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Castro Nascimento ND, Borges ALV, Fujimori E, Reis-Muleva B. Training in preconception care focused on primary health care providers: Effects on preconception care knowledge and provision. Heliyon 2024; 10:e30090. [PMID: 38711651 PMCID: PMC11070810 DOI: 10.1016/j.heliyon.2024.e30090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/31/2024] [Accepted: 04/19/2024] [Indexed: 05/08/2024] Open
Abstract
Objective To assess the effect of a rapid training intervention on the knowledge of health providers and the provision of preconception care in primary health care services. Methods Randomized community trial in eight primary health care facilities (four were randomly allocated to the intervention group and four to the control group) in 2020 in Brazil. The intervention consisted of rapid training in preconception health for all health providers in the intervention group. Health providers who had medicine and nursing backgrounds answered structured questionnaires about their knowledge and practices of preconception health-related topics, and reproductive-age women attending the services completed a questionnaire about their experience with preconception care in pre- and postintervention (three months after the intervention) periods. Findings The level of knowledge among health providers increased after the intervention, but providing information about preconception care and prescribing folic acid showed no significant change, with the exception of screening for future pregnancy intention. Key conclusions and implications for practice Although the knowledge of health providers on preconception care is a fundamental requirement for its provision in primary health care settings, rapid training focused on preconception health topics was not sufficient to change their practices, with the exception of pregnancy intention screening, which experienced a slight increase after the training. It appears that additional elements, such as the reorganization of primary health care services to prioritize non-pregnant women, the development and implementation of specific guidelines, along with strategies for the dissemination of preconception care awareness, may also play crucial roles for full preconception care implementation in addition to health providers' knowledge of such issues.
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Affiliation(s)
- Natália de Castro Nascimento
- Public Health Nursing Department, School of Nursing, University of São Paulo, Av. Doutor Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil
| | - Ana Luiza Vilela Borges
- Public Health Nursing Department, School of Nursing, University of São Paulo, Av. Doutor Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil
| | - Elizabeth Fujimori
- Public Health Nursing Department, School of Nursing, University of São Paulo, Av. Doutor Enéas de Carvalho Aguiar, 419, 05403-000, São Paulo, SP, Brazil
| | - Belarmina Reis-Muleva
- Lúrio University of Nampula, Mozambique, Bairro de Marrere, R Nr. 4250, Km 2,3, Nampula, Mozambique
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Bath SC. Thyroid function and iodine intake: global recommendations and relevant dietary trends. Nat Rev Endocrinol 2024:10.1038/s41574-024-00983-z. [PMID: 38693274 DOI: 10.1038/s41574-024-00983-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 05/03/2024]
Abstract
Iodine is a micronutrient that is essential for thyroid hormone production. Adequate iodine intake is especially important during pregnancy and early life, when brain development is dependent on thyroid hormones. Iodine intake recommendations vary around the world, but most recommendations generally reflect the increased requirements during pregnancy and lactation, although adequate iodine intake before pregnancy is also important. Tremendous progress has been made in improving iodine intake across the world over the past 30 years, mainly through salt-iodization programmes. However, in countries without strong iodine fortification programmes, and with shifts in dietary patterns, a need has arisen for health organizations, governments and clinicians to ensure that adequate iodine is consumed by everyone in the population. For example, in countries in which adequate iodine intake depends on individual food choice, particularly of iodine-rich milk and dairy products, intake can be highly variable and is also vulnerable to changing dietary patterns. In this Review, iodine is considered in the wider context of the increasing prevalence of overweight and obesity, the dietary trends for salt restriction for cardiovascular health and the increasing uptake of plant-based diets.
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Affiliation(s)
- Sarah C Bath
- Department of Nutrition, Food and Exercise Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
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Johnsen M, Braaten T, Skeie G, Laholt H, Hansen S. Midwives and public health nurses' knowledge and clinical practice in securing sufficient iodine status in relation to pregnancy. A cross-sectional study. Nurs Open 2023. [PMID: 36840923 DOI: 10.1002/nop2.1675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/21/2022] [Accepted: 02/08/2023] [Indexed: 02/26/2023] Open
Abstract
AIM To investigate midwives' (MWs) and public health nurses' (PHNs) clinical practice and knowledge related to nutrition, with a particular focus on iodine in northern parts of Norway. Maternal iodine status prior to and during pregnancy, and the lactating period, is crucial for brain development and growth of the foetus and infant, from conception up until the first two years of life. In Norway, studies have documented mild to moderate iodine deficiency in this group. DESIGN/METHODS MWs (n = 128) and PHNs (n = 154) responded to a survey regarding nutrition and iodine. Descriptive data and non-parametric tests were used to analyse data. RESULTS Around half of the participants provided dietary guidance to a great extent. Practice of iodine-specific recommendations was lower, particularly regarding lactating women. Compared to other nutrients, iodine was not a priority. CONCLUSION The study indicates a lack of knowledge and poor clinical practice about iodine among MWs and PHNs.
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Affiliation(s)
- Maren Johnsen
- Department of Health Care and Sciences. Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Tonje Braaten
- Department of Community Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Hilde Laholt
- Department of Health Care and Sciences. Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Solrunn Hansen
- Department of Health Care and Sciences. Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
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A review of current knowledge about the importance of iodine among women of child-bearing age and healthcare professionals. J Nutr Sci 2022; 11:e56. [PMID: 35836700 PMCID: PMC9274385 DOI: 10.1017/jns.2022.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022] Open
Abstract
Iodine is required for thyroid hormone synthesis and fetal neurogenesis. Recent population studies in the United Kingdom (UK) have found iodine deficiency among schoolgirls, women of child-bearing age and pregnant women. This review explores knowledge and awareness of iodine among women of child-bearing age and healthcare professionals (HCPs) in the UK, set within a global context. We aimed to identify gaps in iodine knowledge in the current UK setting of iodine deficiency without iodine fortification and where iodine is not included in antenatal guidelines. The search terms ‘iodine knowledge’ and ‘iodine awareness’ were used to identify relevant papers. Iodine knowledge is poor among women of child-bearing age in the UK according to four studies using questionnaires and qualitative methods. They were unsure of dietary sources of iodine and were not consistently provided with relevant information from HCPs during clinical care. Midwives have been recognised as the main providers of dietary information during pregnancy and, although they recognised the importance of their role in providing nutrition advice, they did not feel equipped to do so and lacked confidence in addressing nutritional concerns. Globally, there was a similar lack of knowledge, however, this was somewhat improved by the inclusion of iodine in antenatal care guidelines. Midwives’ knowledge of iodine was poor, as was knowledge among women of child-bearing age. Improved HCP knowledge and effective communication of information to pregnant women and women planning to conceive may help to improve iodine status which is of particular concern in pregnancy.
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Malek L, Umberger WJ, Zhou SJ, Huynh E, Makrides M. Testing the Impact of Familiarity with Health Benefits Information on Dietary Supplement Choice in Pregnancy: An Online Choice Experiment. Nutrients 2022; 14:nu14091707. [PMID: 35565674 PMCID: PMC9105683 DOI: 10.3390/nu14091707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 12/05/2022] Open
Abstract
To help meet the increased requirements for critical nutrients during and around pregnancy, supplementation with essential nutrients is recommended. This study aims to determine how the previous awareness of nutrient health benefits and/or the provision of this information influences the importance placed on nutrients (folate, iodine, omega-3 fatty acids, and vitamin D) when choosing between dietary supplement products for pregnancy. Discrete choice experiment data were collected as part of a cross-sectional online survey administered to 857 pregnant women living in Australia. Four segments of women were identified that differ in their preference criteria when choosing among dietary supplement products for pregnancy. When choosing between products, the reinforcement of perceived health benefits (i.e., showing information on health benefits to those already aware of the benefits) was most effective at increasing the importance of folate (in all segments) and iodine (in two segments, 63% of the sample). Neither prior awareness of health benefits alone nor information provided at the point-of-purchase without prior awareness were enough to increase the importance of folate. Our findings suggest a need for simultaneous strategies that (1) provide information on health benefits before purchase and (2) ensure that information on health benefits is available at the point-of-purchase.
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Affiliation(s)
- Lenka Malek
- Centre for Global Food and Resources, Faculty of Arts, Business, Law and Economics, The University of Adelaide, Level 6 NEXUS 10 Tower, 10 Pulteney Street, Adelaide, SA 5005, Australia;
- Correspondence: ; Tel.: +61-8-8313-9137
| | - Wendy J. Umberger
- Centre for Global Food and Resources, Faculty of Arts, Business, Law and Economics, The University of Adelaide, Level 6 NEXUS 10 Tower, 10 Pulteney Street, Adelaide, SA 5005, Australia;
| | - Shao-Jia Zhou
- School of Agriculture, Food and Wine, Waite Campus, The University of Adelaide, PMB 1, Adelaide, SA 5064, Australia; (S.-J.Z.); (M.M.)
- Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Elisabeth Huynh
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, Australian National University, Acton, ACT 2006, Australia;
| | - Maria Makrides
- School of Agriculture, Food and Wine, Waite Campus, The University of Adelaide, PMB 1, Adelaide, SA 5064, Australia; (S.-J.Z.); (M.M.)
- Women and Kids, South Australian Health and Medical Research Institute, Women’s and Children’s Hospital, 72 King William Road, North Adelaide, SA 5006, Australia
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Jin Y, Coad J, Zhou SJ, Skeaff S, Benn C, Brough L. Use of Iodine Supplements by Breastfeeding Mothers Is Associated with Better Maternal and Infant Iodine Status. Biol Trace Elem Res 2021; 199:2893-2903. [PMID: 33094447 DOI: 10.1007/s12011-020-02438-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/11/2020] [Indexed: 12/21/2022]
Abstract
Adequate iodine status during conception, pregnancy and lactation is essential for supporting infant neurodevelopment. Iodine status in adults and children was improved after two New Zealand government initiatives, but the status of breastfeeding women is unknown. This study aimed to investigate the iodine intake and status of lactating mother-infant pairs at 3 months postpartum and to assess maternal iodine knowledge and practice. Iodine intake was estimated by a weighed 4-day diet diary (4DDD). Maternal urinary iodine concentrations (UIC) in spot urine, breast milk iodine concentrations (BMIC) and infant UIC were measured. Questions about iodine-specific knowledge and practice were asked. In 87 breastfeeding mother-infant pairs, maternal iodine intake was 151 (99, 285) μg/day, and 58% had an intake below the estimated average requirement (EAR) of 190 μg/day. Maternal median UIC (MUIC) was 82 (46, 157) μg/L indicating iodine deficiency (i.e., < 100 μg/L). Women who used iodine-containing supplements had a significantly higher MUIC (111 vs 68 μg/L, P = 0.023) and BMIC (84 vs 62 μg/L, P < 0.001) than non-users. Infants fed by women using iodine-containing supplements had a higher MUIC (150 vs 86 μg/L, P = 0.036) than those of non-users. A total of 66% (57/87) of women had no or low iodine knowledge. The iodine knowledge score was a statistically significant predictor of consuming iodine-containing supplements [(beta = 1.321, P = 0.008)]. Despite a decade of initiatives to increase iodine intakes in New Zealand, iodine knowledge was low; iodine intake and status of these lactating women were suboptimal, but women who used iodine-containing supplement were more likely to achieve adequate status.Study Registration Number (Australia and New Zealand Clinical Trials Registry): ACTRN12615001028594.
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Affiliation(s)
- Ying Jin
- School of Health Sciences, College of Health, Massey University, Palmerston North, New Zealand
| | - Jane Coad
- Nutrition Science, School of Food and Advance Technology, College of Sciences, Massey University, Private Bag 11 222, Palmerston North, 4474, New Zealand
| | - Shao J Zhou
- School of Agriculture, Food and Wine, Faculty of Sciences & Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Sheila Skeaff
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Cheryl Benn
- Mid Central and Whanganui District Health Board, Palmerston North, New Zealand
| | - Louise Brough
- Nutrition Science, School of Food and Advance Technology, College of Sciences, Massey University, Private Bag 11 222, Palmerston North, 4474, New Zealand.
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Kassa A, Human S, Gemeda H. Level of Healthcare Providers' Preconception Care (PCC) Practice and Factors Associated with Non-Implementation of PCC in Hawassa, Ethiopia. Ethiop J Health Sci 2019; 29:903-912. [PMID: 30700958 PMCID: PMC6341445 DOI: 10.4314/ejhs.v29i1.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Healthcare providers (HCPs) are at the forefront of screening and identifying preconception risk factors leading to adverse pregnancy outcomes (APOs). In Ethiopia, there is no published study that assessed the status of the implementation of PCC. This is a study conducted with the aim of determining the level of HCP's PCC practice and factors associated with non-implementation of PCC. Methods This institution based cross-sectional study conducted among HCPs working in public health institutions (PHI) of Hawassa. The data was collected using a validated instrument called ‘Andarg-Ethio PCC-KAPQuestionnaire’. A ltistage sampling was applied to draw a sample of 634 HCPs. The data were analyzed using SPSS software, version 20. Descriptive statistics and binary as well as multiple logistic regression analysis models were used to determine the cruds and adjusted odds ratios. Results Out of the total study participants, 84.7%(537) were found not totally practising PCC. Those HCPs who do not screen their clients' reproductive life plan (RPL) had 7 times higher odds of not practising PCC (AOR=7.2 95% C.I. 3.6 – 14.5), whereas those HCPs with poor PCC knowledge had 4 times higher odds of not practising PCC (AOR= 4.4, 95% C.I. 2.5–7.6). Conclusion The findings of this study demonstrated the absence of standardized and consistent PCC practice which indicates that PCC is not well introduced to the area. Developing of PCC policy and guidelines plus training of HCPs are recommended.
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Affiliation(s)
- Andargachew Kassa
- College of Medicine and Health Sciences Hawassa University, Ethiopia
| | - Sarie Human
- Department of Health Studies University of South Africa, Pretoria, South Africa
| | - Hirut Gemeda
- Department of Midwifery College of Medicine and Health Sciences Hawassa University, Ethiopia
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Abstract
It is well known that severe iodine deficiency during pregnancy may cause impaired brain development in the child, with effects on cognitive and motor function, hearing and speech. Whether mild-to-moderate deficiency also affects neurological development is less well known, but in the past decade a number of observational studies have been conducted to answer this question and these studies are reviewed in this article. The picture is now emerging that even mild-to-moderate iodine deficiency during pregnancy may be associated with subtle impairments in cognition and school performance, although the evidence from randomised controlled trials is still lacking. As global efforts to eradicate iodine deficiency in populations continue, it is more likely that mild-to-moderate, rather than severe, iodine deficiency will be the issue of concern in pregnancy, and therefore further research in regions of mild-to-moderate deficiency is required to strengthen the research base and to inform public-health policy.
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Contemporary challenges to iodine status and nutrition: the role of foods, dietary recommendations, fortification and supplementation. Proc Nutr Soc 2018; 77:302-313. [PMID: 29704906 DOI: 10.1017/s0029665118000137] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Iodine deficiency (ID) in women of childbearing age remains a global public health concern, mainly through its impact on fetal and infant neurodevelopment. While iodine status is improving globally, ID is still prevalent in pregnancy, when requirements increase. More than 120 countries have implemented salt iodisation and food fortification, strategies that have been partially successful. Supplementation during pregnancy is recommended in some countries and supported by the WHO when mandatory salt iodisation is not present. The UK is listed as one of the ten countries with the lowest iodine status globally, with approximately 60 % of pregnant women not meeting the WHO recommended intake. Without mandatory iodine fortification or recommendation for supplementation in pregnancy, the UK population depends on dietary sources of iodine. Both women and healthcare professionals have low knowledge and awareness of iodine, its sources or its role for health. Dairy and seafood products are the richest sources of iodine and their consumption is essential to support adequate iodine status. Increasing iodine through the diet might be possible if iodine-rich foods get repositioned in the diet, as they now contribute towards only about 13 % of the average energy intake of adult women. This review examines the use of iodine-rich foods in parallel with other public health strategies, to increase iodine intake and highlights the rare opportunity in the UK for randomised trials, due to the lack of mandatory fortification programmes.
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Bouga M, Lean MEJ, Combet E. Iodine and Pregnancy-A Qualitative Study Focusing on Dietary Guidance and Information. Nutrients 2018; 10:nu10040408. [PMID: 29587423 PMCID: PMC5946193 DOI: 10.3390/nu10040408] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/16/2018] [Accepted: 03/23/2018] [Indexed: 12/15/2022] Open
Abstract
Iodine is essential for thyroid hormones synthesis and normal neurodevelopment; however, ~60% of pregnant women do not meet the WHO (World Health Organization) recommended intake. Using a qualitative design, we explored the perceptions, awareness, and experiences of pregnancy nutrition, focusing on iodine. Women in the perinatal period (n = 48) were interviewed and filled in a food frequency questionnaire for iodine. Almost all participants achieved the recommended 150 μg/day intake for non-pregnant adults (99%), but only 81% met the increased demands of pregnancy (250 μg/day). Most were unaware of the importance, sources of iodine, and recommendations for iodine intake. Attitudes toward dairy products consumption were positive (e.g., helps with heartburn; easy to increase). Increased fish consumption was considered less achievable, with barriers around taste, smell, heartburn, and morning sickness. Community midwives were the main recognised provider of dietary advice. The dietary advice received focused most often on multivitamin supplements rather than food sources. Analysis highlighted a clear theme of commitment to change behaviour, motivated by pregnancy, with a desired focus on user-friendly documentation and continued involvement of the health services. The study highlights the importance of redirecting advice on dietary requirements in pregnancy and offers practical suggestions from women in the perinatal period as the main stakeholder group.
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Affiliation(s)
- Maria Bouga
- Human Nutrition, School of Medicine, College of Medical, Veterinary and Life Sciences, 10-16 Alexandra Parade, University of Glasgow, Glasgow G31 2ER, UK.
| | - Michael E J Lean
- Human Nutrition, School of Medicine, College of Medical, Veterinary and Life Sciences, 10-16 Alexandra Parade, University of Glasgow, Glasgow G31 2ER, UK.
| | - Emilie Combet
- Human Nutrition, School of Medicine, College of Medical, Veterinary and Life Sciences, 10-16 Alexandra Parade, University of Glasgow, Glasgow G31 2ER, UK.
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Condo D, Huyhn D, Anderson AJ, Skeaff S, Ryan P, Makrides M, Mühlhaüsler BS, Zhou SJ. Iodine status of pregnant women in South Australia after mandatory iodine fortification of bread and the recommendation for iodine supplementation. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27982512 DOI: 10.1111/mcn.12410] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/02/2016] [Accepted: 11/11/2016] [Indexed: 12/25/2022]
Abstract
Mandatory iodine fortification of bread was introduced in 2009 in Australia in response to the reemergence of iodine deficiency. The aim of this study was to assess iodine intake, urinary iodine concentration (UIC) and their correlation in pregnant women (n = 783) recruited from South Australia 2 years following mandatory iodine fortification. Total iodine intake (food and supplements) and UIC were assessed at study entry (<20 weeks') and at 28 weeks' gestation. Mean (±SD) total iodine intake at study entry and 28 weeks' gestation was 307 ± 128 μg/day and 300 ± 127 μg/day, respectively. Overall, 85.9% of women met the estimated average intake (≥160 μg/day) for iodine in pregnancy, but only 44.5% met the estimated average intake from food alone. The main food sources of iodine were dairy foods and iodine-fortified bread. Median (interquartile range) UIC at study entry and 28 weeks' gestation was 189 μg/L and 172 μg/L, respectively. At study entry, median UIC was higher in women taking supplements containing iodine ≥150 μg/day compared with those containing iodine <150 μg/day (221 μg/L vs. 163 μg/L, p = .003) and those not taking supplements containing iodine (221 μg/L vs. 159 μg/L, p < .001). At 28 weeks' gestation, the median UIC for the groups was 187, 152 and 141 μg/L, respectively (each of the two comparisons yielded p < .001). Total iodine intake (food and supplements) from all women was positively, though weakly, correlated with UIC (r = .23, p < .001). In conclusion, pregnant women in South Australia are iodine sufficient postmandatory iodine fortification of bread. However, without iodine supplementation, it may be difficult to achieve a UIC >150 μg/L.
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Affiliation(s)
- Dominique Condo
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia.,Deakin University, School of Exercise and Nutrition Sciences, Geelong, Australia.,Deakin University, Institute for Physical Activity and Nutrition (I-PAN), Geelong, Australia
| | - Dao Huyhn
- FOOD plus Research Centre, School of Agriculture, Food & Wine, University of Adelaide, Waite Campus, Urrbrae, South Australia, Australia
| | - Amanda J Anderson
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia.,Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Sheila Skeaff
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Philip Ryan
- School of Population Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Maria Makrides
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia.,Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Paediatrics & Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Beverly S Mühlhaüsler
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia.,FOOD plus Research Centre, School of Agriculture, Food & Wine, University of Adelaide, Waite Campus, Urrbrae, South Australia, Australia
| | - Shao J Zhou
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia.,FOOD plus Research Centre, School of Agriculture, Food & Wine, University of Adelaide, Waite Campus, Urrbrae, South Australia, Australia
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