Breastfeeding

Are you a new mother who is breastfeeding? Breastfeeding is the recommended method of feeding infants because it provides babies with ideal amounts of necessary nutrients and immune factors. Though breastfeeding is great for babies, it does it not provide infants with an adequate intake of vitamin D or B12, and it also increases a mother’s need for vitamin B12.
Vitamin D
Breastfed infants are able to get additional vitamin D through routine sunlight exposure (just like children and adults). However, a major public health effort is underway to decrease the risk of skin cancer by encouraging people to limit their sunlight exposure. Plus, there are reports of cases of vitamin D deficiency causing softening and weakness in the bones (also called rickets) among breastfed infants in the United States. Though rare, the Vitamin D deficiency rickets among breastfed infants can occur if the baby does not receive additional vitamin D from a vitamin supplement or from adequate exposure to sunlight.
A number of factors decrease the amount of vitamin D a person will synthesize from sunlight. These factors include:

• Living at high latitudes i.e., farther from the equator; particularly during winter months
• Air quality conditions: high levels of air pollution
• Weather conditions: dense cloud covering
• The degree to which clothing covers the skin
• Use of sunscreen
• Skin pigmentation: darker skin types

To ensure proper intake, a supplement of 400 IU per day of vitamin D is recommended for all breastfed infants. Adequate amounts of vitamin D can be easily provided by currently available liquid vitamin products—giving a boost to the levels found naturally in breast milk. For babies who are not being breastfed, the good news is that  infant formula is required to have 400IU of vitamin D added to every liter.
Not only is vitamin D important for newborns, it’s also important for children and adolescents.  Taking a multivitamin product containing 400 IU of vitamin D per mL or taking 400 IU/mL vitamin D alone without other vitamins will help them get their recommended daily allowance.

Recent research highlights the importance of Vitamin D for everyone. Vitamin D deficiency has now been linked to cancer, multiple sclerosis and diabetes. While infants and small children are the focus of the clinical report from the American Academy of Pediatrics, lactating mothers should also consider taking supplemental Vitamin D. It is unlikely for a person to obtain adequate vitamin D from natural dietary sources alone. Food sources for Vitamin D include:

• Fatty fish
• Fish liver oils
• Eggs (small amount of vitamin D)
• Artificially fortified products (milk, margarine, breakfast cereals, juice)

Vitamin B12
Breastfeeding women have a higher need for vitamin B12, compared to most other adults (including pregnant women). Mild vitamin B12 deficiencies are common since the developing fetus used up much of the mother’s stores of the vitamin during pregnancy. Mild vitamin B12 deficiencies are probably not a cause for much concern. However, a severe deficiency in a breastfeeding woman can lead to a severe deficiency in her infant/child.
Some women are at higher risk for vitamin B12 deficiencies than others. Women who are strict vegetarians or vegans, and women who have undergone bariatric weight loss surgery are at particular risk.
Vitamin B12 is naturally found in foods of animal origin. It can also be round in plant-based foods that have been fortified. The best dietary sources of Vitamin B12 are:

• Organ meats, some game meats
• Fish (sardines, trout and herring)
• Fortified ready to eat cereals
• Milk (cooking greatly reduces the content)
• Fortified meal replacement shakes
• Shellfish

While many women have no difficulty getting plenty of vitamin B12 through a healthy diet, it is probably a good idea for most breastfeeding women to take a multivitamin containing B12. The recommended dietary intake (RDA) based on the dietary reference intake (DRI) for vitamin B12 in breastfeeding women is 2.8 mcg per day compared to 2.6 mcg per day for pregnant women and 2.4 for most other adults. The requirements for vitamin B12 are based on the amount needed to maintain good blood count values. While the RDA is good for preventing deficiencies in most women, much higher doses are required to treat a deficiency. While many women have no difficulty getting plenty of vitamin B12 through a healthy and well- balanced diet, it is probably a good idea for most women to take supplemental vitamin B12 in the form of a prenatal vitamin. Such supplementation is safe, and the consequences of a deficiency can be quite severe.
In children and adults Vitamin B12 deficiencies can lead to hematological, neurological and gastrointestinal conditions.
Vitamin B12 deficiency in an infant can cause:

• Anemia
• Irritability
• Failure to thrive
• Poor appetite
• Apathy
• Developmental delays
• In severe cases it can eventually lead to death

You should talk with your healthcare provider about vitamin D and B12 and breastfeeding. Each mother-baby situation is different, and you and your healthcare provider understand your situation best. After considering what you want and expect, as well as your current health situation and that of your infant, the two of you can make a shared decision about vitamin supplements and breastfeeding that is right for you.