Iodine What’s in your supplement?

Goals & Objectives Goals: Objectives: Increase knowledge of WIC staff regarding the importance of iodine supplementation for pregnant and breastfeeding women. WIC staff can assign Risk 427.4 correctly and discuss iodine supplementation with participants. Objectives: Upon completion of this in-service, WIC staff will be able to: Explain the reasons for iodine supplementation for pregnant and breastfeeding women. Demonstrate their knowledge of iodine supplementation by reading nutrition labels and identifying iodine-containing prenatal vitamins. Indicate that this in-service is being presented to clarify understanding of the new risk 427.4: Justification for iodine supplementation in pregnant and breastfeeding women.

Iodine: What do you know about it? Essential trace mineral Helps with thyroid function Ask the group “What do you know about iodine?” Click to bring in bullet points. Bullet 1 – trace means we need it in really small amounts. Bullet 2 – and prevents goiter, and certain birth defects.

Where is it? Table salt – iodized since the 1920’s Seafood and seaweed Small amounts found in: Grains Dairy Meat Dietary sources of iodine in U.S. are difficult to identify because: There’s a wide variety of potential sources There’s variation in the iodine content of common foods; and The amount of iodine in foods isn’t listed on label Since iodine is naturally found in soil, the iodine content of most foods depends on the amount iodine in the soil Dairy foods contain iodine because animal feed is supplemented with iodine; dairy industry also uses iodine-containing cleaners in their production equipment which may end up in dairy products Iodine containing dough conditioners used in the production of some store-bought breads

Iodine and Public Health Added to salt in the 1920’s One of the first food fortifications designed to prevent a common health issue (goiter) Later found iodine prevented certain birth defects (cretinism) 1920’s – Introduction of iodized salt and addition of iodine to other foods Salt was chosen for iodine supplementation because everyone uses salt, regardless of income or class, or seasons of the year, and supplementation is easy and inexpensive

Why are we worried about iodine? Group Discussion: New risk – established that women of childbearing age are at higher risk for low iodine levels Decreased use of iodized salt in U.S. (this does not mean a decrease in sodium consumption) Examples: an increase in use of non-iodized salt in processed foods; decreased egg and table salt intake Some speculation that the dairy industry is using fewer iodine-containing cleaners and the baking industry is using fewer iodine conditioners in store-bought breads People are using non-iodized salt (i.e. sea salt, kosher salt, flavored salts, rock salt, pickling salt) Activity Suggestion – Bring in different types of salt and look for iodized forms on labels.

What can happen if you don’t get enough? Deficiency is rare in U.S. Iodine Deficiency Disorders (IDDs) Increased number of miscarriages, stillbirths, and birth defects Depends on developmental stage and severity of deficiency IDDs can include cretinism, adverse cognitive development, speech and hearing problems, motor skill problems, and ADHD Cretinism = severely stunted physical and mental growth Important to supplement before or early in pregnancy to prevent IDDs

How much do we need? Adults & adolescents: 150 micrograms /day (Micrograms is abbreviated mcg or µg) Pregnant or Breastfeeding Women: 250-500 mcg/day

Pregnancy & breastfeeding Increased need during pregnancy and breastfeeding because mothers are the sole source of iodine for their babies. Breast milk contains iodine for infant – amount varies depending upon mother’s iodine intake

How much iodine is in salt? One teaspoon of iodized salt contains 400 mcg of iodine Americans get lots of sodium, most of which comes from processed foods not iodized salt. Don’t encourage moms to eat more salt, rather encourage them to consider buying iodized salt when they shop.

Prenatal Vitamins Take before or early in pregnancy First half of pregnancy especially critical Recommend a vitamin that contains 150 mcg of iodine during pregnancy and breastfeeding Not all prenatal multivitamins contain iodine Review labels before making recommendations Ask, “Are you familiar with the iodine content of prenatal multivitamins?” Iodine content of prenatal vitamins is not mandated in the U.S. – almost ½ of the prenatal vitamins marketed in the U.S. do not contain iodine Iodine is typically found in two different forms in supplements: Potassium iodide or 2) Sea kelp – the important thing is to look for 150 mcg! Activity Suggestion – Bring samples of vitamin containers and review labels, looking for iodine and amount.

What does this mean? DO NOT increase salt intake When adding salt to food, consider using iodized forms Vitamins should supplement food About 150 mcg from supplements Combine with foods to reach 250-500 mcg/day

Assigning Risk 427.4 Risk 427.4 is Inadequate Supplementation of Iron, Iodine, or Folic Acid. In TWIST the supplementation question for women reads “Are you taking a vitamin with iron or iron supplement?” Ask if they are taking a prenatal vitamin. If no – assign the risk If yes – ask if it contains iron, folic acid and iodine If they don’t know – do not assign risk and refer to their health care provider. If it does not contain any of the 3 nutrients – assign risk If it contains all 3 nutrients – do not assign risk Although the question in TWIST refers to iron, the risk includes iron, folic acid, and iodine. Screening on use of a prenatal vitamin is the most direct way to assess the intake of these 3 nutrients. If a participant is taking a prenatal vitamin, it is likely that they will not know if it includes iodine. If the participant doesn’t know (the likely response), we don’t assign the risk. We refer to their HCP. If they happen to know if the vitamin includes the nutrients (or not), we can determine whether to assign the risk or not.

Questions?