Iodine nutrition in pregnancy and lactation in Iran.

OBJECTIVE To describe studies evaluating urinary iodine excretion during pregnancy and lactation in women living in cities with adequate or more than adequate iodine intake. DESIGN Cross-sectional study conducted between 1996 and 1998 in pregnant women and a study of lactating women conducted in 2003. SETTINGS AND SUBJECTS Pregnant women attending prenatal clinics in four cities in the Islamic Republic of Iran. Urinary iodine excretion and thyroid volume was measured in 403 women. In a second study, 100 lactating women from Taleghani Hospital in Gorgan, Iran were evaluated for thyroid size, and both urinary and breast milk iodine concentrations were determined. RESULTS In Rasht city, 84% of pregnant women had a urinary iodine concentration of > or = 200 microg l-1, while in the other cities this percentage ranged from 45 to 55%. When data were combined for the cities of Ilam, Isfahan and Tehran, where women have an adequate or more than adequate median urinary iodine concentration, 51% of pregnant women had a urinary iodine concentration less than that recommended during pregnancy. In Rasht, where the median urinary iodine concentration indicates an excessive iodine intake, 15.4% of pregnant women had a urinary iodine concentration < 200 microg l-1. The mean urinary iodine concentration in lactating women was 250 microg l-1, and 16% of women had a urinary iodine concentration < 100 microg l-1. Grade 1 goitre was present in 8% of lactating women, and another 8% had grade 2 goitre. CONCLUSIONS Findings of this study call for further attention to iodine intake during pregnancy and lactation. The currently recommended intake of iodine through universal salt iodisation may not be adequate for pregnant and lactating women, and supplementation during pregnancy and lactation should be further considered in light of the latest recommendations.