Insufficient iodine status in pregnant women as a consequence of dietary changes

Background: Historically, Iceland has been an iodine-sufficient nation due to notably high fish and milk consumption. Recent data suggest that the intake of these important dietary sources of iodine has decreased considerably. Objective: To evaluate the iodine status of pregnant women in Iceland and to determine dietary factors associated with risk for deficiency. Methods: Subjects were women (n = 983; 73% of the eligible sample) attending their first ultrasound appointment in gestational weeks 11-14 in the period October 2017-March 2018. Spot urine samples were collected for assessment of urinary iodine concentration (UIC) and creatinine. The ratio of iodine to creatinine (I/Cr) was calculated. Median UIC was compared with the optimal range of 150-249 mu g/L defined by the World Health Organization (WHO). Diet was assessed using a semiquantitative food frequency questionnaire (FFQ), which provided information on main dietary sources of iodine in the population studied (dairy and fish). Results: The median UIC (95% confidence interval (CI)) and I/Cr of the study population was 89 mu g/L (42, 141) and 100 (94, 108) mu g/g, respectively. UIC increased with higher frequency of dairy intake, ranging from median UIC of 55 (35, 79) mu g/L for women consuming dairy products <1 time per week to 124 (98, 151) mu g/L in the group consuming dairy >2 times per day (P for trend <0.001). A small group of women reporting complete avoidance of fish (n = 18) had UIC of 50 (21, 123) mu g/L and significantly lower I/Cr compared with those who did not report avoidance of fish (58 (34, 134) mu g/g vs. 100 (94, 108) mu g, P = 0.041). Women taking supplements containing iodine (n = 34, 3.5%) had significantly higher UIC compared with those who did not take supplements (141 (77, 263) mu g/L vs. 87 (82, 94), P = 0.037). Conclusion: For the first time, insufficient iodine status is being observed in an Icelandic population. There is an urgent need for a public health action aiming at improving iodine status of women of childbearing age in Iceland.