Is retinol safe while breastfeeding?

Safety of Retinol While Breastfeeding

Retinol (vitamin A) supplementation is not recommended during breastfeeding due to potential risks without clear benefits for maternal and infant health outcomes.

Recommendations for Vitamin A During Lactation

• The World Health Organization (WHO) does not recommend vitamin A supplementation in postpartum women for the prevention of maternal and infant morbidity and mortality 1
• There is no convincing evidence that maternal vitamin A supplementation (both <200,000 IU/day and 200,000 IU/day) during lactation results in a reduction in infant mortality or morbidity in low and middle-income countries 1
• For lactating women, the European Food Safety Authority (EFSA) recommends additional vitamin A requirements of 1300 μg retinol equivalent/day (approximately 4,300 IU/day), related to transfer of retinol into breast milk 1

Safety Concerns with Retinol

• Retinol is a potent teratogen and must be avoided in women of childbearing potential 1
• Vitamin A toxicity can occur with relatively narrow window between deficiency and toxicity 1
• Acute toxicity (approximately >150,000 μg or 500,000 IU) can present with increased intracranial pressure, headache, nausea, vomiting, vertigo, blurred vision, and muscular incoordination 1
• Chronic toxicity (approximately 30,000 μg or 100,000 IU/day) can present with bone abnormalities, dermatitis, alopecia, ataxia, muscle pain, cheilitis, skin and vision disorders, pseudotumor cerebri, and hepatocellular necrosis 1

Vitamin A Transfer Through Breast Milk

• Vitamin A concentration in human milk reflects maternal vitamin A intake more than the infant's requirement 1
• Studies show that maternal supplementation can increase breast milk retinol concentrations, but this doesn't necessarily translate to improved health outcomes for infants 2, 3
• Daily oral low-dose vitamin A supplementation may help improve maternal vitamin A status but has not been shown to affect infant health status through breast milk 2

Safer Alternatives

• Beta-carotene (provitamin A) is subject to negative feedback control and therefore considered safer than preformed vitamin A (retinol) 4
• For those requiring supplementation, beta-carotene can be prescribed at lower doses with reduced risk of toxicity 4
• Adequate dietary intake of vitamin A-rich foods is preferable to supplementation for meeting increased needs during lactation 5

Monitoring and Precautions

• If vitamin A supplementation is deemed necessary, serum monitoring should be conducted 4
• Concomitant administration of vitamin A and other oral retinoids with retinol should be avoided 1
• Both hypervitaminosis A and hypovitaminosis A can cause harm to mother and infant 4

Common Pitfalls to Avoid

• Failing to distinguish between preformed vitamin A (retinol) and provitamin A (beta-carotene) when calculating total vitamin A intake 4
• Not considering dietary sources of vitamin A when prescribing supplements 4
• Using water-miscible forms of vitamin A which may increase risk of toxicity 4

In conclusion, while adequate vitamin A is important during lactation, topical or oral retinol supplementation is not recommended due to safety concerns and lack of proven benefits for maternal and infant outcomes. Focus instead on ensuring adequate dietary intake of vitamin A through food sources.