Consumption of multiple micronutrients or small-quantity lipid-based nutrient supplements containing iodine at the recommended dose during pregnancy, compared with iron and folic acid, does not affect women's urinary iodine concentration in rural Malawi: a secondary outcome analysis of the iLiNS DYAD trial

Seth Adu-Afarwuah, Charles D Arnold, Kenneth Maleta, Per Ashorn, Ulla Ashorn, Josh M Jorgensen, Yue-Mei Fan, Minyanga Nkhoma, Jaden Bendabenda, Andrew Matchado, Kathryn G Dewey, Seth Adu-Afarwuah, Charles D Arnold, Kenneth Maleta, Per Ashorn, Ulla Ashorn, Josh M Jorgensen, Yue-Mei Fan, Minyanga Nkhoma, Jaden Bendabenda, Andrew Matchado, Kathryn G Dewey

Abstract

Objectives: Inadequate iodine intake during pregnancy increases the risk of neonatal morbidity and mortality. We aimed to evaluate whether prenatal supplements containing iodine affect urinary iodine concentrations (UIC) of pregnant women in Malawi.

Design: A randomised controlled trial. Pregnant women (n 1391) were assigned to consume 60 mg/d Fe and 400 µg/d folic acid (IFA) or 18 vitamins and minerals including 250 µg/d iodine (MMN) or 20 g/d small-quantity lipid-based nutrient supplements (SQ-LNS) with similar nutrient contents as MMN group, plus macronutrients (LNS) until childbirth. In a sub-study (n 317), we evaluated group geometric mean urinary iodine concentration (UIC) (µg/L) at 36 weeks of gestation controlling for baseline UIC and compared median (baseline) and geometric mean (36 weeks) UIC with WHO cut-offs: UIC < 150, 150-249, 250-499 and ≥500 reflecting insufficient, adequate, above requirements and excessive iodine intakes, respectively.

Setting: Mangochi District, Malawi.

Participants: Women ≤20 weeks pregnant.

Results: Groups had comparable background characteristics. At baseline, overall median (Q1, Q3) UIC (319 (167, 559)) suggested iodine intakes above requirements. At 36 weeks, the geometric mean (95 % CI) UIC of the IFA (197 (171, 226)), MMN (212 (185, 243)) and LNS (220 (192, 253)) groups did not differ (P = 0·53) and reflected adequate intakes.

Conclusions: In this setting, provision of supplements containing iodine at the recommended dose to pregnant women with relatively high iodine intakes at baseline, presumably from iodised salt, has no impact on the women's UIC. Regular monitoring of the iodine status of pregnant women in such settings is advisable. Clinicaltrials.gov identifier: NCT01239693.

Keywords: Iodine intakes; Multiple micronutrients; Pregnant women; Small-quantity lipid-based nutrient supplements; Urinary iodine concentration; iLiNS DYAD-Malawi.

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