Maternal Vitamin D Supplementation to Improve the Vitamin D Status of Breast-fed Infants: A Randomized Controlled Trial

Abstract

Objective To determine if a single monthly supplement was as effective as a daily maternal supplement in increasing breast milk vitamin D to achieve vitamin D sufficiency in their infants. Patients and Methods Forty mothers with exclusively breastfed infants were randomized to receive oral cholecalciferol (vitamin D3) 5000 IU/d for 28 days or 150,000 IU once. Maternal serum, breast milk, and urine were collected on days 0, 1, 3, 7, 14 and 28; infant serum was obtained on days 0 and 28. Enrollment occurred between January 7 and July 29, 2011. Results In mothers given daily cholecalciferol, concentrations of serum and breast milk cholecalciferol attained steady levels of 18 and 8 ng/mL, respectively, from day 3 through 28. In mothers given the single dose, serum and breast milk cholecalciferol peaked at 160 and 40 ng/mL, respectively at day 1, before rapidly declining. Maternal milk and serum cholecalciferol concentrations were related (r=0.87). Infant mean serum 25(OH)D (±SD) increased from 17±13 to 39±6 ng/mL in the single dose group and from 16±12 to 39±12 ng/mL in the daily dose group (P=.88). All infants achieved serum 25(OH)D concentrations >20 ng/mL). Conclusion Either single dose or daily cholecalciferol supplementation of mothers provided breast milk concentrations that result in vitamin D sufficiency in breastfeeding infants.

Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial

“…7,8,18 It is the parent compound, vitamin D itself, which overwhelmingly gets transferred into human milk from the maternal circulation. 8,17,22,52,53 7,8,19,52 This fact is precisely why the AAP recommends every nursing infant receive a daily supplement of 400 IU vitamin D. 11 However, this last recommendation treats only the infant and does not address the core problem of why breast milk has such low concentrations of vitamin D. Also, the AAP recommendation 11 is rarely followed as evidenced by our baseline entry data for breastfed infants (Table 1). In our study infants, only 12% were being given supplements at baseline, which concurs with previous reports.…”

“…1,3,11 Over the decades, we and others have reported the vitamin D content of human milk and thus its antirachitic activity. 8,22,28,[50][51][52] These studies have provided valuable information. Universally, the antirachitic activity of human milk is quite low, 5 to 80 IU/L, unless the lactating mother is ingesting a significant amount of vitamin D daily or getting significant total body UV exposure.…”

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

“…A dose of 6,400 IU/day raises the milk vitamin D content sufficiently so that the babies achieved 25OHD values of 115 nM (46 ng/ml), the same level reached by babies who received 300 IU of vitamin D directly in the form of oral drops (965). A daily maternal dose of 5,000 IU/day raised maternal 25OHD to 400 nM (160 ng/ml) and neonatal 250HD to 98 nM (39 ng/ml), while a single maternal dose of 150,000 IU had a similar effect (672).…”

“…Observational cohort studies (145,731,862,893) and randomized interventional trials (13,14,60,402,453,672,780,788,789,965) have not shown any effect of higher 25OHD concentrations or vitamin D supplementation to alter maternal mineral or skeletal homeostasis in otherwise healthy, lactating women across a broad range of vitamin D intakes and 25OHD levels. Vitamin D supplementation raises maternal 25OHD levels with a similar dose-response effect as in nonpregnant or nonlactating women.…”

“…Randomized intervention studies indicate that typical maternal vitamin D doses of 400-1,000 IU/day do not consistently increase breast milk content of vitamin D or 25OHD, whereas with maternal vitamin D doses of 2,000 -4,000 IU/day, an increase in milk content of vitamin D and 25OHD and neonatal 25OHD can be demonstrated (13,14,402,780). Additional randomized trials have shown that even higher maternal vitamin D intake increases the amount of vitamin D and 25OHD in milk (also called "antirachitic activity" of milk) (60,672,788,965). A dose of 6,400 IU/day raises the milk vitamin D content sufficiently so that the babies achieved 25OHD values of 115 nM (46 ng/ml), the same level reached by babies who received 300 IU of vitamin D directly in the form of oral drops (965).…”