title: A case for universal salt iodisation to correct iodine deficiency in pregnancy: another salutary lesson from Tasmania.
abstract: OBJECTIVE
  To assess the impact of iodine fortification of bread on the iodine status of pregnant women, and to determine if studies of iodine levels in school-age children were indicative of women's gestational iodine status.
  
  
  METHODS
  Urinary iodine surveys of pregnant Tasmanian women before and after bread was fortified with iodine in October 2001.
  
  
  METHODS
  285 women attending the Royal Hobart Hospital (RHH) antenatal clinic from 1 October 2000 to 30 September 2001 and 517 women attending the RHH antenatal clinic or primary health care centres in 2003-2006.
  
  
  METHODS
  Median urinary iodine concentration (UIC) for comparison against the World Health Organization recommendation of of 150-249 microg/L for pregnant women.
  
  
  RESULTS
  Before supplementation, the median UIC of the 285 women attending the RHH antenatal clinic was 76 microg/L. After supplementation, median UICs were 81 microg/L for 288 women attending primary health care centres and 86 microg/L for 229 women attending the RHH antenatal clinic. Differences in mean UIC were not significant for either the antenatal clinic group (P=0.237) or the primary health care group (P=0.809) compared with the pre-supplementation group.
  
  
  CONCLUSIONS
  Iodine deficiency in pregnancy persists despite being corrected in Tasmanian children. Successful iodine supplementation must target reproductive-age and pregnant women and be substantiated by ongoing monitoring during pregnancy and lactation. A robust national program for correcting iodine deficiency is urgently needed. Mandatory universal salt iodisation has international endorsement, and should be considered the preferred strategy for eliminating iodine deficiency in Australia.
authors.affiliation: Royal Hobart Hospital, Hobart, TAS. jburges@utas.edu.au
authors.forename: John R
authors.initials: JR
authors.lastname: Burgess
authors.forename: Judy A
authors.initials: JA
authors.lastname: Seal
authors.forename: Georgina M
authors.initials: GM
authors.lastname: Stilwell
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Reynolds
authors.forename: E Roscoe
authors.initials: ER
authors.lastname: Taylor
authors.forename: Venkat
authors.initials: V
authors.lastname: Parameswaran
mesh_terms: D000328:Adult; D001939:Bread; D002648:Child; D003677:Deficiency Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000652:urine; D005260:Female; D005527:Food, Fortified; D005865:Gestational Age; D006042:Goiter / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000652:urine; D006291:Health Policy; D006801:Humans; D007455:Iodine / Q000008:administration & dosage* / Q000172:deficiency* / Q000652:urine; D008427:Maternal Health Services; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000652:urine; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage; D013648:Tasmania / Q000453:epidemiology
chemical_list: D017673:Sodium Chloride, Dietary; C034024:iodized salt; D007455:Iodine