Maternal Supplementation of Vitamin D During Lactation to Support Infant Vitamin D Needs: A Systematic Review

摘要

Human milk is generally considered to be insufficient in vitamin D. However, research completed in the 1980s showed that the vitamin D content of human milk is directly related to maternal serum vitamin D levels and therefore may potentially be adequate if the mother’s vitamin D levels are sufficient. Approximately one-third of the adult population, which includes breastfeeding women, in the United States have vitamin D insufficiency or deficiency. Among infants, 90.4% of breastfed infants are vitamin D deficient compared to 15.4% of formula fed infants. The American Academy of Pediatrics (AAP) has therefore recommended all breastfed infants be directly supplemented with 400 IU per day of vitamin D to decrease the risk of vitamin D insufficiency and rickets. According to the AAP, compliance rates with this recommendation ranges between 2% - 36%. Because the recommendation to supplement may undermine breastfeeding, many pediatricians do not inform their patients of the need to supplement. Additionally, some parents are concerned about directly supplementing their infant as risks may include allergic reactions to the ingredients, aspiration pneumonia, accidental overdose, and changes in intestinal flora and pH which may compromise the immune benefits of human milk. A literature review was conducted to examine the effect of maternal supplementation with vitamin D during lactation on human milk vitamin D content and maternal and infant serum vitamin D levels. Although there is no current consensus regarding dosage and timing of maternal vitamin D supplementation, the literature suggests that high-dose vitamin D supplementation of the lactating mother is as effective at maintaining infant vitamin D levels as direct infant supplementation, while also correcting the mother’s vitamin D deficiency.