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Seasonality in urinary and household salt iodine content among pregnant and lactating women of the plains of Nepal

European Journal of Clinical Nutrition volume 57, pages 969–976 (2003)Cite this article

Abstract

Objective: To determine the extent and causes of iodine deficiency among women during pregnancy and lactation in the southeastern plains of Nepal.

Design, Setting and Subjects: Urinary iodine (UI) was assessed as an indicator of iodine status in spot urine samples of women participating in a field trial in three rural communities in the plains of southeastern Nepal. Samples were collected during pregnancy (n=1021) and during lactation at 3–4 months postpartum (n=1028) at a central clinic; 613 women were assessed at both times. Salt iodine (SI) content was assessed semiquantitatively at 6–7 months postpartum in households (n=1572).

Results: During pregnancy and lactation, median UI concentrations were 0.756 and 0.483 μmol/l, respectively, indicating mild iodine deficiency. UI and SI concentrations covaried markedly by season and were highest during hot, dry, premonsoon months and lowest during and following the humid monsoon season. Within women who contributed urine samples during both pregnancy and the postpartum period, iodine status determined by UI was not correlated. The percentage of households with adequately iodized salt (30 ppm) ranged from 85 to 44% from the hot, dry to the humid seasons, respectively.

Conclusions: In the rural southern plains of Nepal, iodine deficiency remains a mild-to-moderate public health problem among pregnant and lactating women despite the availability of iodized salt. Marked seasonality in SI content may account for the lack of intraindividual correlation between maternal iodine status during pregnancy and postpartum periods and contribute to periodicity in the risk of iodine deficiency.

Sponsorship: This study was funded by Cooperative Agreement HRN-A-00-97-00015-00 between Office of Nutrition, US Agency for International Development (USAID), Washington, DC, USA, and the Center for Human Nutrition (CHN), Department of International Health, the Bill and Melinda Gates Foundation, Seattle, WA, USA, and the Sight and Life Research Institute, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.

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Acknowledgements

The authors gratefully acknowledge contributions from other members of the study team: Joanne Katz, Parul Christian, Elizabeth Kimbrough-Pradhan, Sharada Ram Shrestha, Ramesh K Adhikari, Samu M Dali, Tirta Shakya, and field and data management staff of the Nepal Nutrition Intervention Project—Sarlahi (NNIPS).

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Authors and Affiliations

  1. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    K J Schulze, K P West Jr, L A Gautschi, M L Dreyfuss, S C LeClerq, B R Dahal, L S-F Wu & S K Khatry

  2. Nepal Nutrition Intervention Project (NNIPS), Nepal Netra Jyoti Sangh, Kathmandu, Nepal

    K J Schulze, K P West Jr, L A Gautschi, M L Dreyfuss, S C LeClerq, B R Dahal, L S-F Wu & S K Khatry

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  1. K J Schulze
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Contributions

Guarantor: KP West, Jr.

Contributors: KJS developed urinary iodine assay in Nepal, analyzed data, prepared manuscript. KPW Jr assisted in conceptualization of study and interpretation of data. LAG analyzed samples and maintained quality control of urinary iodine assay in Kathmandu laboratory. MLD managed the recruitment of women into the study and data collection activities in the clinic. SCLC supervised collection of salt iodine samples and interpreted findings. BRD served as iodine-deficiency consultant and regularly oversaw urinary iodine analyses in Kathmandu laboratory. LS-FW managed and assisted in analyzing data and interpreting results. SKK served as national principal investigator of the study, providing medical supervision of field work.

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Correspondence to K P West Jr.

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Schulze, K., West, K., Gautschi, L. et al. Seasonality in urinary and household salt iodine content among pregnant and lactating women of the plains of Nepal. Eur J Clin Nutr 57, 969–976 (2003). https://doi.org/10.1038/sj.ejcn.1601632

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