Pregnant women in Austria commonly suffer from iodine deficiency, which can negatively affect the developing brain of their unborn child. This conclusion comes from a joint study by the Endocrinology and Metabolism Unit at the University Department of Internal Medicine III, the University Department of Gynaecology at the Medical University of Vienna (MedUni Vienna), and AGES, published in the European Journal of Clinical Nutrition.
The research indicates that many Austrian women already have depleted iodine stores before they become pregnant. According to the study authors, Heidelinde Lindorfer and Alois Gessl of the University Department of Internal Medicine III at MedUni Vienna, starting iodine supplements only after pregnancy is diagnosed is often too late. Pregnancy increases the body’s iodine requirement by roughly 50 percent, and if pre-pregnancy iodine reserves are low, they cannot be replenished quickly enough during gestation to meet the higher demand.
Austria’s general population appears prone to borderline iodine deficiency. The country’s mandated level of salt iodisation is comparatively low—around 15 to 20 milligrams of iodine per kilogram of salt—and has declined over time. By contrast, World Health Organization (WHO) guidance recommends salt iodisation in the range of 20–40 milligrams per kilogram. Low iodisation contributes to limited dietary iodine intake overall, and this becomes especially consequential for women of childbearing age.
Migrants have higher iodine levels
Using urine measurements by mass spectrometry, the study found that women with a migration background had higher urinary iodine concentrations than native Austrian women. This difference was observed regardless of the week of pregnancy and irrespective of whether the women had gestational diabetes.
The WHO recommends a daily iodine intake of about 250 micrograms for pregnant women, and that same level should be maintained during breastfeeding. In many countries the primary source of dietary iodine is iodised table salt. However, public health messages and medical advice that promote lower salt consumption for cardiovascular health can unintentionally reduce iodine intake unless iodised salt and supplementation are considered together.
Iodine is essential for fetal brain development. Even mild iodine deficiency during pregnancy has been associated with subtle but measurable impacts on cognitive development. The authors note that research from other countries has linked mild iodine deficiency during pregnancy with small reductions in offspring IQ scores, underscoring that adequate iodine is important even when severe deficiency is uncommon.
The most severe consequences of long-standing, extreme iodine deficiency include cretinism, a condition that can involve profound cognitive impairment, growth and skeletal abnormalities, and thyroid dysfunction. Fortunately, such severe forms of iodine deficiency have been eradicated in Austria, though milder insufficiencies remain a public health concern.
Pregnant women in Austria are prevention sceptics
The study also highlights low uptake of preventive supplements among pregnant women. Of the 246 women surveyed in the diabetic outpatient clinic at the University Department of Internal Medicine III and the antenatal clinic at MedUni Vienna’s University Department of Gynaecology, one third reported taking no vitamins or pregnancy supplements at all, including folic acid. Among the remaining two thirds who did take supplements, only about half were using a preparation that contained iodine. Lindorfer and Gessl conclude that most women are not sufficiently aware of iodine’s importance during pregnancy, and they call for more active involvement from health authorities and prenatal care providers to improve education and supplement use.
Contact: Press Office – Medical University of Vienna
Source: Medical University of Vienna press release
Image Source: The image is credited to Skitterphoto and has been released into the public domain
Original Research: Iodine deficiency in pregnant women in Austria by H. Lindorfer, M. Krebs, A. Kautzky-Willer, D. Bancher-Todesca, M. Sager, and A. Gessl, published in the European Journal of Clinical Nutrition (published online December 10, 2014; doi:10.1038/ejcn.2014.253)
Implications for public health are clear: women planning pregnancy should assess their iodine intake and discuss supplementation with their healthcare provider. Clinicians and public health officials should ensure that guidance about salt reduction is balanced with recommendations that preserve adequate iodine intake—through iodised salt where appropriate and through supplements when needed—especially for women of reproductive age. Improving awareness and prenatal care practices can help protect fetal brain development and reduce the risk of preventable cognitive consequences associated with inadequate iodine during pregnancy.