title: Iodine nutrition status in lactating mothers residing in countries with mandatory and voluntary iodine fortification programs: an updated systematic review.
abstract: BACKGROUND
  The aim of this review is to assess data available on iodine nutrition status in lactating mothers residing in countries with mandatory and voluntary iodine fortification programs and/or iodine supplementation.
  
  
  CONCLUSIONS
  A systematic review was conducted by searching articles published between 1964 and 2013 in Pub Med, ISI Web, and Cochrane Library using iodine nutrition, lactation, iodine supplementation, and iodine fortification as keywords for titles and/or abstracts. Relevant articles were included if they reported urinary iodine concentration (UIC) in lactating mothers and, if determined, the type of iodine fortification program and/or iodine supplementation. Forty-two studies met the inclusion criteria. Among these, 21 studies assessed lactating mothers in countries with a mandatory iodine fortification program, 17 studies were from countries with voluntary and/or without iodine fortification programs, and four studies assessed iodine nutrition status in lactating mothers undergoing iodine supplementation. Among countries with mandatory iodine fortification programs, the range of salt iodization level in lactating mothers with a UIC <100 μg/L was between 8 and 40 ppm, whereas among lactating mothers with UIC >100 μg/L, it was between 15 and 60 ppm. Levels of UIC <100 μg/L were observed among lactating women in India, Denmark, Mali, New Zealand, Australia, Slovakia, Sudan, and Turkey, whereas in countries such as Chile, Iran, Mongolia, New Guinea, and Nigeria, the median or mean of UIC was >100 μg/L. There was a median or mean UIC <100 μg/L in nearly all lactating mothers residing in countries where implementation of universal salt iodization program was voluntary, including Switzerland, Australia, New Zealand, Ireland, and Germany. However, in some countries with voluntary iodine fortification programs, such as the United States, Spain, and Japan, a mean or median UIC of >100 μg/L has been reported.
  
  
  CONCLUSIONS
  Although universal salt iodization is still the most feasible and cost-effective approach for iodine deficiency control in pregnant and lactating mothers, UIC in lactating mothers of most countries with voluntary programs and in areas with mandatory iodine fortification is still within the iodine deficiency range, indicating that iodine supplementation in daily prenatal vitamin/mineral supplements in lactating mothers is warranted. However, further investigations are still recommended in this regard.
authors: 1Nutrition and Endocrine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.|2Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Pantea
authors: P
authors: Nazeri
authors: 1Nutrition and Endocrine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.|2Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Parvin
authors: P
authors: Mirmiran
authors: 3Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Niloofar
authors: N
authors: Shiva
authors: 4Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Yadollah
authors: Y
authors: Mehrabi
authors: 3Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Mehdi
authors: M
authors: Mojarrad
authors: 3Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Fereidoun
authors: F
authors: Azizi
mesh_terms: D001942:Breast Feeding; D003677:Deficiency Diseases / Q000097:blood* / Q000517:prevention & control; D019587:Dietary Supplements; D005260:Female; D005527:Food, Fortified; D006801:Humans; D007455:Iodine / Q000097:blood* / Q000172:deficiency / Q000627:therapeutic use; D007774:Lactation / Q000097:blood*; D009752:Nutritional Status; D017673:Sodium Chloride, Dietary; D014131:Trace Elements / Q000627:therapeutic use
chemical_list: D017673:Sodium Chloride, Dietary; D014131:Trace Elements; C034024:iodized salt; D007455:Iodine