Full Circle Midwifery

 UNICEF UK Baby Friendly Initiative

Statement on vitamin D supplementation for breastfed babies

Breastfeeding has a fundamental positive impact on the short, medium and long-term health of children and has an important and lasting impact on women’s health. Not breastfeeding contributes to infant mortality, hospitalisation for preventable diseases, increased rates of childhood diabetes and obesity, and adult disease.

However, concerns are being raised about the low level of vitamin D in breastmilk, since deficiency can lead to seizures, developmental delay and rickets. Vitamin D deficiency is unusual in babies born at term to mothers with adequate vitamin D status. Additionally, most are able to synthesise vitamin D through normal exposure to summer sunlight but some groups have been shown to be at increased risk of insufficiency or deficiency, including:

 Babies of mothers with darker skin types, particularly when living in high latitude areas such as the UK where the winter sun provides little or no access to vitamin D;

 Babies and mothers who wear concealing clothing, preventing skin exposure to sunlight;

 Babies and mothers who spend a lot of time indoors or use sun creams critically reducing exposure to sunlight;

 Babies of obese mothers (BMI >30).

It is essential that vitamin D deficiency is prevented and / or corrected during pregnancy in order to prevent babies being born with depleted stores. A baby born deficient in vitamin D will not restore their levels from breastmilk alone.

The National Institute for Health and Clinical Excellence (NICE) recommends that pregnant and lactating women take a vitamin D supplement of 10 micrograms (or 400 units) daily and that health professionals inform all pregnant women about the importance of this for their health and the future health of their baby. Healthy breastfed babies born to mothers who have followed this recommendation should receive a vitamin D supplement from six months of age (as part of a multivitamin supplement).

However, if the mother’s vitamin D status in pregnancy is uncertain, or if she falls into one of the risk groups, vitamin D supplements for mother and baby should be started soon after birth.

UNICEF UK Baby Friendly Initiative supports the NICE recommendations as a sensible measure to prevent the rare occurrence of vitamin D deficiency in breastfed babies and to promote the health of lactating mothers. Breastfeeding should continue to be supported and promoted for all babies.

UNICEF UK Baby Friendly Initiative Statement on vitamin D supplementation for breastfed babies 21 December 2011

References

Bodnar LM, Catov JM, Roberts JM and Hyariv N. Sinhan. (2007) Prepregnancy Obesity

Predicts Poor Vitamin D Status in Mothers and their Neonates. The Journal Of Nutrition.

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Gordon CM, Feldman HA, Sinclair L, et al. Prevalence of Vitamin D Deficiency Among

Healthy Babies and Toddlers. Arch Pediatr Adolesc Med 2008; 162:505-512.

Grover SR, Morley R. (2001) Vitamin D deficiency in veiled or dark skinned pregnant women. Med J Aust: 173:251-2.

Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res. 2011 Oct; 26(10):2341-57.

Horta, B et al. (2007). Evidence on the long-term effects of breastfeeding. Geneva, World Health Organisation.

Ip, S, et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Agency of Healthcare Research and Quality.

Michie C.A, Bangalore S. Vitamin D and rickets in 21st century London. London Primary Care Journal 2010; 3:1-10.

Quigley, M A, et al. (2007). Breastfeeding and hospitalization for diarrheal and respiratory infection in the United Kingdom Millennium Cohort Study. Pediatrics 119: e837-e842.

UNICEF UK Baby Friendly Initiative Statement on vitamin D supplementation for breastfed babies 21 December 2011

Lerch C, Meissner T. Interventions for the prevention of nutritional rickets in term born

children. Cochrane Database Syst Rev 2007, Issue 4

National Institute for Health and Clinical Excellence. (2008) Public health guidance

PH11. Maternal and child nutrition.