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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.

• Mothers who smoke cigarettes may benefit from additional iodine.

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.

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