What are the recommendations for vitamin D supplementation in breastfeeding mothers?

Vitamin D Supplementation Recommendations for Breastfeeding Mothers

All breastfeeding mothers should take a vitamin D supplement of 10 μg/day (400 IU/day) to ensure adequate vitamin D levels for both themselves and their infants. 1

Evidence-Based Recommendations

Multiple health organizations and guidelines consistently recommend vitamin D supplementation for breastfeeding mothers:

• National Institute for Health and Care Excellence (NICE): Recommends 10 μg/day (400 IU/day) for all breastfeeding women 1
• Public Health England: Advises that lactating women should take a vitamin D supplement (10 μg/day) to ensure adequate vitamin D intake 1
• Scientific Advisory Committee on Nutrition: Confirmed that the reference nutrient intake of 10 μg/day for breastfeeding women should remain unchanged 1
• Scottish Intercollegiate Guidelines Network (SIGN): Recommends breastfeeding mothers take a supplement containing 10 μg vitamin D 1

Rationale for Supplementation

• Breast milk naturally contains low levels of vitamin D, making breastfed infants vulnerable to vitamin D deficiency 2
• Vitamin D deficiency in infants can lead to rickets, which affects bone development and growth 2
• Maternal vitamin D status directly influences the vitamin D content of breast milk 2
• Limited sunlight exposure, increased pollution, and few natural dietary sources of vitamin D contribute to deficiency risk 2

Safety Considerations

• The upper limit of vitamin D for lactating women is 100 μg/day (4,000 IU/day) 1
• Standard supplementation (10 μg/day) is well below this upper limit and considered safe 1
• Exceeding recommended doses without medical supervision should be avoided

Alternative Approaches

Some evidence suggests that higher maternal doses may be an alternative to direct infant supplementation:

• Higher maternal doses (4,000-6,400 IU/day) can increase breast milk vitamin D concentration enough to meet infant needs 1, 2
• However, this approach remains controversial due to safety concerns about high-dose maternal supplementation 2
• Most international guidelines still recommend direct infant supplementation of 400 IU/day during the first year of life as the standard approach 2

Infant Supplementation Considerations

• The American Academy of Pediatrics recommends that exclusively or partially breastfed infants receive vitamin D supplementation of 400 IU/day beginning at hospital discharge 1
• This recommendation applies until infants consume at least 28 ounces of commercial infant formula per day 1
• A Cochrane review found that infant vitamin D supplementation at 400 IU/day increases 25-OH vitamin D levels and reduces vitamin D insufficiency 3

Maternal Preferences

• Studies show that 88% of mothers prefer taking vitamin D supplements themselves rather than giving them to their infants 4
• Taking maternal preferences into consideration may improve adherence to vitamin D supplementation recommendations 4

Calcium Considerations

• There is no evidence that calcium requirements differ between lactating and non-lactating women 1, 5
• Post-lactation maternal bone mineral density is typically restored without requiring higher calcium intake 1
• The recommended calcium intake for lactating women aged 19-50 years is 1,000 mg/day 5

Vitamin D supplementation of 10 μg/day (400 IU/day) for breastfeeding mothers is a simple, safe, and effective strategy to help prevent vitamin D deficiency in both mothers and infants, with potential benefits for bone health and overall development.