Summary of Use during Lactation

Vitamin E is a normal component of human milk.[1] Maternal obesity, smoking and possibly preterm birth (<37 weeks gestational age) are associated with lower milk vitamin E levels. Lactating mothers may need to supplement their dietary intake of vitamin E to achieve the recommended daily allowance of 19 mg.[2] Daily maternal vitamin E supplementation from prenatal multivitamins can safely and modestly increase milk vitamin E levels and improve the vitamin E status of the breastfed infant compared to no supplementation. Higher daily dosages have not been studied. Women with higher intakes of polyunsaturated fatty acids have higher alpha-tocopherol in breastmilk.[3]

Holder pasteurization (62.5 degrees C for 30 minutes) does not reduce milk antioxidant capacity, which is a reflection of vitamin E levels.[4]

Drug Levels

Alpha-tocopherol is the major isoform of vitamin E present in the human diet and in breastmilk.[2,5] Higher alpha-tocopherol milk levels result in greater milk antioxidant capacity.[4,6,7] However, the correlation between maternal serum levels and breastmilk levels is unclear.[8-13] A serum alpha-tocopherol concentration < 12 micromoles/L indicates vitamin E deficiency in adults and children. One international unit (IU) = 0.67 mg of the stereoisomer d-alpha-tocopherol (the natural form); 1 IU = 0.45 mg of racemic dl-alpha-tocopherol (the synthetic form).[2]

Maternal Levels. In mothers not taking a vitamin E supplement, average alpha-tocopherol levels in colostrum range from 20 to 50 micromoles/L. At 1 to 2 weeks postpartum, milk levels are 7 to 14 micromoles/L, and beyond 2 weeks they are 3 to 9 micromoles/L.[1,14] Hindmilk levels are higher than foremilk.[15] Maternal obesity and smoking are associated with lower milk alpha-tocopherol levels.[16,17] Preterm birth (< 37 weeks gestational age) may also be associated with lower milk levels. In some comparative studies, reported levels range from 1/3 to 2/3 lower in preterm than term milk.[16,17] Others have not found a difference associated with prematurity.[18,19]

In a series of prospective studies conducted by the same research group in Brazil, a single supplemental dose of vitamin E given to mothers in the first 48 hours postpartum produced small to modest short-term increases in colostrum and milk levels compared to no supplementation. The best results came from 400 IU of natural vitamin E which increased colostrum levels by nearly 60%, from about 35 micromoles/L at baseline to 50 micromoles/L at 24 hours after the dose compared to a 36% increase from the same dose of synthetic vitamin E.[10] By 7 days after the dose, mothers who received 400 IU of natural vitamin E had milk levels return to baseline, although still significantly higher than milk of unsupplemented mothers whose levels were below baseline. By 30 days, both groups had similar milk levels, which were about one-third of baseline levels.[12] A single 110 IU dose of synthetic vitamin E did not significantly change colostrum levels 24 hours after the dose.[8]

In Tanzania, 320 women with vitamin E deficiency (serum vitamin E levels of approximately 10 micromoles/L) were given a daily multivitamin containing 30 mg (45 IU) natural vitamin E during pregnancy and postpartum. Their average milk levels of alpha-tocopherol at 3, 6 and 12 months postpartum were significantly higher (12.5, 11.5 and 10.3 micromoles/L, respectively) compared to 306 women not given the multivitamin (10.3, 8.8, and 8.4 micromoles/L).[20]

Infant Levels. The average serum level observed in healthy children is 20 micromoles/L.[21]

In 306 HIV positive Tanzanian women who were given a daily multivitamin containing 30 mg (45 IU) daily of natural vitamin E starting at 12 to 27 weeks of pregnancy and continuing postpartum, the average serum alpha-tocopherol levels in their exclusively breastfed infants were significantly higher (17 and 15.7 micromoles/L, respectively) at 6 weeks and 6 months postpartum compared to 288 women not given the multivitamin (15.2 and 14.6 micromoles/L, respectively). All the women studied had similar serum vitamin E levels of approximately 23 micromoles/L at baseline. The contribution of breastmilk to the higher infant vitamin E levels cannot be determined.[22]

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

References

1.

Lima MS, Dimenstein R, Ribeiro KD. Vitamin E concentration in human milk and associated factors: A literature review. J Pediatr (Rio J). 2014;90:440–8. [PubMed: 24953721]

2.

National Institutes of Health Office of Dietary Supplements. Vitamin E fact sheet for health professionals. 2016. https://ods​.od.nih.gov​/factsheets/VitaminE-HealthProfessional/. Accessed December 20, 2017.

3.

da Mata AMB, da Silva AGCL, Medeiros JFP, et al. Dietary lipid intake influences the alpha-tocopherol levels in human milk. J Pediatr Gastroenterol Nutr. 2020;70:858–63. [PubMed: 32443047]

4.

Elisia I, Kitts DD. Quantification of hexanal as an index of lipid oxidation in human milk and association with antioxidant components. J Clin Biochem Nutr. 2011;49:147–52. [PMC free article: PMC3208008] [PubMed: 22128211]

5.

Elisia I, Kitts DD. Different tocopherol isoforms vary in capacity to scavenge free radicals, prevent inflammatory response, and induce apoptosis in both adult- and fetal-derived intestinal epithelial cells. Biofactors. 2013;39:663–71. [PubMed: 23983193]

6.

Tijerina-Sáenz A, Innis SM, Kitts DD. Antioxidant capacity of human milk and its association with vitamins A and E and fatty acid composition. Acta Paediatr. 2009;98:1793–8. [PMC free article: PMC2773529] [PubMed: 19807706]

7.

Quiles JL, Ochoa JJ, Ramírez-Tortosa MC, et al. Coenzyme Q concentration and total antioxidant capacity of human milk at different stages of lactation in mothers of preterm and full-term infants. Free Radic Res. 2006;40:199–206. [PubMed: 16390829]

8.

Dimenstein R, Lira L, Medeiros AC, et al. Rev Panam Salud Publica. 2011;29:399–403. [Effect of vitamin E supplementation on alpha-tocopherol levels in human colostrum] [PubMed: 21829962]

9.

Resende FB, Clemente HA, Bezerra DF, et al. Alpha-tocopherol concentration in serum and colostrum of mothers with gestational diabetes mellitus. Rev Paul Pediatr. 2014;32:178–86. [PMC free article: PMC4183008] [PubMed: 25119748]

10.

Clemente HA, Ramalho HM, Lima MS, et al. Maternal supplementation with natural or synthetic vitamin E and its levels in human colostrum. J Pediatr Gastroenterol Nutr. 2015;60:533–7. [PubMed: 25419678]

11.

Fares S, Sethom MM, Kacem S, et al. Retinol and alpha-tocopherol in the colostrum of lactating Tunisian women delivering prematurely: Associations with maternal characteristics. Pediatr Neonatol. 2016;57:120–6. [PubMed: 26293321]

12.

Pires Medeiros JF, Ribeiro KD, Lima MS, et al. alpha-Tocopherol in breast milk of women with preterm delivery after a single postpartum oral dose of vitamin E. Br J Nutr. 2016;115:1424–30. [PubMed: 26931347]

13.

Kodentsova VM, Vrzhesinskaya OA. Evaluation of the vitamin status in nursing women by vitamin content in breast milk. Bull Exp Biol Med. 2006;141:323–7. [PubMed: 17073150]

14.

Silva ALCD, Ribeiro KDDS, Melo LRM, et al. Vitamin E in human milk and its relation to the nutritional requirement of the term newborn. Rev Paul Pediatr. 2017;35:158–64. [PMC free article: PMC5496727] [PubMed: 28977333]

15.

Bishara R, Dunn MS, Merko SE, et al. Nutrient composition of hindmilk produced by mothers of very low birth weight infants born at less than 28 weeks' gestation. J Hum Lact. 2008;24:159–67. [PubMed: 18436967]

16.

Sámano R, Martínez-Rojano H, Hernández RM, et al. Retinol and alpha-tocopherol in the breast milk of women after a high-risk pregnancy. Nutrients. 2017;9:E14. [PMC free article: PMC5295058] [PubMed: 28045436]

17.

Ortega RM, López-Sobaler AM, Martínez RM, et al. Influence of smoking on vitamin E status during the third trimester of pregnancy and on breast-milk tocopherol concentrations in Spanish women. Am J Clin Nutr. 1998;68:662–7. [PubMed: 9734745]

18.

Haug M, Laubach C, Burke M, et al. Vitamin E in human milk from mothers of preterm and term infants. J Pediatr Gastroenterol Nutr. 1987;6:605–9. [PubMed: 3430268]

19.

Grilo EC, Lira LQ, Dimenstein R, et al. Influence of prematurity and birth weight on the concentration of alpha-tocopherol in colostrum milk. Rev Paul Pediatr. 2013;31:473–9. [PMC free article: PMC4183043] [PubMed: 24473952]

20.

Webb AL, Aboud S, Furtado J, et al. Effect of vitamin supplementation on breast milk concentrations of retinol, carotenoids and tocopherols in HIV-infected Tanzanian women. Eur J Clin Nutr. 2009;63:332–9. [PMC free article: PMC3095494] [PubMed: 17940544]

21.

Traber MG. Vitamin E inadequacy in humans: Causes and consequences. Adv Nutr. 2014;5:503–14. [PMC free article: PMC4188222] [PubMed: 25469382]

22.

Baylin A, Villamor E, Rifai N, et al. Effect of vitamin supplementation to HIV-infected pregnant women on the micronutrient status of their infants. Eur J Clin Nutr. 2005;59:960–8. [PubMed: 15956998]

Substance Name

Vitamin E

CAS Registry Number

59-02-9

Drug Class

Breast Feeding

Lactation

Vitamins

Antioxidants