Breastfeeding is almost always associated with infant vitamin D deficiency – Dec 2021

Breastfeeding and vitamin D - Dec 2021

Clin Exp Pediatr DOI: https://doi.org/10.3345/cep.2021.00444
Ju Sun Heo1 , Young Min Ahn2 ymahn964 at naver.com, Ai-Rhan Ellen Kim3 , Son Moon Shin4
1Department of Pediatrics, Anam Hospital, Korea University College of Medicine, Seoul, Korea
2Department of Pediatrics, Jang’s Hospital, Seoul, Korea
3Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
4Department of Pediatrics, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
Young Min Ahn, Email:

The recent re-emergence of vitamin D deficiency (VDD) and rickets among breastfed infants without adequate sunlight exposure and vitamin D supplementation has been reported worldwide. Breastfed infants are particularly vulnerable to VDD because of the low vitamin D content of breast milk, restricted sunlight exposure, increased pollution, and limited natural dietary sources of vitamin D.
The prevalence of VDD in breastfed infants differs vastly between studies and nations at 0.6–91.1%.
The recommended intake of vitamin D for lactating mothers to optimize their overall vitamin D status and, consequently, of their breast milk is 200–2000 IU/day, indicating a lack of consensus.
Some studies have suggested that maternal high-dose vitamin D supplementation (up to 6400 IU/day) can be used as an alternate strategy to direct infant supplementation. However, concern persists about the safety of maternal high-dose vitamin D supplementation.

Direct infant supplementation is the currently available option to support vitamin D status in breastfed infants. The recommended dose for vitamin D supplementation in breastfed infants according to various societies and organizations worldwide is 200–1200 IU/day. Most international guidelines recommend that exclusively or partially breastfed infants be supplemented with 400 IU/day of vitamin D during their first year of life. However, domestic studies on the status and guidelines for vitamin D in breastfed infants are insufficient. This review summarizes the prevalence of VDD in breastfed infants, vitamin D content of breast milk, and current guidelines for vitamin D supplementation of lactating mothers and infants to prevent VDD in breastfed infants.
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RCT = Randomized Controlled Trial