Is Vitamin A Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Vitamin A? Is Vitamin A safe for nursing mother and child? Does Vitamin A extracts into breast milk? Does Vitamin A has any long term or short term side effects on infants? Can Vitamin A influence milk supply or can Vitamin A decrease milk supply in lactating mothers?

Retinol is also a name for vitamin A which is a natural component of human milk. Content in the human milk is about 2,800 IU/L (750 μ/L). Infant's recommended dietary daily allowance is 2,000 IU (600 μ/L). Mother's recommended daily allowance is 3,200 IU (950 μ/L). There is a risk for severe intoxication after an isolated dose of 25,000 IU or long-standing daily consumption of 5,000 IU. After a megadose administration of vitamin A increases concentration to a double in the colostrum. Supplementation with vitamin A to breastfeeding mothers or infants does not reduce mortality or morbidity among HIV affected offsprings, instead it increases the likelihood of transmission of HIV or subclinical mastitis in those mothers infected with HIV. Vitamin A is widely distributed in the food of animal or vegetable origin. Except for populations affected with food shortage or nutritionally deficient, those women on a complete and varied diet do not need the intake of vitamin A supplementation The List of Essential Medicines of WHO-2002 classifies it as compatible with breastfeeding.

Routine, modest daily supplemental vitamin A results in modest increases in milk vitamin A content and appears to be safe for the infant. Vitamin A (retinol) and provitamin A carotenoids are normal components of human milk.[1] The recommend dietary intake in lactating women is 1300 mcg retinol per day, compared to 770 mcg per day during pregnancy. The recommended daily intake for infants aged 6 months or less is 400 mcg. .[2] Lactating mothers may need to supplement their diet to achieve the recommended daily vitamin A intake. Maternal vitamin A supplementation during pregnancy and lactation has not been shown to reduce mortality or the risk of anemia in breastfed infants living in developing regions, but there may be undiscovered benefits related to improved antioxidant capacity and immune function.[3][4][5] Maternal single doses up to 120,000 mcg or daily doses up to 1500 mcg are not expected to harm the breastfed infant. Daily doses above 3,000 mcg should be avoided in the mother. [2] Vitamin A in milk has antioxidant properties.[6] Holder pasteurization (62.5 degrees C for 30 minutes) does not reduce milk antioxidant capacity.[7]

One-hundred exclusively breastfeeding mothers in India were given 200,000 IU vitamin A or placebo as a single oral dose within 24 hours after delivery. There were no differences in weight gain of their infants during postpartum hospitalization between the groups, and no infants in the vitamin A group had symptoms of hypervitaminosis A, such as excessive crying, raised fontanelle and vomiting. All the infants received a dose of oral polio vaccine (OPV) between 48 and 72 hours after birth. There were no differences between the two groups in OPV seroconversion rates or antibody titers at 6 weeks.[38] Similarly, 1,085 exclusively breastfeeding mothers in Ghana were given 200,000 IU vitamin A or placebo at 3 to 4 weeks postpartum. There were no differences in infant immune response to polio or tetanus vaccination at 6 weeks and 6 months of age.[39] The infants of 197 mothers given either 200,000 or 400,000 IU vitamin A in the first week after delivery showed no signs of adverse reactions to vitamin A during the 12-month follow-up period.[27]

HIV-infected mothers in Tanzania had a higher rate of severe subclinical mastitis (36%), determined by measuring serial milk electrolyte concentrations, when taking a daily vitamin A supplement during pregnancy and postpartum compared to placebo (23%). Mothers taking a multivitamin without vitamin A also had a higher rate (38%) than placebo, suggesting a vitamin A-independent effect. Given the many other benefits of multivitamin supplementation in this specific patient population, the authors did not recommend avoiding supplementation due to a potential risk of mastitis.[40] In a Brazilian study, 57 mothers received either 200,000 IU vitamin A or no vitamin A within 2 days after birth. At 24 hours after administration, the average level of alpha-tocopherol (vitamin E) was 16.4% lower in the colostrum of mothers who received in the vitamin A (28 micromol/L vs 24.5 micromol/L), but was not significantly different at 30 days after administration, at about 6 micromol/L.[25] The reported vitamin E colostrum levels in this study are within normal limits, thus the small reduction in the vitamin A-supplemented mothers may not be clinically important. A different Brazilian research group conducting the same experiment using a vitamin A supplement with low-dose vitamin E 110 IU added as a preservative found no effect of vitamin A on colostrum alpha-tocopherol.[41]