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Practice Guideline
Vitamin D Supplementation for Pregnancy and Lactation
Background and Rationale for Supplementation:
• Vitamin D deficiency during pregnancy affects up to 33% of pregnant females in the
United States.1
• Maternal vitamin D deficiency has been linked to increased risk of pre-eclampsia and
gestational diabetes, indicating a need for Vitamin D supplementation during
pregnancy.2
• Newborn infants depend solely on their mothers’ nutrient stores during gestation, and
are at a higher risk of vitamin D deficiency if they are born to deficient mothers.1,3
• Human breastmilk is low in Vitamin D. Research indicates that breastfed infants are at a
higher risk for vitamin D deficiency during their early stages of life.3
• Postpartum supplementation in breastfeeding mothers is associated with beneficial
outcomes, including decreased risk of rickets in breastfed infants and osteomalacia in
mothers.3,4
Vitamin D Activation and Metabolism2
There are 2 major forms of vitamin D:
• Calcidiol or 25(OH)D: non-active form
• Calcitriol or 1,25(OH)2D: active form
Activation of vitamin D occurs in a 2-step process involving the liver and the kidneys, through a
a double hydroxylation process.2 Activated Vitamin D works in conjunction with parathyroid
hormone (PTH) in the body to maintain calcium and phosphorus homeostasis, via absorption in
the intestines and reabsorption in the kidneys. Through these mechanisms, vitamin D status
impacts cellular processes and bone mineralization in mothers, fetuses, and infants during and
after pregnancy.4
Current DRI’s for Vitamin D5
Age 0-12 months 400 units/day
*While these are the current recommendations,
Pregnancy 600 units/day emerging research suggests these levels may not be
Lactation 600 units/day sufficient during pregnancy and lactation.
More research is necessary to determine fetal and neonatal benefits of maintaining higher
maternal 25(OH)D levels during pregnancy. Research has shown the following benefits of
supplementation on maternal stores during pregnancy:
• Daily supplementation of 2,000 units of 1,25(OH)2D3 is associated with increased
vitamin D content in breastmilk produced 2 months postpartum.6
o However, infants were not able to achieve their recommended Adequate Intake
of vitamin D (200 units/day) when fed this breastmilk alone.6
• A meta-analysis of 15 clinical trials found that:
o Daily supplementation of 1,25(OH)2D3 increased serum 25(OH)D levels more
effectively compared to weekly, monthly, or single megadoses.2