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your questions see more answers to more questions 26.-Iodine and Breastfeeding Why is it necessary to take extra amounts of iodine during breastfeeding? Becaus e the needs of iodine in the nursing mother are nearly double those of an adult and you have to ensure that the child receives all the iodine they need from mil k. 2. What should be the iodine intake during lactation? Breast milk contains a variable amount of iodine intake depends on the mother. If the infant's needs ar e of the order of 90 mcg / day and ingested milk volume of 600-1000 ml / day, th e minimum concentration of iodine in breast milk should be 100 mcg / liter. To a chieve this, the mother should eat a total of at least 250 mcg of iodine per day . 3. Should I keep the same during lactation iodine supplement is taken during p regnancy?: Yes, the supplement of iodine for breastfeeding women is the same as during pregnancy and should be maintained throughout lactation. What dose?: If t he needs of breastfeeding women iodine are estimated at 250-300 mcg / day and co nsumption of salt can be reduced in that period, we recommend a daily supplement of 200 mcg of iodine in the form of iodide potassium. 4. Usually taking iodized salt, "is also needed extra iodine supplement during breastfeeding? YES, becaus e iodized salt gives only half of needs during this period. 5. Are there any res trictions to consume iodized salt in infancy? There are no particular restrictio ns Being breast-feeding, and we refer to exist for the general population. 6. Sh ould iodine supplementation to a nursing woman to which the thyroid has been rem oved and are taking thyroxine? YES, because the supplement of iodine that is adm inistered to nursing mothers is to ensure adequate supply to the son, whose only source of iodine in breast milk, and it does not harm the mother thyroidectomis ed. 7. If a breastfeeding woman to become pregnant and do not want to remove the breast during pregnancy. Will things stay the same recommendation for iodine su pplementation or change the dose? There is no formal recommendation on this, but it seems reasonable to ensure both the needs of the fetus and infant child woul d be advisable to recommend doubling the dose and 400 mcg of iodine per day whil e maintaining the situation. 8. Does the nursing mother of a child with congenit al hypothyroidism with thyroxine replacement therapy, you need an extra supply o f iodine? No, because the extra intake of iodine to the thyroid is to mother of his son and having no thyroid gland needs iodine no. The iodine in iodized salt is sufficient for the mother. www.aeped.es/lactanciamaterna/rpmf26.htm Galician Society of Endocrinology, Nutrition and Metabolism Disorders www.sgenm. com/m2.htm PREVENTION OF IODINE DEFICIENCY CAUSED BY IN GALICIA - iodized salt W HAT IS AND WHAT IT IS USED FOR THE IODINE Iodine is a micronutrient essential fo r the body, would be administered through food. Its function is the synthesis of thyroid hormones. Therefore, if there is iodine deficiency is severe enough aff ect this synthesis. Thyroid hormones play important roles in our body especially in the processes of brain development, growth in the regulation of metabolism. MINIMUM recommended daily iodine in 1992 under the auspices of WHO, the Internat ional Committee for the Control of iodine deficiency disorders, European Thyroid Association, the European Community Commission and UNICEF set the following rec ommendations: mcgr iodine / day premature Children Children under 6 years Childr en 7-10 years Adults Pregnant and breastfeeding 90 90 120 150 200 After numerous studies in areas of poor iodine intake recommended during pregnan cy and lactation, a dose of iodine 260 mcgr / day and this is being done in seve

ral European countries. When the iodine intake falls below the minimum requireme nt for a long time may occur due to deficiency disorders. The parameters used to assess the level of iodine are thyroid size and urinary iodine excretion (urina ry iodine), and that approximately 80% of food ingested iodine is excreted in th e urine. WHERE IS THE IODINE? Iodine is found irregularly distributed in water a nd in food. The seas are the largest store of iodine, therefore, sea fish, is th e main source of iodine.€The iodine content of our soil is very poor, due to was h them during the thaw after a period of glaciation, and therefore many of the a gricultural products and mountainous inland areas are also poor in this element. Furthermore, the iodine content of milk and milk products depends on the feedin g of animals. Because of this and our eating habits is difficult to meet the dai ly needs of the population iodine through the diet, and in practice this deficie ncy is avoided by supplementing the diet with iodized salt. Iodine is not stored in the body over time so must be replenished continuously. IMPLICATIONS OF THE LACK OF IODINE Iodine deficiency is a geological problem. There are wide areas i n the world's population with iodine deficiency and disorders caused are among t he most common deficiency diseases in the world. Until a few years the problem of iodine deficiency focusing on endemic goiter, b ut in recent decades, research conducted in several countries have shown that go itre is not the only manifestation of iodine deficiency, but also - whether or n ot a goiter - disorders caused by iodine deficiency, such as increased neonatal mortality and the number of abortions, congenital abnormalities permanent neurom otor damage, hearing impairment and decreased intellectual capacity and growth. In areas with severe iodine deficiency endemic goiter and cretinism presents (hy pothyroidism iodine deficiency during embryonic and fetal periods). Iodine defic iency is detrimental to the entire population conditioning an IQ lower than in s imilar populations without mental retardation, and have serious repercussions on the socio-economic development of the community. The most recent studies assess ed that the disorders caused by iodine deficiency affect more than 1,500 million people in over 110 countries, where more than 650 million are suffering from go itre and 20 million have significant mental impairment, which is one of the most prevalent and preventable causes of impairment of intellectual development in t he world today. WHO through the 49th World Health Assembly in 1996 endorsed the goal of "achieving the elimination of the serious public health problem posed by disorders caused by iodine deficiency" for all countries. This agreement was si gned by 159 countries, including Spain. In Spain, as in other European countries has shown that iodine deficiency exists in parts of Andalusia, Asturias, Catalo nia, Extremadura, Galicia and Castilla and probably in other areas not studied, and even in non-mountainous areas. This deficiency can be considered medium grad e now but the disorders that arise from it are so important that is considered a public health problem. Epidemiological studies conducted in 14 of the 17 autono mous regions of Spain, the concentrations of iodine in urine were generally mode rately low to very low, demonstrating deficiencies of iodine in all areas studie d. This justifies the presence of endemic goiter especially in pregnant women an d school children. There is also evidence that infants in areas where iodine is deficient, even if mild, have high TSH levels in the test for the Early Detectio n of Congenital Hypothyroidism may reach more than 6 times the level of TSH obse rved in areas where There is no nutritional deficiency. This indicates that thes e children go through a transitional period of hypothyroidism, which is worrying considering that the fetal period and first year of life are critical for brain development. In fact, studies conducted in two regions confirms that average IQ of schoolchildren in these areas is affected to such an extent that most childr en do not reach the average level of other Spanish children. HOW TO CONTRIBUTE T HE NECESSARY IODINE The World Health Organization advocates the universal iodiza tion of salt, meaning the iodization of salt for human and animal consumption, i ncluding that used in the food industries. The first experience of prophylaxis o f endemic goiter with iodine began in Ohio (USA) in 1917 by Marine and Kimball. Was introduced in Switzerland in 1922. In Spain there is iodized salt available in the market since 1983, Royal Decree of 27 April, approving technical and heal

th regulations for the procurement, movement and sale of iodized salt and sets t he iodine content in 60 mgr by Kg of salt, so that the normal daily intake of salt (about 3 grams / day) daily needs are met iodine.€In Galicia on 9 January 1985 was published in the DOGA a d ecree on the prevention of endemic goiter by iodized salt. Currently all school canteens in Galicia used iodized salt but there is no guarantee of its consumpti on at home. All people should use iodized salt in cooking food and dress, especi ally children and women of childbearing age. Its use is especially important in pregnant and lactating women. Iodide supply campaigns have their effect, but it is fleeting if not done continuously, so it is necessary for effective monitorin g program and continuing to monitor the results periodically. This has managed t o eliminate the disruption caused by iodine deficiency in various countries (Nor way, Sweden. Finland, Switzerland and Austria ...) SPECIAL RISK POPULATION inclu des pregnant women and nursing mothers and the child population especially in th e first years of life. When iodine deficiency affects the fetal stage and the fi rst year of life, the damage is irreversible, causing, according to the intensit y of iodine deficiency, decreased IQ and even mental retardation. During pregnan cy and breastfeeding are increased iodine needs so it is especially important to receive an adequate supply, since they must cover the needs of iodine through h er mother and the fetus and newborn. There is evidence that treatment with iodin e to pregnant women and during breastfeeding can prevent disorders caused by iod ine deficiency in children. IMPLICATIONS OF THE LACK OF IODINE FOR MOM: An insufficient supply of iodine in pregnant women and breastfeeding may lead to the development of goiter. It also increases the rate of hypothyroidism and no greater number of abortions and feta l death. IMPLICATIONS OF THE LACK OF IODINE TO THE FETUS AND NEWBORN: Iodine def iciency in the fetus is determined by its deficiency in the mother. If the fetus does not have enough iodine, your thyroid may enlarge and cause goiter which, a lthough small in volume, at the time of birth can cause respiratory and / or swa llowing, and in addition, iodine deficiency causes alteration of thyroid functio n, with delayed development of the Central Nervous System, as well as growth and bone maturation to a greater or lesser degree depending on the severity of the deficiency. When iodine deficiency is severe or there is a risk of neurological cretinism or myxedema type (rare in our country) and may be more frequent perman ent or transient congenital hypothyroidism, the situation is less severe iodine deficiency. Mental disorders caused irreversible. A lack of iodine in the mother breast-feeding the baby also suffers, which contributes to enhancing developmen tal disorders due to physical and mental iodine deficiency during fetal life. Th ese disorders are preventable if done iodide supply women of childbearing age an d before pregnancy, should be maintained and even strengthened during gestation and lactation. You must also ensure an adequate supply iodine to the child after weaning mainly during the first years of life, which m ust subsequently. PRECAUTIONS FOR THE iodide supply with the additional contribu tion of iodine in physiologic (150-200 mcgr / day) administered through iodized salt, we can expect no risk to health or iodine intolerance often occurs, such a llergic reactions. One possible complication of iodized salt prophylaxis is the occurrence of hyperthyroidism. However, the reported cases were mostly in older people and attributed to the presence of autonomous nodules or Basedow-Graves di sease underlying. The question that arises is whether the development of hyperth yroidism is considered as a complication of prophylaxis with iodized salt or the inevitable consequence of the normalization of iodine intake. Even in areas not goiters has been the change of a normal iodine intake, low to high-normal intak e, may reveal hyperthyroidism in people with preexisting autonomous thyroid nodu les. However, iodized salt is safe. In none of the experiences of iodized salt p rophylaxis have been conducted in different parts of Spain there has been excess ive intake of iodine, as was recognized on the determination of urinary iodine. THE iodide supply is based on: 1. Exclusive use of iodized salt for the preparat

ion of food. 2.€Should also be used iodized salt in food preparation in the chai n of industrial production (sausages, bread, etc ...) 3. Eat frequently, if poss ible, sea fish, either fresh, frozen or canned. 4. If the above measures are not possible should be given a daily supplement of 150-200 mcgr iodine (found in an y of the vitamin and mineral complex in the market). ABSTRACT There is evidence that correction of iodine deficiency disorders caused by eliminating iodine deficiency including goiter and endemic cretinism. The la rge amount of information available on the world states clearly that the onset o f hyperthyroidism is exceptional, and benefit greatly from that achieved with th e introduction of iodized salt prophylaxis. Recent data show that iodine deficie ncy still in Spain and to decrease the prevalence of disorders caused by iodine deficiency when it is corrected with iodized salt. The diseases or disorders res ulting from iodine deficiency are avoidable, iodine deficiency remains the most common single cause of preventable mental retardation and brain damage in the wo rld. Doubts that may arise 1. In people with goiter: pay special attention to symptoms of hyperthyroidism (ner vousness, tachycardia, fatigue, heat intolerance, weight loss ...), in which cas e it shall determine thyroid function and refer to endocrinologist if confirmed hyperthyroidism (even on a preferential basis if the patient is severely affecte d or have heart disease, etc). 2. 3. 4. The occurrence of hyperthyroidism in pregnant or breastfeeding requires submissi on to the endocrinologist on a preferential basis pregnant or are breastfeeding can not take S AL (for hypertension, etc ...): administer iodine supplement othe r form eg.: a vitamin-mineral that contains the recommended dose of iodine (150200 mcgr day) People who for some reason they are taking thyroid hormone (thyrox ine) can use iodized salt (except that for other reasons should restrict salt) COMMENTS 1. The salt called "marine" or herbal does not equal that iodized salt (iodine-enriched), for its iodine content is much lower and not enough to compen sate for a deficiency. 2. Iodized salt is advisable to add it to food preferably at the end of cooking. 3. Iodized salt retains its activity for about six month s and should therefore be monitored expiration date of the container. 4. The cos t of iodized salt is the same as that of non-iodized salt. 5. Only iodized salt is one that in labeling the package contained expressly "iodized salt." 6. There should be advised to increase the regular consumption of salt, just indicate "n on-iodized salt substitute for iodized salt." Content is considered sufficient f or a teaspoon of iodized salt a day (about 3 grams) to cover the daily needs of iodine. References 1. Conclusions of the Working Group meeting on disorders caus ed by iodine deficiency of the Spanish Society of Endocrinology and Nutrition. M álaga, February 27, 1998. 2. Escobar del Rey F: Further study on iodine deficien cy in Spain (1993). 3. Escobar del Rey F, Morreale de Escobar G: universal iodiz ation of salt: a human right for children. Endocrinology 1998; 45:3-14. 4. Merkb latt No. 8. Schwandger und Jodgmangel schgt: Ratschläge für Aetze, Arbertskreis Jodmangel 1994, 1541: 1-4. 5. Recommendations on iodine nutrition for Mothers an d infants in Europe, In: Delange F, Dunn JT, Glina D, editors. Iodine deficiency disorders in Europe: a Continuing concern. New York: Plenum Press, 1993, 471-47 8. a) Material disclosure pamphlet published in booklet by the Department of Hea lth "The iodized salt if it is more healthy" and distributed in schools and heal th centers. b) Poster advertising on prevention of iodine deficiency disorders i n parts and supermarkets. SPANISH ANNALS OF PEDIATRICS http://db.doyma.es/cgi-bi n/wdbcgi.exe/doyma/mrevista.fulltext?pident=11050 iodine during pregnancy, infan

cy and early childhood. Minimum and maximum amounts: from micrograms to grams G. Morreale de Escobar to F. Escobar's Reya Biomedical Research Institute Alberto Sols, CSIC and UAM. Madrid. An Esp Pediatr 2000; 53: 1-5 Thyroid hormones, thyroxine (T4) and 3,5,3 '-triiodothyronine (T3) are needed du ring all stages of life to a normal function of central nervous system (CNS). Th ey are especially crucial during the development of the CNS, because a failure o f these hormones is accompanied by injury and permanent neurological defects and irreversible. Both hormones contain iodine, four atoms per molecule in the case of T4, three in the case of T3.€Without iodine synthesis is not possible, despi te which over evolution have not appeared capable of replacing other hormones an d do not have this total dependence on an item, usually found in very small quan tities outside the marine aquatic environment . Instead, it has evolved a struct ure, the thyroid follicle, capable of minimizing the consequences of a variable Amply iodine intake, obtained mostly through food and water. It is the only stru cture capable of storing endocrine hormones such as prohormone (thyroglobulin) w ith such efficiency that an adult who has had adequate iodine nutrition, can mee t the needs of your body hormone for several months after initiated a period of total absence of it in their diet. In turn, the thyroid gland of the adult is ab le to avoid the possible harmful consequences of excessive production of thyroid hormones, which could lead to reach out very high amounts of iodine. However, m ajor problems arise when the deficiency of iodine in the diet becomes chronic, o r when exposure to an excess of iodine is very long, especially when it occurs d uring a developmental period in which the gland is not yet fully prepared for it . Failure to resolve these problems, or solved the wrong time, deficits may occu r more or less severe and irreversible CNS. In this brief commentary will attemp t to define, more precisely, what are the minimum quantities for normal developm ent of the CNS, and what that can lead to problems during pregnancy and early ch ildhood periods that occur in humans crucial stages of brain maturation. There, especially with respect to excess iodine, many practical problems, as described with accuracy and broad support literature and Emparanza Arena in this number1. MINIMUM AMOUNTS OF IODINE From that, a decade ago, was ratified by almost all co untries of the world the World Declaration on the Survival, Protection and Devel opment of Children and a concrete Action Plan prepared by the Convention on Chil dren's Rights, in turn emanated from the Summit for Children organized by the UN in 1989, it can be stated as a basic human right infancia2 that: 1. "Every child has the right to an adequate amount of iodine in their diet." 2. "Every mother should have a proper iodine nutrition to prevent the child has a mental development affected by a deficiency of this essential micronutrient. The second point derives from the increasing evidence that iodine deficiency during pregnancy can lead to maternal circulating levels of T4 insufficient for a harm onious development of the brain of the fetus and newborn. The scientific and epi demiological (which is summarized in a previous issue of this Revista3) have led the World Health Organization declared that iodine deficiency is the most commo n global cause of mental retardation and cerebral palsy preventable, affecting t o a greater or lesser extent, development and welfare of some 1,600 million of t he current inhabitants of our planet. Some of them live in Spain, where he has n oted the persistence of iodine deficiency in the 14 autonomous communities in wh ich recent studies have been done about it. Table 1 shows the current recommenda tions on the minimum amounts of iodine which are necessary during different stag es of life. The amounts have been rising as they have been having more accurate epidemiological data and a more complete understanding of the differences in thy roid physiology at different ages.

Note that the iodine requirements of preterm infants, in infants and young child ren are significantly higher than would be deducted on the basis of their body w eight, as defined for students and adults. For premature infants, humanized prep arations marketed for them did not contain enough iodine, but in recent years th eir content has become more consistent with the requerimientos4, 5. They have al so been increasing the amounts recommended during pregnancy, as they have comple ted studies in Europe. In our country, particularly in the Autonomous Community of Madrid, we have observed that pregnant women need to supplement of 250-300 mg / day so they can achieve optimal concentrations of circulating free T4, and to not develop goiter during embarazo7, 8. Given the great variability of iodine c ontent of foods from non-marine, is recommended to ensure these minimum amounts by supplementing the diet with salt yodada2.€In Spain the law provides for the i odization of table salt refined at 60 mg I / g salt (60 mg / kg, 60 ppm). Typica lly, you use iodized salt (not including sea salt, unless the package specifies that it is iodized), seems sufficient for most of the population. But there are just excluded premature babies and infants and pregnant women, who constitute th e most vulnerable population, the former would have to eat about 2 g of iodized salt a day, and their mothers 5 g / day. As it does not, by the current recommen dations to prevent or restrict the use of salt in these population groups, it is necessary to ensure the minimum amounts of iodine supplementation by daily cont rol. Not having the current Spanish Pharmacopeia prepared potassium iodide or io date (in the form of tablets, drops or tablets) suitable for this, you have to u se multivitamin and mineral preparations that do contain it, as Calcinatal ®, MU LTICENTRUM ®, Superdyne ® and Micebrina ®. When the mother has taken this supple ment throughout pregnancy and during lactation is taking it, their milk contains the quantities of iodine that your child needs, whether or not premature. But i f not possible breastfeeding, will have to resort to formulas that are adequatel y fortified with this micronutriente5. We did not find information on the iodine content of foods to feed children when they stop breastfeeding, so that supplem enting your diet with multivitamins and mineral preparations might be advisable. Often expressed the fear that, when the iodine intake of women was already good before pregnancy, a supplement your diet with 250-300 mg / day may be excessive and harmful. There is no basis for such fear as a daily intake of 1-2 mg of iod ine is common in some populations that consume seaweed, as some of Japón9, no ad verse effects. Measures of urinary iodine in pregnant women in Chile, for exampl e, suggest intakes of 500-700 μg10, also without negative effects. As this is a point of great importance, the World Health Organization commissioned the study to an international committee of experts, meeting of which emanated a document t hat demonstrates that even the use of iodized oils (eg., Lipiodol ®) used as an emergency measure to eliminate iodine deficiency in countries that have not esta blished an adequate distribution of iodized salt, is without its problems for pr egnant women and developing their feto11. Contrast this with the serious problem s related to poor maternal iodine intake during fetal development (Table 2), 12 problems are eradicated with utilización13, 14. It should be noted that 1 ml of iodized oil usually employed (Lipiodol ®) contains 380 mg of I (380 000 g!) And the doses used are usually of 2 ml or more. Although it is administered once, or ally or intramuscularly, and is retained in muscle and fat tissue, iodine is rel eased gradually. But obviously it does in excess of what they ingest a woman who received 300 mg / day throughout pregnancy and lactation. References: 1. Ansotegui Arena J, Emparanza Knörr JI The antiseptics are not harmless. An Es p Pediatr 2000; 53: 25-29. 2. Escobar del Rey F, Morreale de Escobar G universal salt iodization: A human right of children. Endocrinology 1998; 45: 4-16. 3. Mo rreale de Escobar G Interrelationships of maternal and fetal thyroid hormones. A n Esp Pediatr 1999; 50 (Suppl 125): 36-43. 4. Ares S, Quero J, Duran S, Presas M J, Herruzo R, Morreale de Escobar G Iodine content of infant formulas and iodine intake of premature babies: High Risk of iodine deficiency. Arch Dis Child (Fet

al Neonatal) 1994 71: F184-F191. 5. Ares S, Escobar Morrreale G, Quero J Nursing artificial and iodine deficiency in the premature infant. An Esp Pediatr 1999; 50 (Suppl 125): 47-51. 6. Delange F, Dunn JT, Glina Specific Recommendation D on iodine nutrition for Mothers and infants in Europe. In: Delange F, Dunn JT, Gli na D, editors. Iodine Deficiency in Europe. New York: Plenum Press, 1993, 478-47 9. 7. De Santiago J, Pastor I, Escobar del Rey F, Morreale de Escobar G Thyroid function in pregnant Women from an area with mild (grade I) iodine deficiency [a bstract 126]. J Endocrinol Inv 1999; 22 (Suppl 6): 68. 8. De Santiago García J, Pastor I, Escobar del Rey F, Morreale de Escobar G iodine deficiency and thyroid function of pregnant women. 41 National Congress of the Spanish Society of Endo crinology and Nutrition. Málaga, 1999. 9. Katamine S, Mamiya K, Sekimoto N, Hosh ino N, Totsuka K, Naruse A et al contant of Various Iodine Consumed Currently me als by urban Japanese. J Nutr Sci Vitaminol 1986;€32: 487-492. [Medline] 10. Lib erman CS, Pino SC, Fang SL, Braverman LE, Emerson CH British circulating iodide Concentrations During and after-pregnancy. J Clin Endocrinol Metab 1998 83: 3545 -3549. [Medline] 11. Iodized oil WHO During Pregnancy. Safe use of Iodized oil t o Prevent iodine deficiency in pregnant women: a WHO statement. Bull WHO 1996; 7 4: 1-3. 12. Hetzel BS Historical Development of concepts of brain-thyroid Relati onships. In: Stanbury JB, editor. The Damage brain of iodine deficiency. Elmsfor d, NY: Cognizant Communication Co., 1994, 1-8. 13. Pharaoh POD, Buttfield IH, He tzel BS Neurological damage to the fetus Resulting from Severe iodine deficiency During Pregnancy. Lancet 1971; 13: 308-311. 14. Pretell EA, Cáceres A Impairmen t of mental development by iodine deficiency and Its correction. A retrospective view from studies in Peru. In: Stanbury JB, editor. The Damage brain of iodine deficiency. Elmsford, NY: Cognizant Communication Co., 1994, 187-192. 15. Carswe ll F, Kerr MM, Hutchison JH Congenital Goitre and hypothyroidism produced by mat ernal ingestion of iodide. Lancet 1970; 13: 1242-1247. 16. Rodesh F, Camus M, Er mans AM, Dodion J, Delange F. Adverse effects of amniofetography on fetal thyroid function. Amer J Obstet Gynecol 1976 126: 723-726. 17. Delange F, BOURDOUX P, Ermans AM Transient disorders of thyroid function and regulation in preterm infants. In: Delange F, Fisher DA, Malvoux P, editors. Pediatric thyroid ology. Basel: S Karger AG, 1985, 14: 369-393. 18. Ares S, Pastor I, Quero J, Mor reale de Escobar G Thyroid Complications, Including Overt hypothyroidism, relate d to the use of non-radiopaque silastic catheters for parenteral feeding in prem ature infants requiring injection of small Amounts of an iodinated contrast medi um. Acta Paediatr 1995, 84: 579-581. [Medline] UNICEF - http://www.unicef.org/spanish/nutrition/index_iodine.html Provision of essential micronutrients: Iodine GOAL: Achieve sustainable elimination of disorders resulting from iodine deficie ncy by 2005 "The success of the campaign for universal salt iodization has shown that in a f ew years, the diet of children, girls, women and families around the world can b e changed without major changes, but with huge benefits by concerted action at g lobal, national and local levels. " - Carol Bellamy, Executive Director of UNICE F. The challenge Iodine deficiency is the leading cause of mental retardation and b rain injuries are preventable. The most damaging effects of iodine deficiency oc cur in the brain of the fetus during pregnancy and in infants during the first y ears of life. In addition, iodine deficiency increases infant mortality rates, s pontaneous abortions and stillbirth. The majority of children whose mothers had iodine deficiency during pregnancy are a normal but suffered brain damage and re duced IQ, which affects their ability to develop fully. These apparently normal infants suffer learning problems later in school and have difficulties to contin ue their education. Other children whose mothers had iodine deficiency during pr egnancy may pose a severe delay in mental and physical development that is evide nt with an inflammation of the thyroid gland called goiter. Other symptoms of th

is delay is in speech defects, deafness and cretinism. However, these cases repr esent only the tip of the iceberg, and many of them, it is too late to reverse t he effects of iodine deficiency. Therefore, UNICEF's work focuses on the cases " subclinical" of disorders caused by iodine deficiency, or children who have a mo re mild iodine deficiency and that appear normal but have lost 10 to 15 points o f IQ. However, all disorders caused by iodine deficiency can be prevented with a teaspoon of iodine distributed in minute quantities and periodic lapses during a lifetime at minimal cost (five U.S. cents per person each year). During the Wo rld Summit for Children held in 1990 established the goal of virtual elimination of iodine deficiency by 2000. Fortification of salt has made major progress. In 1990, the proportion of households consuming iodized salt in developing countri es reached 20%, while today over 70%. The increasing use of iodised salt protects about 91 milli on children in decreases in learning ability and other intellectual problems cau sed by iodine deficiency. However, the battle to prevent iodine deficiency is no t over yet. In developing countries,€30% of households consume iodized salt, lea ving unprotected to 41 million infants and newborns. Measures should be taken to ensure that women consume iodized salt during pregnancy so that their children receive the necessary protection. You should also take steps to maintain over ti me the progress made to date. The formation of national surveillance involving t he public sector, private sector and consumer groups is an important method of m onitoring in all countries. The solution UNICEF works with various public and pr ivate organizations to eliminate iodine deficiency through universal salt iodiza tion. Among the partners of UNICEF in this cause are the salt producers, governm ents of various countries, the International Council for the control of disorder s caused by iodine deficiency, the World Health Organization (WHO), the Micronut rient Initiative World Bank, Kiwanis International, school teachers, consumer gr oups and children who attend different schools around the world. One of the most extraordinary cases is China, where in the 1990s, the rate of iodization of sal t increased from 39% to 95%. Other countries where salt iodization reached very high levels were Jordan (with coverage rose from 5% to about 90%) and Bangladesh (with iodization increased from 20% to 70%). Latin American countries such as P eru, have a long history of commitment to the iodization of salt, while among th e most notable of Africa are those of Nigeria and Kenya. The breadth and scope o f advocacy activities at national level is one of the reasons for the huge succe ss in terms of salt iodization during the 1990s. In order to achieve their ultim ate goal of eliminating iodine deficiency by 2005, UNICEF is resuming building a ctivities and defense in the government framework for the various governments to commit to that goal and encourage the involvement of salt producers , so that t he process lasts. UNICEF also works closely with civil society and schools, in o rder to generate greater demand for iodized salt. The situation in various count ries: disorders caused by iodine deficiency is a major health problem in the Lao People's Democratic Republic. This is one of the countries most affected by the se disorders because the mountainous terrain and the monsoon wind action prevent s the soil retain micronutrients. With support from UNICEF, the Lao government a nd salt producers are committed to improving the iodine intake of the population and implement the project "Elimination of disorders caused by iodine deficiency ." Through this partnership, more than 90% of Lao households now consume iodized salt. In Nepal also made considerable progress toward the goal of universal iod ization of salt. All salt is imported from India is iodized before being distrib uted in the market. The poor quality of iodized salt in some areas and the popul ation's preference for salt relatively limited progress towards the goal, as han dling practices, marketing and storage of such salt cause a significant loss of iodine . Because one third of households in Nepal still consumes salt with low iodine con tent, UNICEF aims to raise awareness about the need to consume iodized salt and the disorders caused by iodine deficiency. UNICEF also monitors the supply of io dized salt and working with salt producers to improve the quality and packaging

of the product. In Vietnam, UNICEF has focused the activities of elimination of disorders caused by iodine deficiency in the Mekong River Delta, as there is rec orded a high prevalence of disorders caused by iodine deficiency and the number of households consuming iodized salt is very limited. UNICEF has provided refine d salt systems with their counterparts to improve the quality of iodized salt an d is supporting government initiatives to iodized salt is available to everyone in that region. 200 Microgram YODUK S: 1 tablet daily for seeking pregnancy, pregnancy and breas tfeeding period. http://groups.msn.com/lactanciamaternaprolongada 10 thematic forums: Pregnancy and Childbirth * * General (Breastfeeding) * Infan t Food (Paps) * Sleeping without Suffering (Dream Child) * Education * Pour over (Forum to vent in critical cases) * Activities (kedadas, expert talks, meetings ,€conferences) * Family Matters (domestic affairs) * A bit of everything (topic s that do not fit in other forums) Web site created in October 2003 and already has more than 1.070participantes registered, among which there is a doctor ( pra ctitioners, pediatricians and neonatologists) and advisory titled breastfeeding. You only have to click on join the group to participate in all areas of the web . Administrator: psicologa1979@hotmail.com