Is Vitamin D safe while breastfeeding?

Effects on the breastfed infant

Maternal daily doses of 400 to 6,400 IU (10 to 160 mcg) have not been associated with any short-term biochemical abnormalities in breastfed infants.[ 11 , 19 , 34 - 36 , 38 , 40 , 48 ] An 11-day-old, exclusively breastfed, term, female neonate experienced asymptomatic, mild hypercalcemia (total serum calcium 11.4 mg/dL). The mother was taking maintenance vitamin D 2 100,000 IU daily to maintain normal calcium and phosphorus status after a pre-pregnancy thyroid-parathyroidectomy, plus a prenatal vitamin containing 400 IU daily vitamin D (form not specified) during pregnancy and lactation. Vitamin D 2 and 25-OH-vitamin D 2 levels in cord blood and in milk at 14 days of age were both markedly elevated. Serum vitamin D levels were not measured in the infant.[ 29 ] The combination of high daily breastmilk vitamin D 2 intake plus a high infant serum level present at birth likely contributed to the abnormal calcium value. In a study in northern India, short-term maternal use of oral 60,000 IU vitamin D 3 once daily for 10 days beginning after birth was not associated with any differences in serum calcium or phosphorus levels, or of urinary calcium/creatinine ratios, in their exclusively breastfed infants at 14 weeks and 6 months of age compared to infants of mothers given placebo. Infants of mothers given vitamin D had a lower frequency of biochemical rickets compared to placebo (0 vs 17%), but no difference in the frequency of radiological rickets (3.6% vs 3.4%).[ 45 ] One hundred fifty-two mothers in northern India, most of whom were vitamin D deficient, were randomized to receive 120,000 IU (3000 mcg) of vitamin D one time within 7 days postpartum followed by the same dose at 6, 10, and 14 weeks postpartum to coincide with scheduled infant immunization, or placebo. Infants of mothers in the placebo group received 400 IU (10 mcg) of daily vitamin D while those in the treatment group received placebo. At 14 weeks, infant growth parameters and serum biochemical indicators

Effects on milk supply

Relevant published information was not found as of the revision date.

Levels in milk

The major forms of vitamin D present in breastmilk are cholecalciferol (vitamin D 3 ), ergocalciferol (vitamin D 2 ), and their respective 25-hydroxylates (25-OH) also known as calcidiols. Dihydroxylated metabolites are also present in milk, but in such low quantities that their contribution to total milk vitamin D activity is not routinely accounted for. The low potency C-3 stereoisomer of 25-OH-vitamin D 3 is also present in milk. Analytical techniques that do not detect this isomer can potentially overestimate the true 25-OH-vitamin D 3 level. Vitamin D partitions extensively into the fat fraction of whole milk after 1 to 2 days when stored under refrigeration.[ 4 ] Human vitamin D deficiency is defined as a 25-OH-vitamin D serum level 20 mcg/L ( 50 nmol/L), and vitamin D insufficiency as 20 to 30 mcg/L (50 to 75 nmol/L). The goal of vitamin D supplementation is to achieve a serum 25-OH-vitamin D level of 30 to 100 mcg/L (75 to 250 nmol/L).[ 5 ] Darker skin pigmentation is a risk factor for vitamin D deficiency due to decreased UVB-mediated cutaneous vitamin D 3 synthesis.[ 6 ] U.S. infants and children with darker skin pigmentation do not achieve optimal synthesis, even during summer months, from everyday outdoor sun exposures.[ 7 ] Milk levels of vitamin D and 25-OH-vitamin D are 10 to 20% and 1 to 2% of maternal blood levels, respectively.[ 8 - 11 ] As a mother's vitamin D blood levels increase due to increasing light exposure or dietary intake, milk vitamin D content also increases.[ 10 , 12 - 15 ] Maternal serum and milk levels and breastfed infant serum levels can be higher during summer and at lower latitudes due to increased sunlight availability and skin ultraviolet B light (UVB) exposure.[ 11 , 12 , 16 - 21 ] Levels are 1.5 to 2 times higher in hindmilk than in foremilk.[ 10 ] United States Food and Drug Administration standards for dietary supplement labeling recommend mcg rather than the traditional international units (IU) when describing vitamin D d

Alternatives LactMed lists

• Calcitriol