Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
Adv Nutr. 2022 Mar;13(2):568-585. doi: 10.1093/advances/nmab126. Epub 2023 Feb 10.
The optimal vitamin D supplementation plan during lactation is unclear. We investigated the effect of maternal vitamin D supplementation on mother-infant dyads' vitamin D status during lactation. All controlled trials that compared vitamin D supplements to placebo or low doses of vitamin D in breastfeeding mothers were included. Pooled effect size and the associated 95% CI for each outcome were estimated using random-effects models. A 1-stage random-effect dose-response model was used to estimate the dose-response relation across different vitamin D dosages and serum 25-hydroxy vitamin D [25(OH)D] concentrations. We identified 19 clinical trials with 27 separate comparison groups (n = 3337 breastfeeding mothers). Maternal vitamin D supplement dosages were associated with circulating 25(OH)D concentrations in breastfeeding women in a nonlinear fashion. Supplementation with 1000 IU of vitamin D/d increased serum 25(OH)D concentrations by 7.8 ng/mL, whereas there was a lower increase in concentrations at vitamin D doses of >2000 IU/d (3.07 and 2.05 ng/mL increases between 2000-3000 and 3000-4000 IU/d, respectively). A linear relation was observed between maternal vitamin D supplementation dosage and the infants' circulating 25(OH)D concentrations. Each additional 1000 IU of maternal vitamin D intake was accompanied by a 2.7 ng/mL increase in serum 25(OH)D concentration in their nursing infants. The subgroup analysis showed that maternal vitamin D supplementation was accompanied by a statistically significant increase in infants' 25(OH)D concentration in the trials with a duration of >20 wk, vitamin D supplementation >1000 IU/d, East Indian participants, maternal BMI <25 kg/m, and studies with an overall low risk of bias. Long-term maternal supplementation with vitamin D at a high dose (>6000 IU/d) effectively corrected vitamin D deficiency in both mothers and infants. Nevertheless, infants with 25(OH)D concentrations over 20 ng/mL may require a relatively low maternal dose to maintain vitamin D sufficiency.
哺乳期最佳维生素 D 补充方案仍不明确。本研究旨在探讨哺乳期母亲补充维生素 D 对母婴维生素 D 状态的影响。所有比较维生素 D 补充剂与安慰剂或低剂量维生素 D 对母乳喂养母亲作用的对照试验均被纳入。使用随机效应模型估算每个结局的汇总效应量及其相关的 95%置信区间。采用 1 期随机效应剂量-反应模型，估算不同维生素 D 剂量和血清 25-羟维生素 D [25(OH)D]浓度之间的剂量-反应关系。共纳入 19 项临床试验，共包含 27 个独立比较组（n=3337 名母乳喂养母亲）。维生素 D 补充剂量与哺乳期妇女循环 25(OH)D 浓度呈非线性相关。每天补充 1000 IU 维生素 D 可使血清 25(OH)D 浓度增加 7.8ng/mL，而维生素 D 剂量超过 2000 IU/d 时浓度增加幅度较低（2000-3000 IU/d 和 3000-4000 IU/d 时分别增加 3.07 和 2.05ng/mL）。还观察到母亲维生素 D 补充剂量与婴儿循环 25(OH)D 浓度之间存在线性关系。母亲每日多摄入 1000 IU 维生素 D，其哺乳婴儿的血清 25(OH)D 浓度增加 2.7ng/mL。亚组分析显示，在持续时间>20 周、维生素 D 补充量>1000 IU/d、东印度参与者、母亲 BMI<25kg/m2 和总体偏倚风险低的试验中，母亲补充维生素 D 可使婴儿 25(OH)D 浓度显著增加。长期高剂量（>6000 IU/d）补充维生素 D 可有效纠正母亲和婴儿的维生素 D 缺乏。然而，25(OH)D 浓度超过 20ng/mL 的婴儿可能需要相对较低的母体剂量来维持维生素 D 充足。
