Fortifying breast milk: How to get more vitamin E to preterm babies
“Our results provide evidence of the importance of maternal supplementation with vitamin E, especially in women with preterm births, in increasing breast milk α-tocopherol concentrations,” the researchers wrote in the British Journal of Nutrition.
Preterm infants have very low body fat and reserves of fat-soluble vitamins including vitamin E.
This, as well as low red blood cell tocopherol concentrations at birth, means they are vulnerable to vitamin E deficiency and therefore susceptible to infections and conditions like thrombocytosis, retrolental fibroplasia, intraventricular haemorrhage and bronchopulmonary dysplasia.
Researchers from the Federal University of Rio Grande do Norte in Brazil sought to find whether maternal supplementation could help to tackle this by upping α-tocopherol levels via breast milk.
The trial saw 89 women who had given birth prematurely given either a control pill or a single 400 IU ‘megadose’ of RRR-α-tocopheryl acetate.
The findings
Baseline α-tocopherol concentrations in the blood and breast milk were similar across the two groups 48 hours after delivery and none of the women were vitamin E deficient.
Yet 24 hours after supplementation, colostrum breast milk α-tocopherol concentrations increased by 60% in the intervention group but stayed the same in the control group.
Concentrations in the transitional milk collected seven days after delivery were 35% higher in the supplemented group compared with the control group.
However these changes were not seen in mature milk collected 30 days after delivery, where concentrations were similar for both groups.
Therefore they concluded a single 400 IU dose was not enough to increase the α-tocopherol levels of breast milk for a prolonged period of time.
The research group were developing studies to further assess vitamin E dosages and intervals without placing the mother and child at risk of intoxication.
Intoxication risk
The researchers said supplementation of newborns directly came with risk of intoxication and challenges in appropriate administration.
“Therefore, fortification of breast milk through maternal vitamin E supplementation may be a good way to protect newborns from the effects of vitamin E deficiency.”
They said there was no “consensus” on parenteral and enteral supplementation, meaning maternal supplementation was a “safe and excellent alternative” for meeting the vitamin E requirements of newborns and supplying enough vitamin E to protect their bodies against oxidative stress.
The recommendations
Last year the European Food Safety Authority (EFSA) set an ‘adequate intake’ for vitamin E as alpha-tocopherol of 13 mg/day for men and 11 mg/day for women.
It said there was no evidence that pregnant or lactating women should have a higher dose – something Food Supplements Europe (FSE) contested in a public consultation.
The trade group urged EFSA to use “at least” the 2013 recommendations set by D-A-CH for pregnant and lactating women of 13 mg/day and 17 mg per day, respectively.
However this point was rejected in the final opinion.
Source: British Journal of Nutrition
Published online ahead of print, doi:10.1017/S0007114516000477
“α-Tocopherol in breast milk of women with preterm delivery after a single postpartum oral dose of vitamin E”
Authors: J. Franco Pires Medeiros, K. Danielly da Silva Ribeiro, M. Santa Rosa Lima, R. Alexandra Moreira das Neves, A. Cibely Pinheiro Lima, R. Costa Silva Dantas, A. Batista da Silva and R. Dimenstein
