Nutritional Supplements during Breastfeeding

Abstract

Women who are breastfeeding have increased requirements for energy and nutrients. Nutritional requirements for lactation have been the subject of several international reports and are included in general nutrient requirements documents, including those of the USA, Australia, European Union and WHO. Recommendations are made for all pregnant women to take folic acid prior to becoming pregnant and during the first trimester of the pregnancy and iodine supplementation is recommended in Australia and many other countries during pregnancy and lactation. The current WHO/ICCIDD/UNICEF recommendation for daily iodine intake (250 µg for lactating mothers) has been selected to ensure that iodine deficiency does not occur in the postpartum period and that the iodine content of the milk is sufficient for the infant's iodine requirement. While recommendations for nutritional supplements during pregnancy are specific, recommendations are usually less specific for lactation. The aim of this study was to review the use of supplements during lactation and to document the use of nutritional supplements in a cohort of mothers who are breastfeeding in Perth, Western Australia. A literature search was undertaken of reviews published between January 2000 and May 2011 and further analysis was undertaken of supplement usage in the Perth Infant Feeding Survey.In the USA the limited data that is available suggest that supplement use during lactation is dependent on demographic, sociologic, and economic factors and that more women take supplements during pregnancy than during lactation. Data from the NHANES III study show that ethnicity and income predicted iron supplementation during lactation, with 77% of non-Hispanic white women reporting supplement use compared with 41% of non-Hispanic black or Mexican American women. Multivitamin-multimineral use was the most frequently reported dietary supplement (33%). In a cohort study of postpartum mothers in Australia the use of supplements fluctuated between 40% to 30%, with 35% still taking supplements a year after birth. During their pregnancy 78% of mothers took a folic acid supplement and 21 % took an iron supplement. Mothers who took supplements were more likely to continue breastfeeding. More studies are needed to document supplement use by lactating mothers in different cultures and countries.