Kommersiellt obunden läkemedelsinformation riktad till läkare och sjukvårdspersonal

Drugline nr 16947

Publicerat 2000-12-19

Question

Does maternal Calcichew-D3 intake pose any risk to the nursing infant?

A woman treated with prednisolon 15 mg daily, and a calcium (500 mg) and vitamin D (400 IU) supplement twice daily is nursing a 3-month-old healthy baby.

Answer

Both calcium and vitamin D are excreted in breast milk. Breast milk calcium can vary at least two-fold between mothers, and there is no evidence that maternal calcium supplementation affects breast milk levels significantly (1).

As for vitamin D, it seems that there is a direct relationship between the concentrations in maternal serum and breast milk. Maternal ingestion of large doses of vitamin D may lead to higher than normal concentrations in breast milk and result in hypercalcemia in the infant (2). Furthermore, the safety margin between currently accepted safe intakes and those suspected of causing toxicity is smaller than for most other vitamins (1). Dietary factors, season and exposure to sunlight (or UV light) influence maternal and infant vitamin D levels as well. Supplements of 25-50 mikrograms (1000-2000 IU) of vitamin D to Finnish mothers in February resulted in mean vitamin D milk levels comparable to those of unsupplemented mothers in September. However, responses varied widely among individuals (3).

National food administration recommends a daily intake by nursing mothers of 1200 mg calcium and no more than 10 mikrograms (400 IU) of vitamin D. Prednisolon in ordinary therapeutic doses is unlikely to affect the nursing child.

Conclusion

A too high maternal intake of vitamin D may cause hypercalcemia in the nursing infant. In the present case, 2 tablets of Calcichew can probably be taken safely by the lactating mother, at least throughout the winter season. Additional vitamin D supplementation to the infant should be avoided. A dose reduction of Calcichew to one tablet daily can also be considered. Calcium levels can be monitored in the child, to even further ensure its safety.

Bottiger Y
AL-Shurbaji A

References

  1. Bennett JC, Plum F, editors. Cecil, Textbook of medicine Vol 1. 20th ed. Philadelphia: WB Saunders Co; 1996
  2. Briggs GB, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 5th ed. Baltimore: Williams & Wilkins; 1998
  3. Ala-Houhala M, Koskinen P, Parviainen MT, Visakorpi JK: 25-hydroxyvitamin D and vitamin D in human milk: effects of supplementation and season. Am J Clin Nutr 1988; 48: 1057-1060

Senast ändrad 2018-09-20