Breastfeeding And Vitamin D.

Healthy eating and getting the necessary nutrients, vitamins and minerals during pregnancy or when you are breastfeeding is important for the growth and development of your baby. This also applies to the amounts of vitamin D, which helps the baby develop healthy bones.

If you do not get enough vitamin during pregnancy, the baby's bones may not have the necessary strength. This means that they will be softer and easier to break. In such cases, there is a high probability of developing a disease called rickets.

Meeting the needs of vitamin D during pregnancy will provide the necessary amounts for the newborn, and also increases the chances of a normal and smooth pregnancy.

Vitamin D is essential for skeletal growth and bone strength. Its deficiency can lead to developmental delay, rickets and osteomalacia (softening of the bones), seizures, is also associated with autoimmune diseases and some cancers. Unlike other vitamins that we can get from a healthy diet, few foods contain vitamin D (oily fish, egg yolk, plus some artificially fortified margarines, cereals or yogurt). The main source of vitamin D is our body, which produces the vitamin after the skin is exposed to sunlight. However, when it comes to babies and their exposure to the sun, great care must be taken. Therefore, the best way to prevent a deficiency in them is to give the vitamin in the form of drops.

Vitamin D and breastfeeding

While breastfeeding is the recommended method of feeding babies and provides them with the necessary nutrients and immune factors, it cannot provide enough vitamin D. In fact, it is impossible for a person to consume all the vitamin D that his body requires only from food. That is why the sun plays a big role in getting it. When the skin is exposed to sunlight, the body begins to produce the vitamin. However, when you have a newborn, you usually stay indoors for a few days to a few weeks or months. And when you go out, your baby is usually well-dressed, covered with a blanket or using sunscreen, as his skin is very delicate and you also protect yourself from sunburn. Due to these factors, breast milk alone does not provide babies with enough vitamin D.

If a woman has good enough levels of vitamin D before and during pregnancy, her baby will be born with a good supply of the vitamin. After birth, these stores, combined with moderate exposure to the baby's sunlight, plus a small amount of breast milk, would provide a sufficient amount of the vitamin for the breastfed baby. In recent years, however, it has been found that many women are deficient in vitamin D. As a result, its levels in breast milk and therefore in the baby's body are reduced.

Health benefits

The health benefits of taking the right vitamin D are different for mothers and babies. First, let's look at the mother. Older people need vitamin D to absorb calcium and keep bones strong and healthy. Long-term deficiency can lead to osteoporosis in women. Vitamin D also helps regulate the immune system and supports the respiratory system.

Children, and especially infants who do not get enough vitamin, can develop a disease called rickets. The disease does not allow the proper development of your child's bones. They are soft, easy to bend and break.

It is very important for newborns and young children to get enough vitamin D to build strong and healthy bones. Shortly after birth, this vitamin has a major impact on the baby's hormonal balance. It is responsible for regulating phosphate and calcium metabolism and strengthens the bones and teeth of the child. Because breast milk is known to be deficient in vitamin D, most pediatricians recommend giving it as a liquid supplement.

How much vitamin D does breast milk usually contain?

Human breast milk is a very weak source of vitamin D. It usually contains less than 50 IU. This is not a defect in the milk, but the result of insufficient intake of the required amount of vitamin that the breastfeeding mother should receive. If the mother takes 6400 IU a day, she will supply her baby with enough milk and will not need to give extra vitamin in the form of drops.

Vitamin D deficiency

It is very difficult to maintain optimal levels of the vitamin with food, because the body relies on its production when the skin is exposed to sunlight. Limited time spent outdoors or excessive use of sunscreen can cause vitamin deficiency.

Lack of sufficient vitamin intake in infants is a rare condition, but it can occur if the child does not receive it as a supplement in the form of drops or through adequate exposure to sunlight. Virtually everyone is at risk of vitamin D deficiency, only infants fed formula are protected because it is fortified with vitamins and minerals (it contains 400 IU of vitamin D).

A number of factors reduce the amount of vitamin D that a person synthesizes from sunlight. They include:

• those living north of the equator, where daylight hours are reduced (for example, in the UK between October and April, most people are deficient in vitamin D);
• high levels of air pollution;
• dense cloud cover;
• the extent to which clothing covers the skin (babies often fall into this category);
• use of sunscreen (babies often fall into this category);
• skin pigmentation: people with dark skin (more sun is needed to synthesize the same amount of vitamin as people with light skin);
• people with obesity and BMI over 30.

If the expectant mother is at risk of vitamin deficiency, adjusting her levels during pregnancy will prevent the baby from being born with low levels of vitamin D.

Is it possible to get enough vitamin D by sun exposure without taking a supplement?

Yes, although it is difficult to achieve, especially in winter. It is difficult even in other seasons in the far north or if you have darker skin. Vitamin D deficiency is relatively common even in sunny climates such as South America. If you visit a solarium regularly, you will probably get adequate levels of the vitamin (but this carries other risks to your health). Most people find that taking it as a supplement is an easier option.

If the breastfeeding mother knows that the level of vitamin D in her blood is normal, does this mean that her milk will contain enough vitamin D?

NO! The active metabolite of vitamin D in the blood is not a good reflection of the amount of vitamin D that can pass into breast milk. They are two different compounds. Because vitamin D (not the active metabolite 25 (OH) D) is the form that passes into breast milk, the only sure way is for the baby to take the required dose in the form of drops every day.

Some sources claim that vitamin D deficiency in a baby cannot be restored by breast milk alone, even if the mother begins to make up for her own deficiency. Other researchers suggest that when a breastfeeding mother has high enough vitamin D levels, adequate levels of the vitamin will also be achieved in breast milk.

What doses in the mother will increase the amount of vitamin D in breast milk?

A 2013 article on vitamin D during pregnancy and lactation presented by the Vitamin D Council and an article by Robert Heaney discussing research studies showing that taking high levels of 5,000-6,000 IU / daily vitamin D from the mother, increase its values ​​in breast milk.

However, Balasubramanian and others warn that the safety of such high doses in lactating women has not been proven.

Recommendations for vitamin D and breastfeeding

Recommendations for vitamin D supplementation vary between organizations by up to ten times the difference. Most health recommendations currently focus on giving vitamin D drops to breastfed babies to make sure they are getting adequate amounts. However, others such as Robert Heaney recommend that the mother take enough of the vitamin to cover her own needs and those of the baby, without having to give the vitamin in the form of drops.

The Scientific Advisory Committee on Nutrition (SACN) prepared a report in July 2016 on which public health in England based its recommendations. They recommend 400 IU per day for a breastfeeding mother and 340 to 400 IU per day for all breastfed babies from birth to one year of age, unless they take more than 500 ml of formula per day.
The Scientific Advisory Committee on Nutrition recommends:

• reference dietary intake of 10 micrograms (400 IU) of vitamin D per day throughout the year for all of the population over 4 years of age;
• reference dietary intake of 10 micrograms of vitamin D per day for pregnant and lactating women and population groups at increased risk of vitamin D deficiency;
• "safe intake" of 8.5 to 10 micrograms (340-400 IU) per day for all children from birth to 1 year;
• "safe intake" of 10 micrograms per day for children aged 1 to 4 years.

Dr Louis Levy, Head of Public Health Science in England (PHE), said: “A healthy, balanced diet and short sun exposure are enough for most people to get the dose of vitamin D they need in However, everyone will need to consider taking the vitamin as a supplement in the fall and winter if they do not consume enough foods that naturally contain or are fortified with it.Those that do not go out in the sun or always cover their skin , should take a vitamin D supplement throughout the year. "

The American Academy of Pediatrics (AAP ) recommends that all breastfed infants receive 400 IU / day of vitamin D drops, starting within the first few days of life and continuing until they are weaned or until they start taking vitamin D-fortified milk.

The Department of Health and Medical Administration (HMD), formerly known as the Institute of Medicine (IOM), recommends a dose of vitamin D for pregnant and lactating mothers of 600 IU / day with a higher intake of up to 4000 IU.

The Vitamin D Council discusses recommendations for pregnant and lactating mothers and includes those of the Nutrition Council and endocrinologists in its article on vitamin D in 2013. It discusses how to take into account sun exposure when taking solution for vitamin D supplementation in lactating women. The advice of the vitamin D council is that it should not be given as a supplement to the baby if the mother takes 6,000 IU per day (in which case breast milk will be rich in the vitamin). However, if she does not take this amount, takes less than 5,000 IU a day, or is not exposed to the sun, the baby should take vitamin D as a liquid supplement.

According to other sources, 5,000-6,000 IU of vitamin D seem like a high dose, but it is important to know that in just 15 minutes, the whole body exposed to the sun in the middle of the day in summer produces over 10,000 IU of the vitamin.

Vitamin D is extremely important for the health of mother and baby. The good news is that the ways to get it are very simple: eat foods rich in vitamin D, expose yourself moderately to the sun or take a supplement if necessary.

And the need to add vitamin D varies around the world according to climate and lifestyle. The recommendations above are subject to change. Therefore, it is advisable to discuss the news with your doctor and the child's pediatrician.