Maternal Vitamin D Supplementation Among Lactating Mothers in the Prevention of Vitamin D Deficiency Among Breastfed Term Infants: A Meta Analysis
BACKGROUND: Exclusively breastfed infants, pregnant and lactating mothers have been identified as a population in need of special requirements of vitamin D. While breast milk is a nutritionally complete food, studies reporting that it is low in vitamin D may place exclusively breastfed infants at risk for vitamin D deficiency. OBJECTIVE: To determine the optimal dose of maternal vitamin D supplementation to lactating mothers to achieve maternal vitamin D adequacy and to prevent vitamin D deficiency in exclusively breastfed term infants. METHODOLOGY: An electronic search of literature to identify all prospective randomized controlled trials that evaluated the vitamin D level of exclusively breastfed infants supplemented through their mothers via milk transfer published in PubMed, Cochrane Collaboration, Science Direct and Google Scholar from 1999 to 2014 was done. DATA ANALYSIS: Review Manager version 5.3 was utilized to determine the risk ratio for dichotomous data, and weighted mean differences for continuous data. Heterogeneity and overall effect were analyzed. The corresponding 95% CI for both outcomes were determined. RESULTS: Three studies were included where a total of 170 participants were enrolled, but only 83 were included in the results. They were supplemented with vitamin D as follows: 12 participants with 2,000 IU/day vs 13 participants with 4,000 IU/day for 3 months (Basile et al 2006); 9 participants with 2,000 IU/day vs 9 participants with 4,000 IU/day for 3 months (Hollis and Wagner 2004); and 20 participants with 150,000IU once vs 20 participants with 5000 IU/day for 28 days (Oberhelman et al 2013). The three studies’ results favored supplementation with 2,000IU of vitamin D daily and 150,000IU of vitamin D single dose supplementation for better improvement of the vitamin levels in the maternal blood. The overall effect of the 2,000IU and 150,000IU supplementation is statistically significant at 0.0003. The meta-analysis performed on the infant levels of vitamin D after maternal supplementation showed that the two dosages do not have any significant differences (computed overall effect=0.071). The p-value for heterogeneity was above 0.045 indicating the studies were statistically similar. CONCLUSION: A maternal vitamin D supplementation of 2,000 IU daily and a single dose of 150,000 IU can improve maternal vitamin D levels. These doses had an effect on infant vitamin D level, however, this failed to demonstrate a significant difference to favor one dose over another. Supplementing infants with vitamin D via milk transfer shows potential but further studies in the form of randomized controlled trials are required to determine the optimal doses of vitamin D supplementation during lactation for maintaining vitamin D adequacy in breastfed infants.
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