e-Library of Evidence for Nutrition Actions (eLENA)

Iodine supplementation in pregnant and lactating women

Guidance summary*

WHO recommendations

1. Countries, or areas within countries, in which more than 90% of the households have access to iodized salt, should sustain the achievement of universal salt iodization (USI) and periodically reassess the salt iodization programme and population iodine status.

2. Countries, or areas within countries, in which 50-90% of the households have access to iodized salt should make efforts to accelerate USI based on the existing operational guidelines (1, 2). If no progress in scaling up is being made within two years, then the feasibility of increasing iodine intake in the form of a supplement or iodine fortified foods by the most susceptible groups – pregnant and lactating women and children 7-24 months of age - would need to be assessed, using the recommended strategy for countries in which 20-50% of the households have access to iodized salt.

3. Countries, or areas within countries, in which 20-50% of the households have access to iodized salt will need to assess the feasibility of increasing iodine intake in the form of a supplement or iodine fortified foods by the most susceptible groups, as described in the following programmatic steps:

  • Assess population iodine nutrition status, household iodized salt coverage (preferably disaggregated) and salt iodization programmes in order to identify a national or sub-national problem. An initial rapid assessment will be needed for advocacy and for future monitoring if no assessment has yet been made. The methodology of assessments is described in the WHO/UNICEF/ICCIDD guidelines on “Assessment of Iodine Deficiency Disorders and Monitoring their Elimination” (2).

  • Develop new plans to strengthen salt iodization that include increasing political commitment, advocacy, capacity-building of the salt industry for production and quality assurance, adoption and enforcement of appropriate regulations/legislation, and an effective iodized salt monitoring system at production (or importation), retail and community levels.

  • If a country does not succeed in scaling up its salt iodization programme within two years, the feasibility of increasing the iodine intake of susceptible groups by means of supplements or iodine-fortified foods will need to be explored as a temporary measure while strengthening the salt iodization programme. In areas of moderate and severe iodine deficiency (median urinary iodine less than 50 ug/L or total goitre rate more than 20%), the objective should be to provide additional iodine in the form of a supplement to all pregnant and lactating women, and in the form of a supplement or complementary food fortified with iodine for children 7-24 months of age.

  • Assessing the feasibility of providing additional iodine should include: (i) costing of supplementation, (ii) existing channels for distribution to reach the target groups, (iii) likely duration of supplementation, and (iv) potential compliance.

4. Countries, or areas within countries, in which less than 20% of the households have access to iodized salt should assess the current situation of its salt iodization programme to identify national or sub-national problems and to update its strategies and action plans. The most vulnerable groups, pregnant and lactating women, should be supplemented with iodine, and children 7-24 months of age should be given either a supplement or complementary food fortified with iodine until the salt iodization programme is scaled up.

Irrespective of where countries, or areas within countries, are categorized there are specific situations such as in emergencies, among displaced people, and geographically remote areas where additional iodine intake should be considered. If iodized salt is not accessible in these specific situations, increasing iodine intake is required in the form of iodine supplements for pregnant and lactating women, and a supplement or complementary food fortified with iodine for children 7-24 months of age. In cases where it is difficult to reach pregnant women, supplementation to all women of reproductive age is advised.

WHO-recommended dosages of daily and annual iodine supplementation
Population group Daily dose of iodine supplement (µg/d) Single annual dose of iodized oil supplement (mg/y)
Pregnant women 250 400
Lactating women 250 400
Women of reproductive age (15-49 yrs) 150 400
Children < 2 yrsa,b 90 200

a. For children 0-6 months of age, iodine supplementation should be given through breast milk. This implies that the child is exclusively breastfed and that the lactating mother received iodine supplementation as indicated above.
b. These figures for iodine supplements are given in situations where complementary food fortified with iodine is not available, in which case iodine supplementation is required for children of 7-24 months of age.

* This is an extract from the relevant guidance document (3). Additional guidance information can be found in this document.


References

1. UNICEF. The roadmap towards achievement of sustainable elimination of iodine deficiency. Operational Guidance: 2005 and beyond. United Nations Children’s Fund, New York; 2005.

2. WHO, UNICEF, ICCIDD. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers, third edition (updated 1st September 2008). Geneva, World Health Organization; 2001 (http://www.who.int/nutrition/publications/micronutrients/iodine_deficiency/9789241595827/en/).

3. WHO, UNICEF. Reaching optimal iodine nutrition in pregnant and lactating women and young children: a joint statement by WHO and UNICEF. Geneva, World Health Organization; 2007 (http://www.who.int/nutrition/publications/micronutrients/WHOStatement__IDD_pregnancy.pdf).