To the Editor: Dr Stagnaro-Green and colleagues1 argued that a randomized controlled trial (RCT) of iodine in pregnancy would be unethical because many international bodies recommend additional iodine intake, largely for the prevention of cognition-related adverse effects in offspring. We dispute their assertion that such a trial is necessarily unethical.
While in regions of severe iodine deficiency, the benefit of iodine supplementation during pregnancy is indisputable, in regions of mild-to-moderate deficiency, the evidence for benefit is only suggestive.2 Previous RCTs of iodine in pregnancy in such regions lacked cognitive outcomes and only 2 small intervention studies, neither of which was randomized or placebo-controlled, afforded evidence of improvements in child cognition.2
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