Is Vitamin A safe while breastfeeding?

Effects on the breastfed infant

Maternal vitamin A supplementation during pregnancy and lactation has not reduced mortality or the risk of anemia in breastfed infants living in developing regions, but there may be health benefits related to improved antioxidant capacity and immune function.[ 25 , 41 , 42 ] One hundred exclusively breastfeeding mothers in India were given 200,000 IU vitamin A or placebo as a single oral dose within 24 hours after delivery. There were no differences in weight gain of their infants during postpartum hospitalization between the groups, and no infants in the vitamin A group had symptoms of hypervitaminosis A, such as excessive crying, raised fontanelle and vomiting. All the infants received a dose of oral polio vaccine (OPV) between 48 and 72 hours after birth. There were no differences between the two groups in OPV seroconversion rates or antibody titers at 6 weeks.[ 43 ] Similarly, 1,085 exclusively breastfeeding mothers in Ghana were given 200,000 IU vitamin A or placebo at 3 to 4 weeks postpartum. There were no differences in infant immune response to polio or tetanus vaccination at 6 weeks and 6 months of age.[ 44 ] The infants of 197 mothers in Gambia given either 200,000 or 400,000 IU vitamin A in the first week after delivery showed no signs of adverse reactions to vitamin A during the 12-month follow-up period.[ 28 ] Two hundred forty-five healthy, exclusively breastfeeding mothers in Nanjing, China were randomized to receive a daily vitamin A 1800 IU supplement or placebo for 2 months beginning at 1 to 2 months postpartum. By the end of the 2 month study, infants in both groups had similar rates of febrile illnesses, respiratory tract infections, diarrhea, and eczema, although it was not stated how these data were collected.[ 24 ]

Effects on milk supply

HIV-infected mothers in Tanzania had a higher rate of severe subclinical mastitis (36%), determined by measuring serial milk electrolyte concentrations, when taking a daily vitamin A supplement during pregnancy and postpartum compared to placebo (23%). Mothers taking a multivitamin without vitamin A also had a higher rate (38%) than placebo, suggesting a vitamin A-independent effect. Given the many other benefits of multivitamin supplementation in this specific patient population, the authors did not recommend avoiding supplementation due to a potential risk of mastitis.[ 45 ] In a Brazilian study, 57 mothers received either 200,000 IU vitamin A or no vitamin A within 2 days after birth. At 24 hours after administration, the average level of alpha-tocopherol (vitamin E) was 16.4% lower in the colostrum of mothers who received in the vitamin A (28 micromoles/L compared to 24.5 micromoles/L), but it was not significantly different at 30 days after administration, at about 6 micromoles/L.[ 26 ] The reported vitamin E colostrum levels in this study are within normal limits, thus the small reduction in the vitamin A-supplemented mothers may not be clinically important. A different Brazilian research group conducting the same experiment using a vitamin A supplement with low-dose vitamin E 110 IU added as a preservative found no effect of vitamin A on colostrum alpha-tocopherol.[ 46 ]

Levels in milk

Vitamin A (retinol) measurements are expressed in the literature as mcg, IU, or micromoles. One mcg is equal to 3.33 IU (0.3 mcg = 1 IU), and also to 0.0035 micromoles (286 mcg = 1 micromole). Beta-carotene from vitamin supplements is one-half as potent as retinol. One mcg of beta-carotene from vitamin supplements is therefore equal to 0.5 mcg retinol (see the LactMed beta-carotene record). A serum retinol concentration less than 0.7 micromoles/L ( 200 mcg/L) indicates biochemical vitamin A deficiency, and 0.7 to 1.05 micromoles/L (200 to 300 mcg/L) indicates marginal deficiency.[ 2 ] Milk levels less than 1.05 micromoles/L ( 300 mcg/L) indicates low milk vitamin A content.[ 4 ] Most retinol present in milk are retinyl esters (e.g., retinyl acetate), which can be de-esterified in the infant's digestive tract.[ 5 ] Mature milk retinol levels correlate with maternal serum retinol levels, and levels of milk retinol and beta-carotene are correlated with one another.[ 6 - 11 ] Milk retinol and carotenoid levels in colostrum are higher than in mature milk. Intra-individual colostrum levels vary widely, but are consistently higher than and not correlated with maternal serum levels, suggesting active colostrum enrichment.[ 12 ] Levels decrease over the first 1 to 2 weeks postpartum and then stabilize.[ 2 , 13 , 14 ] Vitamin A partitions into milk fat and milk retinol levels are positively correlated with milk fat.[ 9 , 15 ] Hindmilk levels are higher than foremilk.[ 16 , 17 ] Milk vitamin A content increases as maternal dietary vitamin A increases.[ 18 ] Nutritionally deficient mothers have lower milk retinol and provitamin A carotenoid levels than those of well-nourished mothers.[ 6 , 19 , 20 ] Premature birth may also be associated with lower milk retinol levels.[ 21 , 22 ] Maternal Levels. Healthy mothers not taking a supplement have retinol levels averaging 800 to 1400 mcg/L in colostrum and 300 to 800 mcg/L in mature milk.[ 10 , 12 , 14 , 17 , 20 , 23 , 24 ] Beta-carot

Alternatives LactMed lists

• Beta-Carotene