of both groups would recommend prenatal multivitamins for women planning pregnancy, pregnant women and lactating women, whereas iodine-containing prenatal multivitamins were recommended less often during preconception (68.7% of obstetricians; 70.2% of midwives), pregnancy (66% of obstetricians; 67.1% of midwives) and lactation (68.7% of obstetricians; 71.7% of midwives).

Forty-five percent of participants who would recommend iodine supplementation would recommend 150 µg, whereas 75% of all participants would not recommend supplementation or would recommend inadequate amounts.

“Doctors and midwives should be more aware of the need for extra iodine during pregnancy and lactation,” Braverman told Endocrine Today. “We were amazed, after all of the publicity that has been going on in the medical community and the endocrine community about the necessity for extra iodine and lactation for the welfare of the baby and fetus that the vast majority don’t recommend supplementation. Unless physicians prescribe prenatal vitamins with iodine or make sure the ladies are taking it, it is unknown. I think that the patient should bring in their bottle of vitamins and doctors should check the label to see if they contain iodine or not.” – by Amber Cox

For more information:

Lewis E. Braverman, MD, can be reached at lewis.braverman@bmc.org.

Disclosure: The researchers report no relevant financial disclosures.