title: Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant.
abstract: Scientific data pertaining to vitamin D supplementation during lactation are scarce. The daily recommended intake for vitamin D during lactation has been arbitrarily set at 400 IU/d (10 microg/d). This recommendation is irrelevant with respect to maintaining the nutritional vitamin D status of mothers and nursing infants, especially among darkly pigmented individuals. Our objective was to examine the effect of high-dose maternal vitamin D2 supplementation on the nutritional vitamin D status of mothers and nursing infants. Fully lactating women (n = 18) were enrolled at 1 mo after birth to 1 of 2 treatment arms, ie, 1600 IU vitamin D2 and 400 IU vitamin D3 (prenatal vitamin) or 3600 IU vitamin D2 and 400 IU vitamin D3, for a 3-mo study period. High-dose (1600 or 3600 IU/d) vitamin D2 supplementation for a period of 3 mo safely increased circulating 25-hydroxyvitamin D [25(OH)D] concentrations for both groups. The antirachitic activity of milk from mothers receiving 2000 IU/d vitamin D increased by 34.2 IU/L, on average, whereas the activity in the 4000 IU/d group increased by 94.2 IU/L. Nursing infant circulating 25(OH)D2 concentrations reflected maternal intake and the amount contained in the milk. With limited sun exposure, an intake of 400 IU/d vitamin D would not sustain circulating 25(OH)D concentrations and thus would supply only limited amounts of vitamin D to nursing infants in breast milk. A maternal intake of 2000 IU/d vitamin D would elevate circulating 25(OH)D concentrations for both mothers and nursing infants, albeit with limited capacity, especially with respect to nursing infants. A maternal intake of 4000 IU/d could achieve substantial progress toward improving both maternal and neonatal nutritional vitamin D status.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA. hollisb@musc.edu
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Hollis
authors.forename: Carol L
authors.initials: CL
authors.lastname: Wagner
mesh_terms: D000328:Adult; D002762:Cholecalciferol / Q000008:administration & dosage; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D004872:Ergocalciferols / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007774:Lactation / Q000378:metabolism*; D039382:Maternal Nutritional Physiological Phenomena; D008895:Milk, Human / Q000737:chemistry; D018673:Nutrition Policy; D009751:Nutritional Requirements; D014807:Vitamin D / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000097:blood*; D014808:Vitamin D Deficiency / Q000517:prevention & control*
chemical_list: D004872:Ergocalciferols; D014807:Vitamin D; D002762:Cholecalciferol; C104450:25-hydroxyvitamin D