It may not be the breastmilk that has a vitamin D deficiency, but the dietary vitamin D recommendation for the lactating mother!
The common notion that low concentrations of vitamin D in human milk is a defect in design has prompted the recommendation for vitamin D supplementation for breastfeeding infants starting within the first few days after birth. This misconception was revealed in a study that supplemented the lactating mother with 6400 IU of vitamin D per day.The problem is not in the composition of human milk but in the dietary vitamin D recommendation for the lactating mother. The current recommendation of 400 IU per day for the lactating woman is insufficient to maintain blood concentrations of the parent vitamin D compound, the form that crosses from the maternal circulation into human milk. This results in minimal vitamin D transfer into breastmilk. The resulting vitamin D deficiency in the breastfeeding infant, especially darker-pigmented infants, can be significant.This study shows that with appropriate vitamin D intake, the lactating mother can fully transfer from her blood to her milk the vitamin D required to sustain optimal vitamin D nutrition in the nursing infant with no additional supplementation required for the infant.
Hollis BW, Wagner CL, Howard CR, et al. Maternal versus infant vitamin D supplementation during lactation: a randomized controlled trial. Pediatrics 2015; 136:625-634.
Also if mom has plenty of vitamin D stores it can reduce pre term labor by a huge amount. Not to mention help the developing fetus.
I am excited about this for our breastfeeding moms. My question is how to get the OB’s on board with the supplementation for moms, how soon should moms begin the supplementation of Vitamin D, will babies have to have blood work done to insure their level is adequate? Thank you.
Excellent question, Jeannie. At this point, since the recommendation has come from the AAP based on the available evidence, the hope is that ACOG will also recognize this need so that they can educate and advocate their members as well. In the meantime, educating mothers directly, which is within the scope of the IBCLC, will empower them with the knowledge that they need to ask their physicians for their own levels to be tested and for their babies’ levels to be tested if there is a question about their breastfed baby’s Vitamin D status. Historically, breastfed babies have not been tested but rather have been assumed to have low Vitamin D status, leading many IBCLCs and mothers to question this across-the-board assumption. As to how soon mothers should begin supplementation, it is plausible to say that women should ensure their own Vitamin D status is adequate before conceiving so they can have a healthier pregnancy and a healthier baby. This new AAP recommendation is an excellent opportunity to a)revise nutritional recommendations for pre-conception and pregnancy to emphasize adequate Vitamin D intake so that new mothers will not already be low, and b)end unnecessary supplementation of healthy breastfed babies who already have a normal Vitamin D level. We hope that all IBCLCs and breastfeeding families will advocate for these changes and help put these new guidelines into practice quickly!