Vitamin D Supplementation: For Mother or Baby?

Cornelius W. Van Niel, MD reviewing Hollis BW et al. Pediatrics 2015 Oct. Furman L. Pediatrics 2015 Oct.

Either 400 IU for baby or 6400 IU for mother prevents vitamin D deficiency in exclusively breast-fed infants.

Vitamin D supplementation is recommended for breast-fed babies starting in the neonatal period to prevent deficiency (25-hydroxy vitamin D [25(OH)D] level <50 nmol/L) and rickets, but compliance is often poor. Researchers randomized 216 mother-infant pairs (infant age, about 1 month) who planned to breast-feed exclusively to receive 400 IU vitamin D per day for the mother (from a prenatal multivitamin) and 400 IU for the infant (from oral drops), or to receive 6400 IU per day (including 400 IU from a prenatal multivitamin) for the mother and placebo for the infant.

At baseline, mean 25(OH)D levels were 86 nmol/L in mothers and 36 nmol/L in babies; 75% of babies were deficient. Some black and Hispanic babies had undetectable levels (<2.5 nmol/L). In the high-dose group, mean maternal 25(OH)D levels increased to about 150 nmol/L after 3 months and remained at about that level after 6 months. No maternal adverse events were attributable to the high dose. Among infants who exclusively breast-fed through ages 4 months (69%) and 7 months (44%), mean 25(OH)D levels were adequate (about 110 nmol/L) and similar in the two treatment groups. Modeling showed that maternal 25(OH)D levels were largely determined by supplement dose, rather than race/ethnicity, location, or time of year.

Citation(s):

Hollis BW et al. Maternal versus infant vitamin D supplementation during lactation: A randomized controlled trial. Pediatrics 2015 Oct; 136:625.

Furman L.Maternal vitamin D supplementation for breastfeeding infants: Will it work? Pediatrics 2015 Oct; 136:763.