Question

I am a breastfeeding mother and i want to know if it is safe to use Iodine? Is Iodine safe for nursing mother and child? Does Iodine extracts into breast milk? Does Iodine has any long term or short term side effects on infants? Can Iodine influence milk supply or can Iodine decrease milk supply in lactating mothers?

Iodine lactation summary

Iodine is unsafe in breastfeeding
  • DrLact safety Score for Iodine is 5 out of 8 which is considered Unsafe as per our analyses.
  • A safety Score of 5 indicates that usage of Iodine may cause serious side effects in breastfed baby.
  • Our study of different scientific research indicates that Iodine may cause moderate to high side effects or may affect milk supply in lactating mother.
  • Our suggestion is to use safer alternate options rather than using Iodine .
  • It is recommended to evaluate the advantage of not breastfeeding while using Iodine Vs not using Iodine And continue breastfeeding.
  • While using Iodine Its must to monitor child for possible reactions. It is also important to understand that side effects vary largely based on age of breastfed child and time of medication in addition to dosage.
  • Score calculated using the DrLact safety Version 1.2 model, this score ranges from 0 to 8 and measures overall safety of drug in lactation. Scores are primarily calculated using publicly available case studies, research papers, other scientific journals and publically available data.

Answer by Dr. Ru: About Iodine usage in lactation

Disinfectant that contains high amount (2-7%) of Iodine in solution with alcohol or water (Lugol's solution) Not absorbed through intact skin of adults. However, it may trespass the inflamed skin, wounds, mucosa surfaces like vagina, in which case can reach concentration in grams in the human serum (1 g = 1,000 milligrams = 1,000,000 micrograms). Normal daily allowance is considered to be as high as 100 to 150 micrograms that increases to 200 – 300 micrograms in pregnancy or nursing period. The latter means less than one third of a milligram. Iodine is concentrated into breast milk with a level that could reach 20 times higher than the concentration in the blood. It has been found higher levels of Iodine, altered results of neonatal screening test for thyroid function, and, transient hypothyroidism in infants whose mothers were exposed to Iodine Povidone. Use should be avoid in the Delivery Room, Operating Room (C-section), Neonatal Units, Toddler admision areas and during the breastfeeding period. Sporadic or inadvertent use, specially on normal skin, does not require special test or procedures because it does not pose higher risk to the child.

Answer by DrLact: About Iodine usage in lactation

Iodine is an essential trace nutrient for all infants that a normal component of breastmilk. Infant requirements are estimated to be 15 mcg/kg daily in fullterm infants and 30 mcg/kg daily in premature infants.[1] Systematic reviews and studies on iodine nutrition found that iodine in breastmilk is adequate in iodine-sufficient countries, but in countries with iodine fortification of foods, many mothers did not obtain adequate iodine and that additional supplementation was desirable.[2][3][4][5] In iodine-deficient areas, supplementation of breastfeeding mothers with iodine appears to be more effective than direct supplementation of the infant in reducing infant iodine deficiency.[6] The American Thyroid Association recommends that breastfeeding women should supplement their diet with a daily oral supplement that contains 150 mcg of iodine, but sustained iodine intake while breastfeeding that exceeds 500 to 1100 mcg daily should be avoided.[7] A survey in the United States between 2011 and 2014 found that only 19% of lactating women used a dietary supplement that contained iodine.[8] The use of excessive amounts of iodine in the mother near term and during breastfeeding (e.g., seaweed soup) can increase breastmilk iodine levels and cause transient hypothyroidism in breastfed infants. The absorption of iodine can be marked after application to open wounds or mucous membranes. Exposure of mothers to unnecessary iodine who are or will be breastfeeding should be avoided or minimized to the extent possible by avoiding its use on maternal mucous membranes (e.g., vaginal use, wound therapy), avoiding prolonged contact time, avoiding repeated applications, and applying it to the smallest possible surface areas of the body. It is possible that maternal exposure to iodine near term could interfere with thyroid studies done as a part of newborn screening tests.

Iodine Side Effects in Breastfeeding

In Switzerland, a girl born at 29 weeks of gestation with adequate size for gestational age showed negative TSH screening on day 5. Her mother developed an abscess of the abdominal wall 1 week after her cesarian section and the wound was packed with tampons containing about 10.5 mg of iodine. The baby's TSH was elevated to 23 milliunits/L on day 23, and 288 milliunits/L on day 29. Free thyroxine (T4) levels were decreased to 2.8 ng/L and free liothyronine (T3) with 1.52 ng/L, without signs or symptoms of hypothyroidism. Iodine contents of maternal milk and of infant urine were 4.4 mg/L and 3.9 mg/L, respectively. Treatment with levothyroxine was started, breastfeeding was discontinued and disinfection with iodine was stopped. The infant's thyroid function tests normalized after 6 days.[16] The infant's abnormal thyroid function tests were probably caused by maternal iodine use. The mother of a 31-week, 961 gram preterm infant packed her cesarean section wound with iodine-soaked gauze because of wound dehiscence and infection. She was expressing milk for her hospitalized infant. The infant's thyroid function tests were normal at birth, but at 2 weeks of age, the infant's serum thyroxine was borderline low and TSH levels were elevated. One week later, TSH had increased to 77 milliunits/L and both thyroxine and free thyroxine levels were low. Breastmilk was discontinued and levothyroxine was started. The mother discontinued the iodine packing and 1 week later breastmilk feeding was resumed. At 2 months of age, the infant's thyroid function test were normal while taking levothyroxine.[17] A study of 31 preterm infants born at 34 weeks gestational age or less was performed in Korea where mothers typically ingest large amounts of seaweed soup during the first month postpartum. Subclinical hypothyroidism was frequently found in the infants with high intake of iodine from breastmilk.[18] A mother used an iodine antiseptic on her episiotomy wound for 10 to 12 days postpartum. At 15 days of age, her infant had elevated TSH and low free T4 serum levels, an enlarged thyroid gland, and an elevated urinary iodine concentration. The infant's symptoms were probably related to maternal iodine application.[19] Two mothers originally from Asia (Korea and China) reportedly ate large amounts of soup made from seaweed from their home countries in the postpartum period. Their infants had elevated thyrotropin (TSH) levels when tested at 3 to 4 weeks of age and signs of hypothyroidism. Both were treated with thyroid hormones and regained normal thyroid function.[20] A 21-day-old breastfed (extent not stated) infant presented with unconjugated hyperbilirubinemia. Neonatal TSH screening was normal, but at 21 days it was 87.3 IU/L (normal 0.27 to 4.2 IU/L). Free T4 was 7.3 pmol/L (normal 12 to 22 pmol/L) and the thyroid was slightly enlarged. The infant's parents were of Korean origin and the mother had consumed 3 to 4 bowls of brown seaweed (Undaria pinnatifidia) soup daily from the time of birth. The infant's hypothyroidism was probably caused by the high iodine content of the seaweed soup.[29] Twenty-three mothers in Japan were treated with potassium iodide for Graves disease. Doses were adjusted to maintain normal thyroid function; the median dose was 50 mg daily (range 10 to 100 mg/day). Their 26 infants (1 pair each of twins and triplets) were breastfed, some exclusively and some partially. Twenty-five of the 26 infants had normal thyroid function. One 5-month-old infant presented with subclinical hypothyroidism, indicated by a blood thyrotropin level of 12.3 microIU/mL, after 1 month of maternal therapy. Two months after potassium iodide discontinuation, the blood thyrotropin level normalized to 2.3 microIU/mL. In other infants, thyrotropin levels deceased over time without discontinuing maternal iodine or breastfeeding.[26] A breastfed Korean infant was found to have an elevated TSH at 15 and 22 days of age and a low free T4 level at 22 days of age. The infant also had markedly elevated urine iodine levels. Her mother had been drinking seaweed soup almost daily during pregnancy and postpartum. The infant was started on levothyroxine and the mother told to feed the infant formula and stop breastfeeding temporarily. The mother resumed nursing at 1 month of age and levothyroxine was at a lower dose until 4 months of age. The infant's thyroid function remained normal up to 12 weeks off of levothyroxine. It is probable that the thyroid dysfunction was caused by excess iodine in breastmilk.[30]

Alternate Drugs

Mupirocin(Safe)
Iodine(Unsafe)
Levofloxacin(Low Risk)
Mupirocin(Safe)
Kanamycin(Safe)
Aztreonam(Safe)
Cefprozil(Safe)
Ofloxacin(Safe)
Erythromycin(Low Risk)
Cefoxitin(Safe)
Clindamycin(Low Risk)
Gatifloxacin(Low Risk)
Cefotetan(Safe)
Enoxacin(Low Risk)
Neomycin(Safe)
Doxycycline(Low Risk)
Amikacin(Safe)
Nalidixic Acid(Low Risk)
Nafcillin(Safe)
Capreomycin(Low Risk)
Cefixime(Safe)
Demeclocycline(Low Risk)
Moxifloxacin(Low Risk)
Ertapenem(Safe)
Cefepime(Safe)
Methicillin(Low Risk)
Cefdinir(Safe)
Methenamine(Unsafe)
Cefazolin(Safe)
Iodine(Unsafe)
Cefaclor(Safe)
Lomefloxacin(Low Risk)
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