Background
Methods
Literature search
Hand searching
Ethical consideration
Data management
Selection criteria
Inclusion criteria
Exclusion criteria
Assessment of study quality
Quality of included studies and risk of bias assessment
First author surname, citation number | Type of Supplement | Characteristics of Participants | Type of study | Aim | Type of Nutrients Evaluated in Milk | Main findings | Jadad scale points and WHO divisions |
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Ayah [18] | maternal vitamin A (400 000 IU) or placebo,24 h postpartum | 435 mothers infant pairs. | A randomised, placebo-controlled, double blind, two-by-two factorial trial | To assess the effects of high-dose postpartum maternal supplementation with 400,000 IU and infant supplementation with 100,000 IU at 14 weeks of age, on maternal and infant vitamin A status in the 6-month postpartum period. | Retinol | Maternal serum retinol was not different between groups, but milk retinol was higher in the vitamin A group. Vitamin A supplementation was associated with significantly higher milk retinol per volume at 4, 14 and 26 weeks postpartum and higher milk retinol expressed per gram fat at week 4, but not at weeks 14 and 26. | 5/5 Africa (AFRO) |
Bahl [19] | Single dose of 60 mg vitamin A or placebo at enrolment. | A total of 9424 mother-infant pairs were enrolled in the trial, 18–28 d postpartum in India and Peru and 21–42 d after delivery in Ghana. | Multicenter randomized, double-blind, placebo-controlled trial | To determine the effect of maternal vitamin A supplementation on breast milk retinol and of maternal and infant supplementation on infant vitamin A status. | Retinol | Maternal supplementation resulted in higher breast milk retinol at 2 mo postpartum. At 6 and 9 mo, maternal supplementation did not affect breast milk retinol or the proportion of mothers with low breast milk retinol. At the doses used, maternal supplementation improved breast milk retinol status at 2 mo (P = 0.001) and maternal and infant supplementation modestly increased (P = 0.03) infant vitamin A status at 6 mo of age. | 3/5 (SEARO), (AMRO), (AFRO) |
Basu [20] | A single oral dose of 209 μmol of retinol (200,000 IU of vitamin A) | 300 mothers, 150 in control and 150 in treatment group. Mean age: 24.6 and 25.2 years respectively. | A randomised controlled prospective study | To evaluate the effect of a single oral mega dose of vitamin A on the breast milk concentration. | Retinol | After supplementation, the treatment group showed a rise in mean breast milk retinol content (12.08 v 2.96 μmol/l) which remained significantly higher for four months. The breast milk retinol concentration increased significantly in the test population within 24 h of supplementation. | 1/5 South East Asia (SEARO) |
Bezerra [21] | retinyl palmitate consisted of a single dose of 200,000 IU (experimental group) and zero IU (control group). | 113 healthy women aged 18–40 years. | randomised clinical trial | To evaluate the effect of maternal supplementation with a single dose of retinyl palmitate during the postpartum period, in order to supply vitamin A to the infant at the concentration of retinol in maternal milk. | Retinol | There was a significant increase in mean retinol levels in the colostrums of the supplemented group: 3.22 (sd = 1.81) μmol/l and 5.76 (sd = 2.80) μmol/l (p < 0.0001), between time zero and 24 h, respectively. This increase did not occur in the control group (p = 0.69). | 2/5 Americas (AMRO) |
Bezerra [22] | Participants were randomly allocated to 3 groups and supplemented in the postpartum period with a single retinyl palmitate dose of 200,000 IU (S1), a double dose of 200,000 IU 24 h apart (S2), or no supplementation (C). | 199 healthy women within 16 h postpartum, aged between 18 and 40 years. | randomised clinical trial | To assess the effect of 2 different mega doses of retinyl palmitate on the level of retinol in the breast milk of healthy women. | retinol | The retinol content in mature milk differed between no supplementation group and groups S1 and S2 (P < .05). The double dose of vitamin A did not significantly increase the retinol content of milk at 4 weeks postpartum in comparison to a single dose. | 3/5 Americas (AMRO) |
Bhaskaram [23] | vitamin A supplementation (200,000 IV) | 102 women who did not receive any vitamin A supplements during pregnancy and have full term normal deliveries | a double blind controlled prospective study | To investigate the vitamin A status of breast fed infants, extent of cornea1 lesions and the impact of postnatal maternal vitamin A supplementation on their growth and vitamin A status. | Retinol | The mean values were significantly higher at 10 and 30 days in supplemented mothers compared to control group. | 2/5 South East Asia (SEARO) |
Canfield [24] | Mothers in Group I received 90 mg β-carotene as red palm oil concentrate. Mothers in Group II received capsules containing 90 mg purified β-carotene (BASF) and Group III mothers received placebo capsules identical in appearance to those containing β-carotene. | Ninety-eight mothers mean age: 26.0 ± 6.5 | randomised clinical trial | To investigate the effect of β- carotene added to the diets of mothers as red palm oil or supplements on the vitamin A status of mothers and their nursing infants in a marginal barrio of Tegucigalpa, Honduras. | Carotenoids and retinol | Changes in milk concentrations of α-carotene (P < 0.01) and β-carotene (P < 0.02) before and after supplementation were significantly different between the three experimental groups. Increases in β- carotene concentrations were greater for the palm oil group (2.5 fold, p < 0.0001) than for the β-carotene supplement group (1.6 fold, p < 0.006) relative to placebo. | 2/5 Americas (AMRO) |
Canfield [25] | B-carotene beadlets (30-mg capsules) | Forty-four lactating mothers who had vitamin-A–poor diets. Mean age 23.7 ± 6.4 years. | randomised clinical trial | Investigation the effect of short-term b-carotene supplementation of lactating mothers on maternal milk. | Milk retinol and carotenoids | B-Carotene supplementation markedly elevated maternal serum and milk b-carotene concentrations (nine- and sevenfold, respectively). Maternal serum and milk retinol were unchanged in response to the treatment. | 2/5 Americas (AMRO) |
Darboe [26] | vitamin A as retinyl palmitate | 197 mothers With a child weighing more than 2200 g and delivering over 37 weeks | Randomised, double blind, placebo controlled trial. | To compare the efficacy of the International Vitamin A Consultative Group early high-dose protocol with that of the WHO protocol by the assessment of adverse events at dosing, maternal and infant vitamin A concentrations, mucosal integrity, growth and morbidity patterns, and measurements of infant immunity. | vitamin A | At 1 month postpartum, there was a non-significant trend towards higher levels of breast milk retinol in the high dose group than in the WHO group. | 4/5 Africa (AFRO) |
Dijkhuizen [27] | All women received iron and folic acid (30mgiron as ferrous fumarate/d and 0.4 mg pteroylglutamic acid/d). In addition, one group of women received β –carotene (4.5 mg as water-soluble granulate/d; β-carotene group), one group received zinc (30 mg zinc as sulfate/d; zinc group), one group received β –carotene plus zinc (4.5 mg β –carotene and 30 mg zinc/d; β –carotene zinc group), and one group received only iron and folic acid (control group). | Pregnant women (n = 170). Mean age 25.1 ± 5.6 years. | A double-blind, placebo-controlled study | To investigates whether supplementing women during pregnancy with β-carotene and zinc, in addition to the standard supplementation with iron and folic acid, can improve vitamin A and zinc status of mothers and newborns 1 and 6 months postpartum. | Breast-milk b-carotene Retinol Zinc | Breast-milk β-carotene concentrations were higher in all women supplemented with β –carotene, but breast-milk retinol concentrations were higher only in women who received β –carotene + zinc. Zinc concentrations did not differ among groups in mothers and infants. Six months postpartum, plasma retinol concentrations were higher in the women who received zinc during pregnancy than in women who did not. | 4/5 South East Asia (SEARO) |
Garcia-Guerra [28] | 100 to 150% of the recommended dietary vitamin A | 249 mothers with 23.0 ± 5.2 years. | A randomized controlled trial | To assess the impact of daily supplementation with multiple micronutrients during pregnancy on zinc, vitamin A and folate status during pregnancy and 1 month postpartum, zinc and vitamin A in cord blood, and breast milk retinol concentration at one month postpartum. | Retinol | Breast milk retinol concentration at one month postpartum didn’t differ between groups. | 4/5 Americas (AMRO) |
Gossage [29] | All mothers were randomly assigned to 4 weeks of supplementation with either β carotene (30 mg/d; n = 11) or placebo (n = 10) beginning on day 4 postpartum (day 0 of the study). | Twenty-one pregnant women who had breast-fed at least one infant, did not smoke, had not taken prenatal supplements. | randomized controlled trial | To investigate the effects of β -carotene supplementation on human milk composition. | Milk concentrations of β -carotene, the other carotenoids, retinol, or α-tocopherol. | Β carotene supplementation did not significantly change the milk concentrations of β -carotene, the other carotenoids, retinol, or α tocopherol. | 2/5 Americas (AMRO) |
Grilo [30] | A mega dose of 200,000 IU of retinyl palmitate. | 33 voluntary postpartum women aged 18 to 35 years | quasi-experimental study | To investigate the effect of vitamin A supplementation on the retinol concentration in colostrums under fasting and postprandial conditions | retinol | After supplementation, the values were 89.5 (32.9–264.2) g/dL and 102.7 (37.3–378.3) g/dL in fasting and postprandial conditions in breast milk, respectively (p < 0.05), representing an increase of 14.7%. | 3/5 Americas (AMRO) |
Grilo [31] | The supplemented group received 200,000 IU of retinyl palmitate after the first colostrum collection. | Healthy puerperal women were randomly distributed into a control group (n = 44) and a supplemented group (n = 44). | prospective, controlled, randomised and parallel-design trial | To assess the influence of maternal retinyl palmitate supplementation on the levels of retinol and a-tocopherol in the colostrum and mature milk of healthy lactating women. | Retinol a-tocopherol | The colostrum retinol levels of the supplemented group increased significantly 24 h after the intervention (P < 0.001). However, the retinol levels in the mature milk of both groups did not differ (P > 0.05). Moreover, after maternal supplementation with vitamin A, the colostrums a-tocopherol level decreased by 16.4%, which is a significant reduction (P < 0.05). However, vitamin A supplementation did not affect the a-tocopherol level of mature milk (P > 0.05). | 3/5 Americas (AMRO) |
Idindili [32] | 60,000 g vitamin A palmitate | 780 newborn infants and their mothers | Randomised, double blind, placebo controlled trial. | To compare the safety and efficacy of the previously tested low-dose regimen 25,000 IU vitamin A palmitate on breast milk. | Vitamin A | There were no significant difference in breast milk concentration of vitamin A in high and low dose group. | 5/5 Africa (AFRO) |
Johnson [33] | Participants were given either seven doses of a placebo (n = 4) or seven doses of naturally occurring BC (n = 8). | Twelve healthy lactating women (1–8 months postpartum, 18–40 years old). | randomized controlled trial | To determine effect of continuous oral doses of b-Caroten on breast Milk composition. | Carotenoids b-Caroten isomers | In the experimental group, the mean maternal milk concentration of all-trans b-carotene significantly increased to seven times the baseline level by the end of the supplementation period. The maternal milk concentration of 9-cis b-carotene significantly increased to three times the baseline level by the end of the supplementation period. | 2/5 Americas (AMRO) |
Klevor [34] | Women were randomly assigned to receive either the multiple-micronutrient supplement (MMN) providing 18 micronutrients, including 800 mg retinol equivalents of vitamin A, or the lipid-based nutrient supplement (LNS) with the same nutrients as the MMN group, plus 4 minerals and macronutrients, until 6 mo postpartum; a control group received iron and folic acid during pregnancy and a placebo (calcium tablet) during the first 6 months postpartum. | 1320 women during pregnancy (≤20 wk. of gestation to delivery) and the first 6 mo postpartum. | A randomized, partially double-blind, controlled trial | Assessing effect of daily supplementation with approximately the recommended daily intake of vitamin A in LNS or a multiple-micronutrient supplement (MMN) during pregnancy and the first 6 mo postpartum on breast milk retinol concentration at 6 mo postpartum. | Breast milk vitamin A | There were no significant differences in any of these outcomes among intervention groups and results did not change after controlling for significant covariates. We found no significant effect of daily low-dose vitamin A provided in LNS or MMN during pregnancy and the first 6 mo postpartum on breast milk retinol concentration at 6 mo postpartum. | 5/5 Africa (AFRO) |
Lietz [35] | control group (n = 30), the sunflower oil group (n = 30), and the red palm oil group (n = 30) | Ninety rural, pregnant Tanzanian women from 3 randomly selected villages were recruited during their third trimester. | randomized controlled trial | To efficacy of red palm oil in increasing retinol and provitamin A status in pregnant and lactating women. | carotenoid and retinol | Supplementation with red palm oil, which is rich in provitamin A, increased α- and β- carotene concentrations significantly in both plasma and breast milk. The difference in change in breast-milk retinol concentration between the red palm oil group and the control group was significant. | 2/5 Africa (AFRO) |
Lietz [36] | Red Palm Oil | 56 Pregnant women (in their 3rd trimester, aged 18–45 years). | quasi-experimental study | To investigate the effect of maternal red palm oil supplementation throughout the 3rd trimester of pregnancy and the first 3 mo postpartum on carotenoid pattern in both plasma and breast milk. | Xanthophyll and Hydrocarbon Carotenoid | Red palm oil supplementation increases the milk concentrations of provitamin A carotenes without decreasing the milk concentrations of xanthophylls. | 2/5 Africa (AFRO) |
Martins [37] | a single dose of 200,000 IU vitamin A (retinyl palmitate) | 66 mother–infant pairs, 33 mothers in control and 33 mothers in intervention group. | A double blind, placebo-controlled randomized clinical assay | Assess the impact of maternal supplementation with a single dose of retinyl palmitate on the vitamin A status of mother, breast milk and infant. | Serum and milk retinol | Reduction in breast milk retinol was observed in the control group compared with the pre-supplementation levels (1.93 and 1.34 mmol/l, respectively; P ≤ 0.0001) and to the post-supplementation levels of the supplemented group (1.56 mmol/l; P = 0.0003). There was significant difference in the prevalence of VAD in breast milk after supplementation, 55.6% (15/27) in the control group and 16.1% (5/31) in the supplemented group (P = 0.002). | 3/5 Americas (AMRO) |
Muslimatun [38] | One group received (n 5 88) a weekly supplement of iron (120 mg Fe as FeSO4) and folic acid (500 mg) and another (n 5 82) the same amount of iron and folic acid plus vitamin A [4800 retinol equivalents (RE)]. | 170 women with age 17–35 years. | A randomized double-blind, community-based trial | To investigate whether retinol and iron variables in breast milk and in serum postpartum were enhanced more with weekly vitamin A and iron supplementation during pregnancy than with weekly iron supplementation alone. | Fat, iron and vitamin A | Compared with the weekly iron group, the weekly vitamin A and iron group had a greater (P < 0.05) concentration of retinol in transitional milk (as mmol/L) and in mature milk (as mmol/g fat). However, no positive effects were observed on iron status and iron concentration in breast milk. | 3/5 South East Asia (SEARO) |
Nagayama [39] | Chlorella tablets. | Twenty healthy pregnant women (age range, 24–39 years. | randomized controlled trial | Investigation the effect of maternal supplementation with Chlorella on the carotenoid concentrations of breast milk. | carotenoids | Among the carotenoids detected in breast milk, lutein, zeaxanthin and b-carotene concentrations in the Chlorella group were 2.6-fold (p = 0.001), 2.7-fold (p = 0.001) and 1.7-fold (p = 0.049) higher, respectively, than those in the control group. | 2/5 WPRO (Western Pacific Regional Office) |
Rice [40] | a single dose of 200,000 international units [60,000 retinol equivalents (RE)] vitamin A followed by daily placebos (n = 74), (2) daily doses of b-carotene [7.8 mg (1300 RE)] (n = 73) or (3) daily placebos (n = 73) until 9 mo postpartum | 220 women in three treatment group. b-carotene Vs Placebo Vs Vitamin A | Randomized double blinded clinical trial | To investigate the the effects of maternal postpartum vitamin A or b-carotene supplementation on maternal and infant serum retinol concentrations and breast milk vitamin A concentrations. | Vitamin A | Compared to placebos, vitamin A supplementation resulted higher milk vitamin A concentrations at 3 mo, but these improvements were not sustained. Women receiving b-carotene supplements produced breast milk with increasingly higher vitamin A concentrations from 3 to 9 mo, but the concentration was significantly different from the placebo group only at 9 mo. | 5/5 South East Asia (SEARO) |
Roy [41] | 209 mmol retinol. | 50 pregnant women in their last trimester aged 16 ± 35 year. | Randomized clinical trial | To evaluate the effect of vitamin A supplementation 24 h after delivery on breast milk retinol concentration. | serum retinol, Breast milk retinol | Mean serum retinol levels increased in the supplemented mothers at 2.77 (2.3, 3.2) compared to 1.15 (0.9, 1.4) mmol/l in controls (P < 0.05) and remained at a significantly higher level of 1.59 (1.4, 1.8) mmul/l compared to 1.33 (1.8, 1.5) mmol/l in the control group (P < 0.001) up to a period of three months. | 2/5 Eastern Mediterranean (EMRO) |
Stoltzfus [42] | 300,000 IU vitamin A as retinyl palmitate (n = 77) 2. Mother received placebo (n = 76). | 153 mothers and their infants. Mother received supplement (n = 77) mother received placebo (n = 76). | Randomised, double blind, placebo controlled trial. | To measure the effects of supplementing mothers postpartum with vitamin A and effects on their milks. | breast milk retinol concentration | The milk retinol concentrations of the vitamin A group were higher than those of the placebo group (P < 0.05). | 5/5 South East Asia (SEARO) |
Tomiya [43] | Group 1 e received one 200,000 IU (retinol palmitate) capsule 40 mg of vitamin E orally immediately after delivery and, 10 days after delivery, the second 200,000 IU (retinol palmitate) capsule 40 mg of vitamin E were given. Group 2 e received one 200,000 IU (retinol palmitate) capsule 40 mg of vitamin E orally immediately after delivery and, 10 days after delivery, the second “placebo” capsule containing 40 mg of vitamin E diluted in soybean oil were given. | 158 women from 13 to 42 years of age. | A randomized, controlled, triple blind and hospital based clinical trial. | To determine if the 400,000 IU supplementation with retinol palmitate, immediately after delivery, promotes an additional effect in the concentrations of retinol in the human milk, when compared to the 200,000 IU supplementation. | Retinol | There was no significant difference between retinol concentrations in breast milk between treatment groups (400,000 IU vs 200,000 IU) in the studied period: 2 months (p = 0.790) and 4 months (p = 0.279). | 5/5 Americas (AMRO) |
First author surname, citation number | Type of Supplement | Characteristics of Participants | Type of study | Aim | Type of Nutrients Evaluated in Milk | Main findings | Jadad scale points and WHO divisions |
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Bates [44] | 60 mothers living in two Gambian villages were given either 2 mg riboflavin or a placebo daily on a double-blind basis for 12 wk. Their riboflavin intake from dietary sources was about 0.5 mg/day | 60 lactating mothers (mean age was 28.0 yr; their mean parity, 4. 1,) | Randomized double-blinded clinical trial | To evaluate the effect of a moderate increase in riboflavin intake on breast milk riboflavin level. | Riboflavin | Clinical signs associated with riboflavin deficiency improved more rapidly in the supplemented group; their breast milk riboflavin levels increased, and their infants’ activation coefficients (AC) were reduced, compared with those of the placebo group. After withdrawal of the supplement, the maternal and infants’ AC’s rose toward those of the placebo group. | 4/5 Africa (AFRO) |
Chang [45] | Mothers received pyridoxine (PN) supplements of 2.5, 4.0, 7.5, or 10.0 mg/d, respectively | Forty-seven infants born to healthy women were divided into four groups. | Randomized clinical trial | To assess maternal vitamin B6 intake and breast milk concentration of vitamin B6. | Vitamin B6 | Mean vitamin B6 concentrations in breast milk were significantly lower for women supplemented with 2.5 mg PN.ehcl/d than for those supplemented with 4.0, 7.5, or 10.0 mg/d. | 1/5 Americas (AMRO) |
Duggan [46] | Daily oral dose of vitamin B-12 (50 mg) or a placebo identical in appearance. | One hundred eighty-three women were randomly assigned to receive vitamin B-12 and 183 to receive placebo. | A randomized, double-blind, placebo-controlled trial | To evaluate the effect of maternal supplementation of vitamin B-12 during pregnancy and lactation on maternal and infant biomarkers of vitamin B-12 status. | Milk vitamin B-12 | At 6 wk. postpartum, median breast milk vitamin B-12 concentration was increased in vitamin B-12–supplemented women than placebo group (P < 0.0005). Oral supplementation of urban Indian women with vitamin B-12 throughout pregnancy and early lactation significantly increases vitamin B-12 status of mothers and infants. | 5/5 South East Asia (SEARO) |
Hampel [47] | Lipid-based nutrient supplements (LNS) | (n = 258) or 6 (n = 104), and 24 weeks (n = 362) from HIV infected Malawian mothers. | Randomized clinical trial | To investigate the contribution of each thiamin and riboflavin vitamer and the effect of lipid-based nutrient supplements (LNS) on the vitamer distribution at early and later stages of lactation. | Thiamin vitamers, Riboflavin and FAD, Thiamin-pyrophosphate (TPP), | Lipid-based nutrient significantly increased Thiamin-monophosphate and free thiamin only at 2 weeks compared to the control. Free riboflavin was consistently and significantly increased with LNS versus control. | 1/5 Africa (AFRO) |
Hampel [48] | Thiamin, riboflavin, niacin, and vitamins B-6, B-12, A, and E. | 18 healthy women (aged 18–26 years) | Randomized clinical trial | To evaluate the effects of sample collection protocols, variations in circadian rhythms, subject variability, and acute maternal micronutrient supplementation on milk vitamin concentrations. | Thiamin, riboflavin, niacin, and vitamins B-6, B-12, A, and E and fat were measured in each sample | No significant differences were observed for thiamin and vitamins B-12, A, E, and A. Vitamin B-6 concentrations increased linearly after supplements were consumed, whereas milk concentrations of riboflavin increased on day 3 and 4 compared with day 1. | 1/5 South East Asia (SEARO) |
Siddiqua [49] | 250 μg/day B12 or a placebo throughout pregnancy and 3-month postpartum along with 60 mg iron + 400 μg folate. | 68 women age 18–35 years. | Randomized clinical trial | To assess the effect of B12 supplementation in pregnancy and lactation on alleviation of anemia, and improvement of B12 status and vaccine-specific immunity in mothers and infants. | Vitamin B12 | Supplementation increased B12 in plasma, colostrums and breast milk (p < 0.05) and lowered methylmalonic acid in neonates, mothers and infants at 3 months (p < 0.05). Supplementation with 250 mg/day B12 during pregnancy and lactation substantially improved maternal, infant and breast milk B12 status. | 4/5 South East Asia (SEARO) |
Styslinger [50] | Pyridoxine HCI | Twenty-four healthy, lactating women with full-term, healthy infants and their ages ranged from 20 to 36 years. | Randomised-controlled trial | To examine the effects of such changes on the breastfed infants’ intake of vitamin B-6. | Vitamin b6 | A significant (p < 0.001) positive correlation (r = 0.80) was found between maternal intake and the level of the vitamin in milk. The mean vitamin 8–6 content in milk of subjects supplemented with 20.0 mg vitamin 8–6/day was significantly higher (p < 0.05) than that for any other group. | 1/5 Americas (AMRO) |
Thomas [51] | Vitamin A, Vitamin D, Vitamin E, Vitamin C, Folic acid, Thiamin, Riboflavin, Niacin, Vitamin B6, Vitamin B12, Calcium, Iodine, Iron, Magnesium. | 17 mothers at the end of gestation (18 to 35 years of age) | Randomised-controlled trial | To study the effects of vitamin supplements and/or diet on the levels of vitamin C, vitamin B6, and vitamin B12 in milk and blood of lactating women. | Vitamin B6, B12 and C | The vitamin B6 level in breast milk of the unsupplemented group of mothers was significantly lowers (P < 0.05) than the supplemented group of women at 5 to 7 days postpartum. Vitamin B12 concentration in milk of nonsupplemented mothers at 43 to 45 days postpartum was significantly lowers (P < 0.05) than the supplemented group of women at 43 to 45 days postpartum. | 1/5 Americas (AMRO) |
First author surname, citation number | Type of Supplement | Characteristics of Participants | Type of study | Aim | Type of Nutrients Evaluated in Milk | Main findings | Jadad scale points and WHO divisions |
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Byerley [52] | 25 lactating women administered 90 mg of ascorbic acid for 1 day followed by 250, 500 or 1000 mg/day for 2 days or unsupplemented for 1 day followed by either 0 or 90 mg ascorbic acid supplement for 2 days | 25 well-nourished lactating women from 20 to 36 years old. | Randomized clinical trial | To assess effect of maternal intake of vitamin C on the vitamin C concentration in human milk and on the vitamin C intakes of breast-fed infants. | Vitamin C of human milk | Total maternal intakes of vitamin C, which exceeded 1000 mg/day or 10-fold the RDA for lactation (100 mg/day), did not significantly influence the vitamin C content in milk or the vitamin C intakes of infants. | 1/5 Americas (AMRO) |
Daneel-Otterbech [53] | Effervescent tablets (1000 mg ascorbic acid) | Apparently healthy, lactating women | Randomised-controlled trial | To compare human milk ascorbic acid content in European and African women and to evaluate the influence of increased ascorbic acid intake on human milk ascorbic acid output. | Ascorbic acid | Ascorbic acid (AA) supplementation (1000 mg/d for 10 d) increased mean human milk AA from 19 to 60 mg/kg (P ≤ 0.001) and from 60 to 70 mg/kg (P ≤ 0.03) in 18 African and 10 European women, respectively. In 11 African women, mean human milk AA increased from 17 to 36 mg/kg (P ≤ 0.001) after intake of 100 mg AA/d for 10 d. | 1/5 Europe (EURO) |
First author surname, citation number | Type of Supplement | Characteristics of Participants | Type of study | Aim | Type of Nutrients Evaluated in Milk | Main findings | Jadad scale points and WHO divisions |
---|---|---|---|---|---|---|---|
Ala-Houhala [54] | Half of the mothers were supplemented daily throughout the study with one tablet containing 1000 IU (25 mg) of ergocalciferol. Throughout | 20 mothers who delivered babies in the winter and from 20 mothers who delivered in the summer. | Randomized clinical trial | To investigate the possible effects of supplementing breast-feeding mothers with vitamin D and of the seasons on the concentrations of antirachitic sterols, ie, 25-hydroxyvitamin D (25- [OH]D) and vitamin D, in milk. | 25 (OH) vitamin D | Supplementation had no effect on vitamin D levels. Milk 25-(OH) D levels of mothers receiving either 1000 or 2000 IU (25 or 50 g) vitamin D/d was significantly higher than those of un supplemented mothers in February and April. | 1/5 Europe (EURO) |
Basile [55] | Mothers were randomized to receive either 2000 or 4000 IU vitamin D supplementation per day. Groups 1 and 2 received 1600 and 3600 IU per day vitamin D2, respectively, in an oral suspension. Both groups received additional multivitamin capsules containing 400 IU vitamin D3 and were instructed to take them daily. | 25 Lactating mothers (mean age: 30.6 ± 4.6) | Prospective, double-blinded, randomized Controlled trial | To investigate breast milk [Ca] as a function of vitamin D supplementation regimen. | Circulating and Milk concentrations of vitamin D2, vitamin D3, 25(OH)D2, and 25(OH)D3 | Mean maternal and infant total circulating 25(OH) D levels had statistically significant increases during the 3 months of high-dose vitamin D supplementation. Mothers in group 1 (who received 1600 IU/day vitamin D2 and 400 IU/day vitamin D3) exhibited increases in total circulating concentrations of 25(OH) D from baseline to 3 months (p ≤ 0.002). | 4/5 Americas (AMRO) |
Ketha [56] | Vitamin D3 as a single oral dose of 150,000 IU (N = 20), or 5000 IU daily (N = 20) for 28 days. | 40 lactating females, ages 24–40 years, with a singleton infant between the ages of 1 and 6 months. | Randomized controlled trial | To investigate the effect of bolus versus daily vitamin D3 dosing regimens on temporal changes in 25(OH)D3/24,25(OH)2D3 ratio in a group of breast feeding mothers | Serum vitamin D3, 25(OH) D3, 24,25(OH)2D3, 1,25(OH)2D3, and breast milk vitamin D3. | Greater production of 24, 25(OH) 2D3 resulting from a single, high dose bolus of vitamin D than with a daily dose of vitamin D over the course of 28 days. | 2/5 Americas (AMRO) |
Niramitmahapanya [57] | One group received vitamin D3 1800 IU/d supplementation for 6 weeks, and members of the other group were given a placebo. | 200 mothers at the third trimester (delivered singleton infants at term > 37 weeks). | Randomized double blinded control trial | To investigate whether vitamin D3 supplementation (1800 IU/day) can improve breastfed serum of infants and breast milk 25 (OH) D levels. | 25 (oh) d | At 6 weeks, maternal 25 (OH) D levels had increased significantly in the vitamin D group (VD) 68.30 + 15.40 nmol/L compared to 55.15 + 13.57 nmol/L in the placebo group (p < 0.001). | 4/5 South East Asia (SEARO) |
Oberhelman [58] | Participants received oral cholecalciferol (vitamin D3) 5000 IU/d for 28 days or 150,000 IU once. | Forty mothers, mean age: 30.3 ± 2.9 | Randomized clinical trial | To determine if a single monthly supplement was as effective as a daily maternal supplement in increasing breast milk vitamin D to achieve vitamin D sufficiency in their infants. | Cholecalciferol | In mothers given daily cholecalciferol, concentrations of serum and breast milk cholecalciferol attained steady levels of 18 and 8 ng/ ml, respectively from day 3 through 28. In mothers given the single dose, serum and breast milk cholecalciferol peaked at 160 and 40 ng/ml, respectively at day 1, before rapidly declining. | 2/5 Americas (AMRO) |
Wall [59] | A placebo group, a group who received one dosage of daily oral vitamin D3 (1000 IU), or a group who received 2 dosages of daily oral vitamin D3 (2000 IU) | 48 pregnant mothers and their infants | A randomized, double blinded, Placebo-controlled trial | To examine the effect of vitamin D supplementation during pregnancy on breast-milk VDA in the first 2 mo of lactation. | Concentration Of vitamin d2, vitamin d3, 25(oh)d2, and 25(oh)d3 in Breast milk | Maternal vitamin D supplementation during pregnancy of 2000 IU/d (compared with 1000 IU/d and with a placebo) results in a higher VDA of breast milk ≥2 mo postpartum. | 3/5 WPRO (Western Pacific Regional Office) |
First author surname, citation number | Type of Supplement | Characteristics of Participants | Type of study | Aim | Type of Nutrients Evaluated in Milk | Main findings | Jadad scale points and WHO divisions |
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Clemente [60] | A control group without treatment, a group receiving an acetate capsule with natural RRR-a-TOH (GNAT), and a group receiving an acetate capsule with synthetic all-rac-a-TOH (GSINT) | 109 healthy lactating women ages 18 to 40 year. | A randomized double-blind clinical trial | Evaluate levels of vitamin E in human colostrums when lactating mothers were given supplements of either natural or synthetic forms of alpha-tocopherol. | A-tocopherol | Women who received supplementation had higher concentrations of a-TOH in colostrums than the control group, with 57 and 39% increases in women supplemented with the natural and synthetic forms of a-TOH, respectively. | 4/5 Americas (AMRO) |
Gaur [61] | The 3 groups were as follows: 1) 45.5 mg all-rac-a-TAc (ARAC), 2) 22.8 mg all-rac-a-Tac + 20.1 mg RRR-a-tocopherol (MIX), and 3) 40.2 mg RRR-a-tocopherol (RRR | Eighty-nine mothers aged 19–40 years. | Prospective, randomized, double-blinded, and placebo-controlled | To elucidate the effect of a-tocopherol supplementation with RRR-a-tocopherol, all-rac-a-tocopherol acetate (Tac), or a mixture (combination of RRR-a-tocopherol and all-rac-a-Tac) on the a-tocopherol stereoisomer distribution in plasma and milk. | A-tocopherol structural isomers and a-tocopherol stereoisomers | There were no significant treatment group or time-dependent changes in milk or plasma a, g, or d-tocoph erol. Supplementation changed both milk and plasma percentage RRR-a-tocopherol (P < 0.05) and percentage non-RRRa-tocopherol (P < 0.05). In the RRR group, percentage RRR-a-tocopherol increased in milk (mean 6SEM: 78 62.3% compared with 82 61.7%) (P < 0.05) | 3/5 Americas (AMRO) |
Johnson [33] | Beta carotene | Healthy lactating women (1–8 mo postpartum, 18–40 y old) | Randomized clinical trial | Examination of the concentration of BC isomers in breast milk and buccal mucosa cells after continuous oral doses of BC isomers is a simple, non-invasive method. | Beta carotene | The changes in breast milk concentration of all-trans BC in response to a continuous oral dose of BC followed a pattern similar to that for serum. A significant increase in concentration was observed by d 3 (P < 0.009) and steadily increased to six times the baseline level (d 1) by the end of the supplementation period (d 8, P < 0.0001). | 2/5 Americas (AMRO) |
Kanno [62] | d-α.Tocopherol | Mother, who had delivered a low-birth-weight infant (1975 g) after 38 weeks of gestation | Quasi experimental study | To investigated the transfer of a-T into the breast milk of a lactating mother who was orally administered with α.Tocopherol | α.Tocopherol | By a single dose of α. Tocopherol, the content of α. Tocopherol per lipid was increased by a maximum of 7-fold and the ratio of α. Tocopherol equivalent/PUFA was markedly improved, although the total amount of α. Tocopherol transferred into the milk was small. | 1/5 WPRO (Western Pacific Regional Office) |
Medeiros [63] | A single oral dose of 400 IU natural vitamin E. | Participants were women aged between 18 and 45 years. | Randomized clinical trial | To assess the effect of vitamin E supplementation on the α-tocopherol concentrations of colostrums, transitional milk and mature milk of women who had given birth prematurely. | Α-Tocopherol | Breast milk α-tocopherol concentrations increased by 60% 24 h after supplementation in the intervention group and did not increase at all in the control group. Α-Tocopherol concentration of the transitional milk in the supplemented group was 35% higher compared with the control group. | 2/5 Americas (AMRO) |
Melo [64] | capsules containing 400 international units (IU) of alpha-tocopherol | 99 healthy pregnant women; mean age was 24 ± 6 years. | Randomized clinical trial | To evaluate the effect of maternal supplementation with vitamin E on the concentration of α tocopherol in colostrums and its supply to the newborn. | a-tocopherol | After supplementation, the mean concentration of -tocopherol in the mothers’ colostrums was 1650.6 ± 968.7 and 2346.9 ± 1203.2 mg/dL in the CG and SG groups, respectively. However, the mean αtocopherol concentrations in supplemented women increased the concentration of αtocopherol secreted in colostrums by 61% (p < 0.001). | 3/5 Americas (AMRO) |
First author surname, citation number | Type of Supplement | Characteristics of Participantss | Type of study | Aim | Type of Nutrients Evaluated in Milk | Main findings | Jadad scale points and WHO divisions |
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Bolisetty [63] | 2.5 mg phylloquinone (vitamin K1) orally daily for 2 weeks | Six healthy lactating mothers who gave birth to preterm infants at a median post conceptional age of 29.5 (range 26–30) weeks. | Randomized clinical trial | To raise the vitamin K content in the breast milk to levels recommended for infant formulae by RDA and to look at day-to-day variation in the breast milk vitamin K levels with maternal supplementation of vitamin K. | phylloquinone vitamin K1 | Phylloquinone levels in the breastmilk increased from a baseline of 3 ± 2.3 ng ml− 1 to 22.6 ± 16.3 ng ml− 1 (mean ± SD) after the first dose (p < 0.05); a gradual increase was noted until phylloquinone levels reached a plateau of 64.2 ± 31.4 ng ml− 1 after the sixth daily dose. | 2/5 WPRO (Western Pacific Regional Office) |
Greer [65] | Ten mothers received 2.5 mg/d oral phylloquinone, and 10 mothers received 5.0 mg/d oral phylloquinone. | Twenty exclusive breastfeeding mothers. | longitudinal, randomized, double-blind, placebo-controlled | To increase the phylloquinone (Vitamin K1) concentration of human milk with maternal oral phylloquinone supplements. | Phylloquinone | Both 2.5 and 5.0 mg/d phylloquinone significantly increased the phylloquinone content of human milk at both 2 and 6 weeks. As expected, 5.0 mg had a greater effect. | 3/5 Americas (AMRO) |
Kries [66] | Vitamin K1 | Nine mothers (age of the mothers ranged between 17 and 34 yr, mean 24 yr) | Randomized clinical trial | To assess the effect of Vitamin KI Supplements on maternal milk. | Vitamin K1 | To test the influence of diet, mothers were given oral supplements of vitamin K I. Doses of 0.5–3 mg produced substantial rises in breast milk vitamin K I with peak levels between 12 and 24 h. In one mother in whom the milk sampling was standardized, a dose-response relationship was observed. | 1/5 Europe (EURO) |
First author surname, citation number | Type of Supplement | Characteristics of Participants | Type of study | Aim | Type of Nutrients Evaluated in Milk | Main findings | Jadad scale points and WHO divisions |
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Canfield [67] | Purified b-carotene in capsules | Five healthy mothers, between the ages of 23 and 36 years. | Randomized clinical trial | Investigate changes in concentrations of milk and serum carotenoids, retinol, and a-tocopherol of five healthy women over a 28-d supplementation trial with 30 mg b-carotene and for 4 wk. thereafter. | milk a-tocopherol and retinol | B Carotene supplementation increased mean b-carotene concentrations in milk and serum 6.4- and 7.4-fold, respectively. Concentrations of other major carotenoids, retinol, and a-tocopherol did not change substantially in either milk or serum. | 3/5 Americas (AMRO) |
Garcia [68] | One retinyl palmitate capsule (200,000 UI) | 73 Healthy parturient women, control (n = 37) and supplemented (n = 36). | Randomized clinical trial | To determine the effect of maternal supplementation with a megadose of retinyl palmitate in the immediate post-partum on a-tocopherol concentration in the colostrums. | Retinol, a-tocopherol | A significant increase (P = 0.00) was observed in colostrums retinol in the supplemented group 24 h after administration of the retinyl palmitate capsule. A significant increase (P = 0.04) was also found in colostrums a-tocopherol concentration after vitamin A supplementation. | 1/5 Americas (AMRO) |
Gossage [29] | B-carotene (30 mg/d; n = 11) or placebo (n = 10) beginning on day 4 postpartum (day 0 of the study). | Twenty-one pregnant women were recruited during their last trimester. | Randomized clinical trial | To assess milk carotenoid concentrations during days 4–32 postpartum and the effects of maternal B-carotene supplementation. | lutein + zeaxanthin, b-cryptoxanthin, lycopene, a-carotene, B-carotene, retinol, and a-tocopherol. | B-carotene supplementation did not significantly change the milk concentrations of B –carotene, the other carotenoids, retinol, or tocopherol. There were no significant overall effects of carotene supplementation on milk concentrations of lutein, cryptoxanthin, lycopene, or carotene. | 2/5 Americas (AMRO) |
Sherry [69] | Either 0 mg/d of lutein (placebo), 6 mg/d of lutein (low-dose), or 12 mg/d of lutein (high-dose). | Eighty-nine lactating women 4–6 wk. postpartum. | A multisite, prospective, randomized, placebo controlled dose-response study | To determine the impact of lutein supplementation in the breast milk and plasma of lactating women and in the plasma of breast-fed infants 2–3 mo postpartum. | Carotenoids, Lutein, zeaxanthin | Total lutein + zeaxanthin concentrations were greater in the lowand high-dose–supplemented groups than in the placebo group in breast milk (140 and 250%, respectively; P < 0.0001) | 5/5 Americas (AMRO) |
Webb [70] | (1) vitamin A and b-carotene (VABC: 5000 IU (1500 mg retinol activity equivalents) of preformed vitamin A plus 30 mg of b-carotene), (2) multivitamins (MV) that did not include vitamin A and b-carotene (20 mg of thiamine, 20 mg of riboflavin, 25 mg of vitamin B6, 100 mg of niacin, 50 mg of vitamin B12, 500 mg of vitamin C (purified L-ascorbic acid), 30 mg of vitamin E RRR-a- tocopherol acetate) and 0.8 mg of folic acid), (3) MV that included vitamin A and b-carotene (same doses as above), or (4) placebo. | 1078 HIV-infected pregnant women. | A randomized, double-blind, placebo-controlled trial | To assess the impact of daily vitamin supplementation during pregnancy and lactation on concentrations of retinol, b-carotene, a-carotene, a-tocopherol, g-tocopherol and d-tocopherol in breast milk. | retinol, total b-carotene, a-carotene, a-tocopherol, d-tocopherol and g-tocopherol | Women who received VABC had significantly higher concentrations of breast milk retinol, b-carotene and acarotene at all-time points during the first year postpartum compared to women who did not receive VABC. Supplementation with VABC did not influence concentrations of a-, g- or d-tocopherol from delivery to 1 year postpartum. | 4/5 Africa (AFRO) |
First author surname, citation number | Type of Supplement | Characteristics of Participants | Type of study | Aim | Type of Nutrients Evaluated in Milk | Main Findings | Jadad scale points and WHO divisions |
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Chierici [71] | 20 mg zinc sulfate, 2 mg copper sulfate and 116 mg potassium iodide. | 32 non-smokers, non-vegetarian, with normal weight gain during pregnancy mothers. | Randomized controlled trial | To determine the effect of dietary zinc, copper and iodine supplements on the milk concentration. | Mineral content of zinc, copper and iodine | The milk zinc concentration declined significantly over the study period for all lactating subjects. There was no significant difference in the rate of decline between the women who started supplementation during lactation and those who were not supplemented. | 1/5 Europe (EURO) |
Krebs [15] | 15 mg of zinc (as ZnSO47H2O). | 39 women who did not receive a zinc supplement and 14 women who received daily zinc supplement. | Randomized controlled trial | To calculate dietary zinc intakes, evaluate maternal zinc nutritional status, and determine zinc concentrations in milk. | Zinc | The rate of decline in milk zinc during lactation was significantly less for the supplemented group compared to that of the control group (p = 0.02). It is concluded that milk zinc concentrations are influenced by maternal zinc intake. | 2/5 Americas (AMRO) |
Shaaban [72] | 10 mg/d of Zn sulfate capsules. | 60 primiparous lactating mothers. | Randomized controlled trial | To determine effect of maternal Zn supplementation on maternal and infant Zn stores. | Zinc | Zn supplementation caused significantly higher maternal hair, nail, and breast milk Zn levels. In conclusion, Zn supplementation for lactating women positively influenced breast milk Zn concentrations and maternal body stores although it had no significant influence on the infants’ physical growth. | 2/5 Eastern Mediterranean (EMRO) |
First author surname, citation number | Type of Supplement | Characteristics of Participants | Type of study | Aim | Type of Nutrients Evaluated in Milk | Main Findings | Jadad scale points and WHO divisions |
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Dodge [73] | 50 mg selenium daily as selenomethionine or a placebo. | Twenty-two healthy young women between the ages of 20–30 years. | Single blind clinical trial | To evaluate the effect of selenium supplementation on the concentration of breast milk fatty acids in lactating women. | selenium and activity of glutathione peroxidase (Gpx) | Selenium concentration of breast milk was significantly increased by the supplementation (P = 0.0001 and 0.003, respectively), but glutathione peroxidase activity was unchanged. The selenium supplement also significantly increased the concentration of polyunsaturated fatty acids in breast milk (P = 0.02), especially linoleic acid (P = 0.02), and decreased the concentration of saturated fatty acids (P = 0.04). | 3/5 WPRO (Western Pacific Regional Office) |
Dylewski [74] | sodium selenate at 20 lg/day | 23 lactating women who had not smoking, having no pregnancy complications, having an infant born at term (37 to 40 weeks). | Randomized clinical trial | To evaluate the impact of supplemental selenium as sodium selenate at 20 lg/day on maternal milk. | Selenium | Selenium supplementation increased milk Se from 3 (295 ± 18 nmol/L; 23 ± 7 ng/ mL) to 6 months (417 ± 39 nmol/L; 32 ± 14 ng/mL) postpartum (P ≤ 0.01) | 1/5 Americas (AMRO) |
Flax [75] | lipid-based nutrient supplements (LNS) that contained 1.3 times the Recommended Dietary Allowance of sodium selenite, antiretroviral drugs (ARV), LNS and ARV, or a control. | 526 HIV-infected Malawian mothers and their uninfected infants attended in the Breastfeeding, Antiretrovirals, and Nutrition study | Randomized clinical trial | To determine the effects of lipid-based nutrient supplements maternal plasma and breast-milk selenium concentrations. | Selenium concentrations | Selenite supplementation of women was not associated with a change in their plasma or breast-milk selenium concentrations. | 3/5 Africa (AFRO) |
Moore [76] | Two groups and given either a placebo (n = 10) as yeast or selenium-enriched yeast tablets (n = 11) | 21 pregnant women between the ages of 20 and 30 years living in Xichang County, China, a rural area in this country with historically low selenium intake | a single-blind, placebo-controlled, intervention study | To evaluate the effect of selenium supplementation on plasma and milk selenium concentrations and GPX activity over time after parturition. | Selenium | The milk selenium levels were higher in supplemented women but there were no differences in the milk GPX activity between the two groups of women. The plasma a-tocopherol concentrations declined after parturition in both groups but no differences were found between the two groups of women. | 3/5 WPRO (Western Pacific Regional Office) |
Trafikowska [77] | 200 mg Se/day in the form of yeast-Se and sodium selenate. | Sixty seven lactating healthy women with aged 19 to 39 years (mean 26.7 years). | Randomized clinical trial | To determine the effect of selenium supplementation to lactating women on milk Se concentrations. | Selenium glutathione 1eroxidise (GSH-Px) | After 1 month in both groups SE level reached a plateau at 14–16 mglL. In both Se-supplemented groups the levels increased significantly reaching a plateau of 14–16 mg/L after 1 month. The difference was significantly higher than controls in the yeast-Se group (P < 0.0001) and the selenite-Se supplemented group (P < 0.01). | 1/5 Europe (EURO) |
Trafikowska [78] | Sixteen lactating women were supplemented for 3 months with 200 pg Seday-‘in the form of SeY. The supply was started 3–4 weeks postpartum. | 16 healthy lactating mothers. | Randomized clinical trial | To assess the ability of maternal supplementation with Se-enriched yeast (SeY) to influence the Se status of lactating women and infants, mother’s milk, and additionally to estimate the infant’s dietary Se intake. | Se and GSH-Px activities of red cell haemolysate. | Supplementation of lactating mothers with selenium-enriched yeast increases rapidly and significantly the Se concentration and glutathione 2eroxidise activity in maternal blood components. Se concentration in milk is also significantly elevated. After 1 month the mean Se intakes by breastfed infants were greater than the recommended dietary allowance of 10 pg day-‘for infants from birth to 6 months of age. | 1/5 Europe (EURO) |
First author surname, citation number | Type of Supplement | Characteristics of Participants | Type of study | Aim | Type of Nutrients Evaluated in Milk | Main Findings | Jadad scale points and WHO divisions |
---|---|---|---|---|---|---|---|
Breymann [79] | A single dose of 100 mg intravenous iron sucrose. | Ten healthy lactating mothers with functional iron deficiency 2–3 days after delivery. | Randomized controlled trial | To study the transfer of parenteral iron sucrose into maternal milk in the postpartum period. | Milk iron | No significant difference between the groups was found on any study day as well as in the mean change from baseline over all four days. We could not show transfer of iron-sucorose into maternal milk for the given dosage. | 1/5 Europe (EURO) |
Holm [80] | Single dose of intravenous 1200 mg iron isomaltoside or oral iron at a mean daily dose of 70.5 mg. | 65 women with sufficient breast milk. | Randomized controlled trial | To compare the iron concentration in breast milk after a single high dose of intravenous iron isomaltoside or daily oral iron for postpartum haemorrhage. | Total iron concentration in breast milk | The mean (±SD) iron concentration in breast milk in the intravenous and oral groups was 0.72 ± 0.27 and 0.40 ± 0.18 mg/L at three days (p < 0.001) and 0.47 ± 0.17 and 0.44 ± 0.25 mg/L after one week (p = 0.64). | 3/5 Europe (EURO) |
Yalcın [81] | 80 mg of elementary iron as ferrous sulfate. | 47 Healthy mothers were enrolled in the study 10 to 20 days after delivery. | A prospective, placebo controlled, double-blinded, and randomized intervention | To determine the factors that affect milk iron content at the second week of lactation and whether supplementation to lactating mother with iron might increase breast milk iron content between 2 weeks and 4 months postpartum. | Iron and zinc | Iron supplementation to lactating nonanemic mothers did not change milk iron content and the decline in milk iron content and milk-to-serum iron ratio. Milk iron content and milk-to-serum iron ratio of iron could be regulated by active transport in cooperation with maternal iron status. | 2/5 Europe (EURO) |
zapata [73] | Iron sulfate (FeSO4.7H20) tablets containing 40 mg of Fe each. | Twenty-eight volunteer nursing women Their ages ranged from 19 to 35 years (average of 27); | Randomized controlled trial | To evaluate longitudinally the effect of moderate maternal iron supplementation during the first 3 months of lactation on milk iron levels and iron related milk components. | Concentrations of iron and zinc, lactoferrin, total iron-ligands in milk were measured | Iron supplementation did not alter significantly iron and zinc levels in milk and the low iron to lactoferrin ratio was maintained, thus preserving the important functions of lactoferrin for the infant organism. However, iron supplementation increased total iron ligands in milk as measured by the total iron-binding capacity and increased the proportion of lactoferrin in total protein secreted. Also, lactoferrin levels tended (P = 0.059) to be higher in milk of the supplemented women. | 2/5 Americas (AMRO) |