Iodine Global Network (IGN)

Pregnant women in Macedonia are iodine sufficient thanks to iodized salt

December, 2018
by Borislav Karanfilski and Neda Milevska Kostova

New studies confirm the success of a national coalition against iodine deficiency disorders.

In the 1990s, the Macedonian population was found to be iodine deficient, and many were at risk from iodine deficiency disorders. Fortunately, the authorities and the professional community reacted very rapidly to find a solution to this serious public health problem.

A National Committee for Iodine Deficiency was established more than 20 years ago. It united a dedicated group of professionals, researchers, civil society members, and representatives of the industry in a common goal: to improve iodine nutrition and stave off the risk of IDD.

It didn’t take long. By the early 2000s, Macedonia was proclaimed free of iodine deficiency. Thanks to iodized salt, a simple but effective intervention, iodine nutrition has improved, and iodine intakes have remained optimal.

Unless iodine is regularly added to foods, the risk of iodine deficiency in a previously affected geographical area remains high. Especially at risk of deficiency are women during pregnancy, when they should be consuming more iodine than usual to cover the needs of the baby. It is, therefore, important to include pregnant women and women who may become pregnant in regular monitoring activities to assess population iodine status and intake.

"When correctly iodized salt is widely accessible to a majority of the population over a period of time, women enter pregnancy in a good nutritional status, and may not need additional iodine-containing supplements."

In many countries, including some in Western Europe, iodine intakes are optimal when measured in schoolchildren, but are marginally low when measured in pregnant women. This could be because children and adults have slightly different diets, which affect their nutritional status.

In Macedonia, to re-evaluate and compare the situation with other countries, new studies were conducted in 2016–2018. One study, which was conducted as part of the continent-wide EUthyroid project, measured biomarkers which reflect short- to mid-term iodine status in pregnant women. Another study, conducted with support from UNICEF, evaluated iodine status and intake of prenatal iodine supplements in pregnant women.

The results of both studies are optimistic: pregnant women are consuming enough iodine to meet their needs and the needs of the developing fetus. What’s more, women who are not taking prenatal supplements with iodine are also iodine sufficient. This implies that the same solution–iodized salt–works equally well for children as it does for pregnant women in achieving optimal iodine nutrition. It can be concluded that, when correctly iodized salt is widely accessible to a majority of the population over a period of time, women enter pregnancy in a good nutritional status, and may not need additional iodine-containing supplements.

Another population test which could help assess the iodine status is conducted in newborns by measuring their levels of TSH, a thyroid stimulating hormone. If there is a considerable prevalence of high newborn TSH levels in a country, there is a good chance that iodine deficiency is present. As part of the national newborn screening program, Macedonian doctors measured TSH levels in over 290,000 babies between 2002 and 2017, and confirmed that iodine deficiency is not likely.

The success of the Macedonian national program for the elimination of iodine deficiency can be ascribed to the ongoing work of the National Committee, and its continued efforts to keep iodine nutrition high on the agenda of all stakeholders in the partnership

About the Authors

Prof. Borislav Karanfilski is a renowned professor and the driving force behind IDD prevention efforts in Macedonia. Although his illustrious career spans more than six decades, he remains professionally active and interested in new challenges. Prof. Karanfilski is President of the National Committee for Iodine Deficiency, the national team coordinator of EUthyroid, and IGN’s National Coordinator for Macedonia.

In December 2018, Prof. Karanfilski received the St. Kliment Ohridski State Award for lifetime achievement in medicine, for iodine deficiency prevention in Macedonia.
Dr. Neda Milevska Kostova is Executive Director of Studiorum think tank and a researcher with academic background in molecular biology and public health, working on topics in preventive and social medicine. Her areas of interest include social determinants of health and wellbeing, reducing health inequalities and behavior change models for better health outcomes.

She is also a Board Member of the International Alliance of Patients’ Organisations (IAPO), an alliance of over 260 organisations in 70 countries covering 52 disease areas.