Is Iron Salts safe while breastfeeding?

Effects on the breastfed infant

One-hundred thirty-one non-anemic, lactating mothers in Ankara, T rkiye randomly received 80 mg elemental iron as ferrous sulfate daily or placebo beginning 10 to 20 days postpartum and continued for 4 months. Hematological indices and biochemical iron status values were no different between the two groups of infants at the end of the study.[ 19 ]

Effects on milk supply

Iron-enriched human milk fortifier intended for preterm hospitalized infants increases milk microbial growth compared to iron-free fortifier under in vitro experimental conditions.[ 22 ] The clinical consequences of these findings have not been evaluated. Such studies tested milk iron concentrations in the range of 13 to 14 mg/L, which were common for fortifiers in the countries where the studies were conducted. Currently available U.S. premature infant milk fortifier provides a much lower iron supplemental dose resulting in a milk iron level of 3 mg/L above the mother s underlying milk level.

Levels in milk

Iron is normally present in human breastmilk, with higher concentrations in hindmilk.[ 1 ] One-third of milk iron is found in the fat fraction bound to metalloproteins in the outer membrane of fat globules. Most of the remainder is in the whey fraction bound mostly to lactoferrin, but also to other proteins such as transferrin and to smaller ligands. About 10% of milk iron is bound to casein.[ 2 ] Quantities are highest in colostrum, and they decrease as lactation progresses. Reported average milk iron levels in the first postpartum week are about 1 mg/L, decreasing to a range of 0.4 to 0.9 mg/L during the first postpartum month, then 0.2 to 0.4 mg/L from 1 to 3 months, and 0.1 to 0.3 mg/L from 3 to 6 months.[ 1 - 4 ] Mammary epithelial trace element active transporters regulate milk iron content and are believed to be responsible for insulating milk iron levels from changes in maternal iron status.[ 5 ] However, severe maternal malnutrition and anemia can lead to lower milk iron levels. Maternal Levels. In a study of 75 postpartum women in India, the average milk iron level at 12 to 18 days postpartum was 0.69 mg/L in women with severe anemia, defined as a hemoglobin level 6 grams/dL during the third trimester, compared to 0.74 to 0.79 mg/L in those with less severe anemia, and 0.83 mg/L in those with hemoglobin 11grams/dL.[ 6 ] A similar study in Cairo, Egypt reported an average milk level of 0.29 mg/L in malnourished, severely anemic mothers compared to 0.78 mg/L and 1.6 mg/L in mildly anemic and non-anemic mothers, respectively.[ 7 ] A study of 212 non-malnourished and mostly non-anemic mothers in West Java, Indonesia identified a 1.9% and 0.4% change in milk iron concentration for every 1 gram/L change in maternal hemoglobin and 1 mcg/L change in serum ferritin, respectively, but milk iron levels were not associated with maternal dietary iron intake.[ 8 ] A lack of correlation between milk levels and maternal dietary iron intake has also been reported in simila

Alternatives LactMed lists

• Ferric Carboxymaltose
• Ferric Derisomaltose
• Iron Sucrose