Iodine Deficiency Disorders among Pregnant Women in Sarawak, Malaysia

Lim Kuang Kuay



Iodine deficiency disorders among pregnant women in Sarawak, Malaysia

 Lim Kuang Kuay1 , Chan Ying Ying1, Nur Azna Mahmud1, Tan Beng Chin2, Hasimah Ismail1,  Chua Boon Kee2, Foo Leng Huat3.


1Institute for Public Health, Ministry of Health, Malaysia.

2 Sarawak State Health Department, Ministry of Health, Malaysia.

3Program of Nutrition, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.


Introduction:  Iodine deficiency disorders (IDD) during pregnancy may impair the neurological development of the fetus. The aim of this study is to determine the iodine status among pregnant women (PW) in Sarawak after seven years of mandatory USI.


Methods: A total of 508 first trimester PW attending government Maternal and Child Health Care Clinics in all 11 divisions in Sarawak between 1st April to 15th June 2015 were recruited. Urine samples were obtained and analysed for urinary iodine concentration (UIC) using the modified Sandell-Kolthoff reaction method. For pregnant women, an adequate iodine intake was defined as a median UIC between 150-249 µg/L according to The WHO/UNICEF/ICCIDD’s criterion. For further analyses, the 11 divisions were then combined into 3 regions, namely Central (Kapit, Mukah, Sibu, Sarikei, Betong), Southern (Kota Samarahan, Kuching, Sri Aman) and Northern (Miri, Bintulu, Limbang). 


Results: The median UIC of the PW in Sarawak was 105.6 µg/L, indicating iodine deficiency. A total of 330 (65.0%) PW had UIC<150 µg/L. In terms of urinary iodine levels by region, the median UIC in Central, Southern and Northern region were 85.5 µg/L, 97.4 µg/L, 136.3 µg/L respectively. The differences in median UIC between regions were significant. In addition, the Northern region (p = 0.001) and parous parity (p = 0.014) were significantly associated with higher median UIC. No significant association was found for age, ethnicity nor gravida.


Conclusions: This study indicates inadequate iodine status among PW in Sarawak despite seven years of mandatory USI. In fact, the majority of PW appear not to be protected against IDD and its consequences. Therefore, a comprehensive assessment of iodine status during pregnancy in Sarawak is urgently needed, in particular, the reasons for the ineffectiveness of the USI legislation.


Keywords: Iodine deficiency disorders, pregnant women, mandatory USI, Sarawak






Iodine deficiency disorders, pregnant women, mandatory USI, Sarawak

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Zimmermann MB, Andersson M. Assessment of iodine nutrition in population:past, present, and future. Nutrition rev. 2012;70(10):533-70.

Konrade I, Neimane L, Makrecka M, Strele I, Liepinsh E, Lejnieks A, et alA cross-sectional survey of urinary iodine status in Latvia. Medicina. 2014;50:124-29.

Zimmermann MB. The effect of iodine deficiency in pregnancy and infancy. Paediatr and perinat epidemio. 2012;26 (suppl.1): 108-17.

Zimmermann MB. The role of iodine in human growth and development. Semin Cell & Dev Biol. 2011;22:645-652.

Pearce EN, Green AS. Iodine and pregnancy: a call to action. Lancet. 2013;382:292-93.

Hetzel BS. Iiodine deficiency and the brain:An overview. In Comprehensive handbook of iodine. Edited by Presly VR, Burrow GN, Watson R. Burlington: Academic Press; 2009.

Torre EM, Alvarez ED, Artal AR, Gutierrez LS, caballero MGR, Blanco JA, Naya LD, Fernandez JCF. Iodine nutrition in pregnant women in the Oviedo area. Is iodine supplementation required ?. Endocrinol Nutr. 2014;61(8):404-409.

WHO/ICCIDD/UNICEF. Assessment of iodine deficiency disorders and monitoring their elimination, a guide for programme managers. 3rd edition. Geneva: WHO; 2007.

Donnay S, Arena J, Lucas A, Velasco I, Ares S. Iodine supplementation during pregnancy and lactation. Position statement of the working group on disorders related to iodine deficiency and thyroid dysfunction of the Spanish society of endocrinology and nutrition. Endocrinol Nutr. 2014:61(4):27-34.

Costeira MJ, Oliveira P, Santos NC, Ares S, Sanez-Rico B,de Escobar GM, Palha JA. Psychomotor development of children from an iodine-deficient region. J. Pediatri. 2011;159(3):447-53.

Aburto N, Abudou M, Candeias V, Wu T. Effect and safety of salt iodization to prevent iodine deficiency disorders: a systematic review with meta-analyses. WHO eLibrary of Evidence for Nutrition Actions (eLENA). Geneva: World Health Organization; 2014.

Salarkia N. Mirmiran P, Azizi F. Timing of the effect of iodine supplementation on intelligence Quotients of school children. Int. J Endocrinol Metab. 2004;2:95-102.

Zhang H, Lv S, Mu Z, Li W, Wang Y, Rutherford S. Iodised salt contribution to iodine nutrition status of pregnant and lactating women. Br J Nutr. 2015;114:126-133.

Food Act 1983 and Food Regulations 1985. Ministry of Health Malaysia: MDC Publishers Sdn Bhd; 2011.

Lim Kuang Kuay, Jambai Endu, Chan Ying Ying, Teh Chien Huey, Hasimah Ismail, Lim Kuang Hock, Kee Chee Cheong.. Iodine Status After A 3-year Universal Salt Iodisation in Sarawak, Malaysia. Int J Pub Health Res. 2015;5(2): 631-636.

Yang J, Zheng M, Li X, Zhu L, Hao Z, Chen G, et al. Assessment of iodine status and associated factors in vulnerable populations in Henan Province, China, in 2012. Asia Pac J Clin Nutr. 2014;23(4):626-33.

Lindorfer H, Kautzky-Willer A, Bancher-Todesca D, Sager M, Gessl A. Iodine deficiency in pregnant women in Austria. Eur J Clin Nutr. 2015;69(3):349-54.

Habimana L, Twite KE, Wallemacq P, Nayer PD, Daumerie C, Donnen P, Kalenga MK, Robert A. Iodine and iron status of pregnant women in Lubumbashi, Democratic Republic of Congo. Pub Health. 2013;16(8):1362-70.

Anaforoglu I, Algun E, incecayir O, Topbas M, Erdogan MF. Iodine status among pregnant women after mandatory salt iodisation. Br J Nutr. 2016;115:405-410.

Husniza H, Wan Nazaimoon WM. A cost effective modified micro method for measuring urine iodine. Trop Med. 2006; 23(1):109-115.

Leung AM, Pearce EN, Braverman LE. Iodine nutrition in pregnancy and lactation. Endocrinol Metab Clin North Am. 2011;40(4):765-777.

Pearce EN. Effects of iodine deficiency in pregnancy. J Trace Elements in Med Bio. 2012; 26:131-133.

Zimmermann MB. Are mild maternal iodine deficiency and child IQ link ?. Nutrition. 2013;9:505-06.

Sekitani Y, hayashida N, Takahashi J, Kozlovsky AA, Rudnitskiy S, Petrova A, Gutevych OK, Chorniy SA, Yamashita S, Takamura N. Urinary iodine concentrations of pregnant women in Ukraine. Clin Chem Lab Med. 2013;51(4):811-816.

Kuang Kuay Lim, Ying Ying Chan, Chien Huey Teh, Hasimah Ismail, Rafidah Yusof, Jamail Muhi, Kuang Hock Lim, Foo Leng Huat Foo. Iodine Status among Pregnant Women from Selected Rural Divisions in Sabah, Malaysia. Asia Pac J Clin Nutr. 2017;26 (5):861-866

Sultanalieva RB, Mamutova S, van der Haar F. The current salt iodization strategy in kyrgyzstan ensures sufficient iodine nutrition among school-age children but not pregnant women. Pub Health Nutr. 2009;13(5):623-30.

Zhang H, Lv S, Mu Z, Li W, Zhang X, Wang Y, Rutherford S. Iodised salt contribution to iodine nutrition status of pregnant and lactating women. Br J Nutr. 2015;114:126-33.

Sadou H, Seyfoulaye A, Alma MM, daouda H. Inadequate status of iodine nutrition among pregnant women resideng in three districts of Niamey, the Niger republic’s capital. Maternal & Child Nutr. 2013;10:650-66.

IPH. National Health and Morbidity Survey 2016 (NHMS 2016). Vol II: Maternal and Child Health Care. Kuala Lumpur: Institute for Public Health; 2016.

Untoro J, Timmer A, Schultink W. The challenges of iodine supplementation: a public health programme perspective. Clin Endocrinol Metab. 2010;24:89-99.

Mirmiran P, Nazeri P, Amiri P, Mehran L, Shakeri N, Azizi F. Iodine nutrition status and knowledge, attitude, and behavior in Tehranian women following 2 decades without public education. J Nutr Edu Behav. 2013;45(5):412-419.

Charlton KE, Yeatman HR, Houweling F. Poor iodine status and knowledge related to iodine on the eve of mandatory iodine fortification in Australia. Asia pac J Clin Nutr. 2010;19:250-255.

Andersson M, de Benoist B, Delange F, Zupan J. Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old: conclusions and recommendations of the Technical Consultation. Pub Health Nutr. 2007;10(12A):1606–1611.

Granfors M, Andersson M, Stinca S, Akerud H, Skalkidou A, Poromaa IS, Wikstrom AK, Nystrom HF. Iodine deficiency in a study population of pregnant women in Sweden. Acta Obstet Gynecol.2015; 94:1168-1174.

Kut A, Gursoy A, Senbayram S, Bayraktar N, Irem Budakoglu I, Akgun HS. Iodine intake is still inadequate among pregnant women eight years after mandatory iodination of salt in Turkey. J. Endocrinol Invest. 2010;33:461-464.


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