Maternal High Dose Monthly Vitamin D May Be Useful During Breastfeeding Interview with:


Dr. Ben Wheeler

Dr. Ben Wheeler MB ChB(Otago) DCH CCE FRACP
Senior Lecturer / Paediatrician / Paediatric Endocrinologist
Department of Women’s & Children’s Health : Te Tari Hauora Wāhine me te Tamariki
Dunedin School of Medicine What is the background for this study?

Response: Vitamin D is essential for calcium and bone metabolism. It is unique among vitamins in that it is mainly derived from synthesis in the
skin after exposure to UV-B radiation. In the absence of fortification, few foods are rich in vitamin D, including human milk, which contains very low amounts. Breastfeeding infants in higher latitude countries such as New Zealand, much of North America and
Central/Northern Europe are at risk of vitamin D deficiency.

The most profound manifestation of vitamin D deficiency in growing children is rickets, characterized by bone deformities, impaired growth, biochemical abnormalities, and depending on the severity of deficiency, seizures. Studies also identified a number of common factors that potentially affect the risk of rickets, including darker pigmented skin, maternal vitamin D deficiency during pregnancy, season of birth, and age.

A potential alternative strategy to improve the vitamin D status of breastfed infants is high-dose vitamin D supplementation to pregnant and lactating women. This would be attractive from a compliance perspective, promote exclusive breastfeeding, and treat both the mother and her infant.

Thus, the primary aim of this randomized, placebo-controlled study was to determine the effect of two different monthly doses of maternal vitamin D supplementation on the vitamin D status of non–vitamin D–supplemented breastfed infants and their mothers. What are the main findings?

Response: The main findings of our study were that a high dose monthly maternal vitamin D dose of 100,000 IU appears promising for safely increasing both the infant and mother vitamin D status and preventing severe vitamin D deficiency. Importantly, the lower and commonly used monthly dose of 50,000 IU / month was ineffective at improving baby vitamin D status. In addition, the results of our study reinforce the importance of nutrition trials with robust design including true placebo controls, and blinding of all to the study intervention. Vitamin D deficiency also clearly remains very common in both new mothers and their exclusively breastfed infants. What should readers take away from your report?

Response: High dose monthly vitamin D (at 100,000 IU) may offer an alternative option to daily infant supplementation. Further trials are required to establish to optimal dosing frequency and safe duration of this therapy. While a daily dose will remain the most physiological option for infant supplementation, this may be an attractive option for those who a daily infant dose is difficult, or in those wishing to provide true exclusive breastfeeding to their infants.

Your readers should view with caution the results of any nutrition (or medical trials) that do not adhere to robust study design, in particular nutrition trials without randomisation, blinding, and of most importance true placebo controls. What recommendations do you have for future research as a result of this study?

Response: Further studies are needed to confirm these results, and to determine the optimum dose and dosing frequency. These need to adhere to robust study design principles. Further understanding of changes in vitamin D status, and factors influencing this he Is there anything else you would like to add?

Response: Thank you for the opportunity to discuss our research. Thank you for your contribution to the community.


B. J. Wheeler, B. J. Taylor, P. Herbison, J. J. Haszard, A. Mikhail, S. Jones, M. J. Harper, L. A. Houghton. High-Dose Monthly Maternal Cholecalciferol Supplementation during Breastfeeding Affects Maternal and Infant Vitamin D Status at 5 Months Postpartum: A Randomized Controlled Trial. Journal of Nutrition, 2016; DOI:10.3945/jn.116.236679

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on August 31, 2016 by Marie Benz MD FAAD