The role of vitamin supplementation during lactation (including indications for multivitamins; recommendations for patients who eat plant-based diets)

Multivitamin supplementation is not necessary for most lactating women in high income countries

A varied and balanced diet usually meets the additional requirements for nutrients during lactation in high income countries such as Australia. The exception is iodine. The Australian National Health and Medical Research Council (NHMRC) recommends a daily 150 microgram supplement of iodine for lactating women.

However, review by a GP or dietician is necessary, and supplementation may be required, if there is a maternal history of

• Dietary elimination of cow's milk protein

• Malabsorption

• Bariatric surgery

• Inflammatory gut conditions

• Plant-based diet (e.g. vegan or vegetarian - see information below).

If a multivitamin tailored for lactation is required, it needs to be taken at least up until the infant starts eating solids.

A 2016 Cochrane Review showed no benefits from multivitamin supplementation during lactation

Dr Perichart-Perera states:

"Multiple micronutrient supplementation has been scarcely studied in lactation. A Cochrane review found no conclusive evidence that supplementing ≥3 micronutrients in breastfeeding mothers affects the mother or baby’s health compared to women supplemented with two or fewer micronutrients. Only two studies were included, and they were of limited quality, with small sample sizes and limited reported outcomes (Abe et al 2016). Due to limited studies and inconsistencies in current evidence, it is not easy to decide when to start supplementation during this period."

Multivitamin supplementation may have a role in low or middle income countries and in situations of food insecurity

I have attached a pdf of a 2025 Mexican (middle income economy) review of nutrition during lactation by nutritionist and researcher Dr Otilia Perichart-Perera. This article offers a useful, research-based analysis of requirements for various micronutrients such as vitamin D and iron during lactation. Please see Table 2 in Perichart-Perera, here, for notes on individual nutrients that more commonly result in deficiency in maternal milk, and when supplementation benefits.

The advice Dr Perichart-Perera's article offers concerning supplementation during lactation is relevant for low and middle income countries.

In general, vitamin supplements generate billions of dollars of revenue for international corporations yet do not improve heart health or longevity, nor help prevent cancer

As clinicians we need to be mindful of the commercial drivers behind vitamin supplementation (other than in the context of specific medical conditions and risk factors). We need to be mindful of the failure of vitamin supplementation to improve population health outcomes, and the potential for unintended outcomes from vitamin supplementation.

You might be interested in these high quality media reports which offer overviews of the existing research, found here and here.

When your breastfeeding patient mostly follows a plant-based diet (such as a vegetarian or vegan diet)

Numerous studies highlight the health benefits of plant-based diets. Existing evidence supports the safety of these diets across all stages of life, including pregnancy, lactation, and childhood, without negative effects on growth or development. But regular intake of a breastfeeding-tailored multivitamin, such as Elevit Breastfeeding, during the whole course of lactation is important for breastfeeding women on plant-based diets.

There is a review attached to this Lactation Module by the Spanish researchers Jimenez et al 2025 which details current evidence concerning increased risk of nutritional deficits when your lactating patient is following a plant-based diet, which have potential impact on infant development.

Here are some notes from Jimenez et al 2025.

• Vitamin B12 deficiency is a significant global public health problem with higher prevalence in the elderly, pregnant women, and young children. This deficiency can be caused by plant-based diets, as well as malabsorption issues and certain medications. Vitamin B12 supplementation is often required for those on vegan diets, although a well planned diet rich in vitamin B12 can be adequate during lactation.

• Dietary vitamin D intake may be limited by a vegetarian diet, and vitamin D deficiency is more prevalent among vegetarians and vegans.

• Vegan and vegetarian women are at greater risk of choline deficiency, which is involved in infant cognitive development and found in protein foods such as milk, eggs, meat, and peanuts. Not all antenatal multivitamin preparations contain choline.

• Vitamin A is mostly obtained from animal-based foods.

Recommended resources

Activity 3. An evidence-based approach to maternal nutrient supplementation during lactation

Selected references

Abe SK, Balogun OO, Ota E, Takahashi K, Mori R. Supplementation with multiple micronutrients for breastfeeding women for improving outcomes for the mother and baby. Cochrane Database Syst Rev. 2016;2(2):CD010647. https:/doi.org/10.1002/14651858.CD010647.pub2

Bando, Nicole. "Breastfeeding: when vitamin and mineral supplementation is required", Australian Breastfeeding Association Factshee for Health Professionals. Date unknown.

Favara G, Maugeri A, Barchitta M. Maternal lifestyle factors affecting breast milk composition and infant health: a systematic review. Nutrients. 2025;17(62):https://doi.org/10.3390/nu17010062.

Jimenez MPH, De la Calle S, Vives CC, Saez DE. Nutritional supplementation in pregnant, lactating women and young children following a plant-based diet: a narrative review of the evidence. Nutrition 2025;136:112778.

Kankaew S, Briere C-E. Maternal nutrition and human milk nutrients: a scoping review. American Journal of Maternal and Child Health Nursing. 2025;50(1):doi: 10.1097/NMC.0000000000001059.

National Health and Medical Research Council. (n.d.). Healthy eating when you’re pregnant or breastfeeding. Eat for Health. https://www.eatforhealth.gov.au/eating-well/healthy-eating-throughout-all-life/healthy-eating-when-you’re-pregnant-or-breastfeeding

National Health and Medical Research Council. (2012). Infant Feeding Guidelines. Information for health workers. https://www.nhmrc.gov.au/about-us/publications/infant-feeding-guidelines-information-health-workers#block-views-block-file-attachments-content-block-1

National Health and Medical Research Council. (2010). Public statement: Iodine supplementation for pregnant and breastfeeding women. https://patientinfo.org.au/patientinfo/NHMRC%20Iodine%20Supplementation%20Fact%20Sheet.pdf

Perichart-Perera O. Nutrition for optimal lactation. Annals of Nutrition and Metabolism. 2024:DOI: 10.1159/000541757.

Perrin a, Fogleman A, Newburg D, Allen J. A longitudinal study of human milk composition in the second year postpartum: implications for human milk banking. Maternal and Child Nutrition. 2017;13(1):e12239. doi: 12210.11111/mcn.12239.