Safety of Retinol During Breastfeeding

Recommendations for Vitamin A During Lactation

The World Health Organization (WHO) does not recommend vitamin A supplementation in postpartum women for the prevention of maternal and infant morbidity and mortality 1
There is no convincing evidence that maternal vitamin A supplementation during lactation results in a reduction in infant mortality or morbidity in low and middle-income countries 1
For lactating women, the European Food Safety Authority (EFSA) recommends additional vitamin A requirements of 1300 μg retinol equivalent/day, related to transfer of retinol into breast milk 1

Retinol is a potent teratogen and must be avoided in women of childbearing potential 2, 3
Vitamin A toxicity can occur with a relatively narrow window between deficiency and toxicity 4
Acute toxicity can present with increased intracranial pressure, headache, nausea, vomiting, vertigo, blurred vision, and muscular incoordination 4
Chronic toxicity can present with bone abnormalities, dermatitis, alopecia, ataxia, muscle pain, cheilitis, skin and vision disorders, pseudotumor cerebri, and hepatocellular necrosis 4

Vitamin A concentration in human milk reflects maternal vitamin A intake more than the infant's requirement 1

Beta-carotene (provitamin A) is subject to negative feedback control and therefore considered safer than preformed vitamin A (retinol) 5

If vitamin A supplementation is deemed necessary, serum monitoring should be conducted 5
Concomitant administration of vitamin A and other oral retinoids with retinol should be avoided 3
Both hypervitaminosis A and hypovitaminosis A can cause harm to mother and infant 5

Failing to distinguish between preformed vitamin A (retinol) and provitamin A (beta-carotene) when calculating total vitamin A intake 5
Not considering dietary sources of vitamin A when prescribing supplements 5
Using water-miscible forms of vitamin A which may increase risk of toxicity 5

The World Health Organization does not recommend routine vitamin A supplementation in the postpartum period for the prevention of maternal and infant morbidity and mortality in developed countries with adequate access to vitamin A-rich foods 6
In areas with endemic deficiency, the administration of 200,000 IU of vitamin A within the first 2 months postpartum is recommended to provide adequate amounts in breast milk, according to the Centers for Disease Control and Prevention 7, 8
If administration within the first 2 months postpartum is not possible, 100,000 IU may be given during the third trimester of pregnancy as an alternative, based on guidelines from the Centers for Disease Control and Prevention 7, 8

There is a narrow therapeutic window between vitamin A deficiency and toxicity, requiring extreme caution in dosing, as noted in Clinical Nutrition 9
The American Academy of Nutrition and Dietetics recommends promoting the consumption of vitamin A-rich foods, regardless of the context, to support maternal and infant health 6
The Centers for Disease Control and Prevention recommend documenting the administration of vitamin A supplements in the child's growth record 7, 8