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Vitamins & other supplements for breastfeeding mothers
By Kelly Bonyata, IBCLC
If you eat a reasonably-well balanced diet, vitamin supplements
are not considered necessary for breastfeeding mothers.
This is even true for mothers who are eating for three during tandem
nursing, or while breastfeeding during pregnancy (see Nutrition
for mom in our Nursing During Pregnancy and Tandem Nursing FAQ).
According to Nutrition During Lactation (Hamosh,
1991):
"The evidence
does not warrant routine vitamin-mineral supplementation of lactating
women... Encourage lactating women to follow dietary guidelines
that promote a generous intake of nutrients from fruits and vegetables,
whole-grain breads and cereals, calcium-rich dairy products, and
protein-rich foods such as meats, fish and legumes. Such a diet
would ordinarily supply a sufficient quantity of essential nutrients...
Encourage sufficient intake of fluids -- especially water, juice,
and milk -- to alleviate natural thirst. It is not necessary to
encourage fluid intake above this level... Calcium, multivitamin-mineral
supplements, or both may be advised when dietary sources are marginal
and it is unlikely that appropriate dietary practices will or
can be followed."
What if I do NOT eat a reasonably-well balanced diet?
Except in special circumstances, women in developed countries
are not likely to have nutritional deficiencies that will affect
their milk.
The Recommended Intakes (RI) for nutrients have a wide safety
margin built in – if you do not meet the RI for a nutrient,
it does not mean that you are deficient. If a mother does not get
adequate amounts of certain nutrients (such as vitamin B6, vitamin
B12 or iodine) it can decrease nutrient levels in her milk, however
this is usually only a problem in areas of malnutrition. The
best solution in such cases is to improve or supplement the mother’s
diet. For other nutrients (including folic acid, iron, calcium,
copper, magnesium, zinc) milk levels will be fine even if the mother’s
intake is too low.
- The nutrients most likely to be of concern for a woman
eating an average (unsupplemented) American diet of 2700
calories per day are calcium and zinc. However, your intake of
calcium or zinc does not affect breastmilk levels of
these minerals, so if supplements are needed, they are for your
benefit -- not baby's.
(Hamosh, 1991; Lawrence & Lawrence, 2005)
- For mothers who are cutting calories:
Mothers who get 2200 calories per day may need extra
calcium, zinc, magnesium, thiamin (vitamin B1), vitamin B-6
& vitamin E.
Mothers who get 1800 calories per day may need extra
calcium, zinc, magnesium, thiamin, vitamin B6, vitamin E,
folic acid, riboflavin (vitamin B2), phosphorus and iron.
Breastmilk levels of calcium, magnesium, phosphorus, zinc,
iron and folic acid are fine even if your diet is deficient.
If supplements are needed, they are for your benefit
-- not baby's.
Levels of B vitamins in breastmilk are related to the mother’s
intake, but a deficiency in the mother serious enough to affect
her breastfed baby is very rare in the United States.
(Hamosh, 1991; Lawrence & Lawrence,
2005)
- Mothers who eat no
animal products or are otherwise at risk for vitamin
B-12 deficiency need to get adequate amounts of vitamin B12
from supplements or fortified foods.
- Mothers who have little exposure to sunlight
need to get adequate amounts of vitamin
D from supplements or vitamin D-rich foods.
What if I would like to take extra vitamins or other nutritional
supplements? Is this safe?
- Most mineral supplements (e.g., iron, calcium, copper, chromium,
zinc) taken by the mother do not affect breastmilk levels.
- Water soluble vitamin supplements (e.g., B vitamins, vitamin
C) taken by the mother usually increase breastmilk levels. Breastmilk
levels of some water soluble vitamins, such as vitamin C, only
increase up to a certain point, then remain steady – even
if mom increases her dose.
- Fat soluble vitamin supplements (e.g., vitamins A & E) taken
by the mother can concentrate in human milk, and thus excessive
amounts may be harmful to a breastfeeding baby.
- The safety of herbs and other nutritional supplements should
be evaluated on a case-by-case basis – some are safe and
some are not.
For information on specific vitamins, minerals and other nutritional
supplements, see:
@ 
Hamosh M, Dewey KG, Garza C, et al: Nutrition
During Lactation. Institute of Medicine, Washington, DC, National
Academy Press, 1991, pp. 133-140. This book is available free from
the HRSA
Information Center (look under Nutrition publications).
FAQ
Sheet: Frequently Asked Questions on Breastfeeding and Maternal
Nutrition from the LINKAGES Project
Hale, Thomas. Medications
and Mothers' Milk, 10th Edition. Pharmasoft Medical Publishing,
2002.
Dietary
Reference Intakes (DRI) and Recommended Dietary Allowances (RDA)
from the US Department of Agriculture's Food and Nutrition Information
Center
Nutrient
Information from the the American
Society for Nutritional Sciences includes current information
on food sources, diet recommendations, deficiencies, toxicity, clinical
uses, recent research and references for further information for
many micro- and macronutrients.
Nutrition
Fact Sheets from Feinberg School of Medicine at Northwestern
University
Nutrition Analysis
Tool (NAT) from the Food Science and Human Nutrition Department
at the University of Illinois
Page last modified:
10/10/2005
Written: 04/05/02
