Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial

Abstract

OBJECTIVE: Compare effectiveness of maternal vitamin D 3 supplementation with 6400 IU per day alone to maternal and infant supplementation with 400 IU per day.METHODS: Exclusively lactating women living in Charleston, SC, or Rochester, NY, at 4 to 6 weeks postpartum were randomized to either 400, 2400, or 6400 IU vitamin D 3 /day for 6 months. Breastfeeding infants in 400 IU group received oral 400 IU vitamin D 3 /day; infants in 2400 and 6400 IU groups received 0 IU/day (placebo). Vitamin D deficiency was defined as 25-hydroxy-vitamin D (25(OH)D) ,50 nmol/L. 2400 IU group ended in 2009 as greater infant deficiency occurred. Maternal serum vitamin D, 25(OH)D, calcium, and phosphorus concentrations and urinary calcium/creatinine ratios were measured at baseline then monthly, and infant blood parameters were measured at baseline and months 4 and 7.RESULTS: Of the 334 mother-infant pairs in 400 IU and 6400 IU groups at enrollment, 216 (64.7%) were still breastfeeding at visit 1; 148 (44.3%) continued full breastfeeding to 4 months and 95 (28.4%) to 7 months. Vitamin D deficiency in breastfeeding infants was greatly affected by race. Compared with 400 IU vitamin D 3 per day, 6400 IU/day safely and significantly increased maternal vitamin D and 25(OH)D from baseline (P , .0001). Compared with breastfeeding infant 25(OH)D in the 400 IU group receiving supplement, infants in the 6400 IU group whose mothers only received supplement did not differ. CONCLUSIONS:Maternal vitamin D supplementation with 6400 IU/day safely supplies breast milk with adequate vitamin D to satisfy her nursing infant's requirement and offers an alternate strategy to direct infant supplementation. WHAT'S KNOWN ON THIS SUBJECT:The vitamin D concentration in breast milk of women taking 400 IU vitamin D per day is relatively low, leading to vitamin D deficiency in breastfeeding infants. As a result, the American Academy of Pediatrics recommends breastfeeding infant vitamin D supplementation within days after birth. WHAT THIS STUDY ADDS:Maternal vitamin D supplementation alone with 6400 IU/day safely supplies breast milk with adequate vitamin D to satisfy the requirement of her nursing infant and offers an alternate strategy to direct infant supplementation. Dr Hollis, as the principal investigator (PI) of the project, worked with Dr Wagner in the conception of the project, study design, implementation of the study, laboratory analyses, data analyses, and writing of the manuscript; Dr, Wagner as clinical PI of the study, worked with Drs Hollis and Howard, site PI at the University of Rochester (U of R), and all other coinvestigators in the conception of the project, study design, implementation of the study, review of clinical and laboratory data, subject safety, data analyses, and writing of the manuscript; Dr Howard as clinical site PI at the U of R worked directly with Dr Wagner; she was involved in the conception of the project, study design, implementation of the study, laboratory analyses, data analyses, and writing of the manuscript; M...

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