Maternal vitamin D supplementation to improve the vitamin D status of breast-fed infants: a randomized controlled trial

Abstract

Objective: To determine whether a single monthly supplement is as effective as a daily maternal supplement in increasing breast milk vitamin D to achieve vitamin D sufficiency in their infants.

Patients and methods: Forty mothers with exclusively breast-fed infants were randomized to receive oral cholecalciferol (vitamin D3) 5000 IU/d for 28 days or 150,000 IU once. Maternal serum, breast milk, and urine were collected on days 0, 1, 3, 7, 14, and 28; infant serum was obtained on days 0 and 28. Enrollment occurred between January 7, 2011, and July 29, 2011.

Results: In mothers given daily cholecalciferol, concentrations of serum and breast milk cholecalciferol attained steady levels of 18 and 8 ng/mL, respectively, from day 3 through 28. In mothers given the single dose, serum and breast milk cholecalciferol peaked at 160 and 40 ng/mL, respectively, at day 1 before rapidly declining. Maternal milk and serum cholecalciferol concentrations were related (r=0.87). Infant mean serum 25-hydroxyvitamin D concentration increased from 17±13 to 39±6 ng/mL in the single-dose group and from 16±12 to 39±12 ng/mL in the daily-dose group (P=.88). All infants achieved serum 25-hydroxyvitamin D concentrations of more than 20 ng/mL.

Conclusion: Either single-dose or daily-dose cholecalciferol supplementation of mothers provided breast milk concentrations that result in vitamin D sufficiency in breast-fed infants.

Clinical trial registration: clinicaltrials.gov NCT01240265.

Keywords: 1,25(OH)(2)D; 1,25-dihydroxyvitamin D; 25(OH)D; 25-hydroxyvitamin D; AAP; American Academy of Pediatrics; IOM; Institute of Medicine.

Figure 1

Maternal Vitamin D Metabolite Values with Two Vitamin D Supplementation Regimens: (A) Serum 25-hydroxyvitamin D, (B) Serum cholecalciferol, and (C) Breast milk cholecalciferol. Error bars represent standard deviation.

Figure 1

Maternal Vitamin D Metabolite Values with Two Vitamin D Supplementation Regimens: (A) Serum 25-hydroxyvitamin D, (B) Serum cholecalciferol, and (C) Breast milk cholecalciferol. Error bars represent standard deviation.

Figure 1

Maternal Vitamin D Metabolite Values with Two Vitamin D Supplementation Regimens: (A) Serum 25-hydroxyvitamin D, (B) Serum cholecalciferol, and (C) Breast milk cholecalciferol. Error bars represent standard deviation.

Figure 2

25-hydroxyvitamin D Concentrations in Breast-fed Infants in Response to Two Vitamin D Supplementation Regimens of Their Mothers. Error bars represent standard deviation, the upper error bars are the standard deviation for the 5000 IU/day group and the lower error bars are the standard deviation for the 150,000 IU single dose group.