Prenatal Plus Breastfeeding
Do you know that important immune protective proteins are present in breast milk? Breast milk also contains required vitamins, minerals, saturated and un saturated fats. These things are extremely important for development of healthy brain. If you are taking any medicine for short term or for the chronic reason then that passes in breast milk as well, that is why you should always check the drug with your health care provider. Here at DrLact we try to analyze drugs based on available researches and in this sheet we will present our analysis for Prenatal Plus.

What is Prenatal Plus used for?

Indication To provide Vitamin and Mineral supplementation throughout pregnancy and during the postnatal period for both the lactating and non lactating mother. It is also useful for improving nutritional status prior to conception

Is Prenatal Plus usage safe while breastfeeding? If a lactating mother is using it can there be any effect on growth or development of infant?

Prenatal Plus Contains 15 active ingredients that are Vitamin a, Cyanocobalamin, Ascorbic acid, Cholecalciferol, Folic acid, Thiamine, Riboflavin, Niacinamide, .alpha.-tocopherol, dl-, .beta.-carotene, Zinc oxide, Calcium cation, Ferrous cation, Pyridoxine hydrochloride, Cupric cation. We do have breastfeeding analysis and safety rating of some of the active ingredients but unfortunately we do not have any information of some of active ingredients used. Below we have provided whatever information we do have. But please do not take any decision based on below provided information and contact your health care provider as this information is incomplete.

Prenatal Plus Breastfeeding Analsys

Vitamin a while Breastfeeding


CAS Number: 68-26-8

Retinol is also a name for vitamin A which is a natural component of human milk. Content in the human milk is about 2,800 IU/L (750 μ/L). Infant's recommended dietary daily allowance is 2,000 IU (600 μ/L). Mother's recommended daily allowance is 3,200 IU (950 μ/L). There is a risk for severe intoxication after an isolated dose of 25,000 IU or long-standing daily consumption of 5,000 IU. After a megadose administration of vitamin A increases concentration to a double in the colostrum. Supplementation with vitamin A to breastfeeding mothers or infants does not reduce mortality or morbidity among HIV affected offsprings, instead it increases the likelihood of transmission of HIV or subclinical mastitis in those mothers infected with HIV. Vitamin A is widely distributed in the food of animal or vegetable origin. Except for populations affected with food shortage or nutritionally deficient, those women on a complete and varied diet do not need the intake of vitamin A supplementation The List of Essential Medicines of WHO-2002 classifies it as compatible with breastfeeding.

Cyanocobalamin while Breastfeeding


CAS Number: 68-19-9

Is Prenatal Plus safe while breastfeeding

Vitamin B12 exists naturally in milk at a concentration of 1 nanogram / mL (range: 0.3 to 3 ng / mL). Maternal supplementation with cyanocobalamin barely increases milk levels in well-nourished women (Sandberg 1981), but it does improve the levels in women of low socioeconomic status (Sneed 1981). The concentration in colostrum is up to 28 times higher than that of mature milk.The daily requirements for Vitamin B12 are 2.4 micrograms and increase to 2.8 micrograms daily during breastfeeding. Foods rich in vitamin B12 are meat, offal, eggs, dairy products, salmon, sardines, clams and fortified cereals. With a varied and balanced diet no vitamin supplements are needed, but B12 deficiency has been observed in the plasma and milk of women with strict vegetarian diets (vegans), malabsorptive diseases (eg, Crohn's disease, celiac disease), bariatric surgery, poor nutritional status, pernicious anemia, low socio-economic status and in cases of natural disasters or wars. There are numerous publications showing that infants of these mothers are at high risk of disease due to vitamin B12 deficiency, which can lead to anemia, stunting and psychomotor retardation. "Flash pasteurization" applied to breast milk of mothers who are HIV+ does not decrease vitamin B12 concentration. American Academy of Pediatrics: medication usually compatible with breastfeeding (AAP 2001).

Ascorbic acid while Breastfeeding

Low Risk

CAS Number: 50-81-7

Vitamin C is abundantly present in food. A balanced and comprehensive diet makes vitamin supplementation useless. Any amount of vitamin C taken by the mother as a supplement does not affect significantly the concentration in breast milk of women who are on a varied and balanced diet.

Cholecalciferol while Breastfeeding


CAS Number: 67-97-0

Daily allowance of Vitamin D for the breastfeeding woman is still an issue and a matter of disagreement among experts. Vitamin D is hardly found in common food and mostly synthesized by skin under sunlight stimulus. Low concentration in breast milk is thought to be due to deficient levels in the serum of mothers. As high as 6.400 IU daily doses of Vitamin D given to the mother have been required to normalize the infant serum content of 25-OH Vitamin D. Moderate exposure of mothers to sunlight, avoiding any burning, is probably the most cost-effective measure to fight Vitamin D deficiency in the infant. 1 mg = 40.000 IU.

Folic acid while Breastfeeding


CAS Number: 59-30-3

Prenatal Plus safe for breastfeeding

Soluble B group vitamin that is very abundant in green vegetables, legumes and fruits (citric fruits). It is actively excreted in breast milk with priority over maternal folate in such extent that may even cause maternal deficit. Exclusive breastfeeding meets the daily allowances of infant folic acid.The concentration is higher in mature milk (85 micrograms / L) than in colostrum and premature breast milk.Administration to nursing mothers increases slightly the usual concentration of folate in breast milk. Folic acid needs are increased during pregnancy and lactation (500-600 micrograms / day) and in case of taking anticonvulsant medication. No harmful effects have been observed by taking folic acid during lactation. Excess of folic acid is eliminated by the kidneys every day. No supplements are needed if diet and nutritional status are adequate. The American Academy of Pediatrics rates it as a mediation usually compatible with breastfeeding.WHO List of Essential Medicines 2002: compatible with breastfeeding.

Thiamine while Breastfeeding


CAS Number: 59-43-8

Thiamine or Vitamin B1 is a water soluble vitamin. In addition to Thiamine, other chemical compounds with similar activity: Acetiamine, Benfotiamine, Bisbentiamine, Bisbutiamina, Cetotiamina, Cicotiamina, Cocarboxylase, Fursultiamine, Monofosfotiamina, Octotiamine, Pyrophosphotiamine, Prosultiamine and Sulbutiamine.It is essential for the metabolism of carbohydrate nutrients. Its deficiency causes severe neuromuscular and cardiac symptoms known as Beriberi and Wernicke-Korsakoff disease. Thiamine deficiency is common among disadvantaged populations in Southeast Asia (predominantly consumers of refined rice), other malnourished people (refugees, low socioeconomic status ...) and chronic alcohol consumption. Beriberi of childhood, both infants and children, may arise from breastfeeding by Thiamine deficient mothers. Reportedly, several severe cases have occured after feeding the babies with artificial formulas that were not supplemented with vitamin B1. Daily allowance is higher during pregnancy and lactation (1.5 mg / day) which is readily obtained through a varied diet with adequate content of whole grains, legumes, nuts, eggs and lean meat.Thiamine is excreted in breast milk and gradually increases with time, being lower in colostrum (28 ng / mL) and transitional milk than in mature milk (180 ng / mL). The concentration is lower in milk from mothers of preterm (90 ng / mL). Taking vitamin supplementation is not required if diet and nutritional status are adequate. Supplementation does not increase levels in milk of well-nourished women, but of those with a low nutritional status. The supplementation of group B vitamins and C and E vitamins to HIV positive mothers improves the weight growth of their breasted babies.There is no evidence of their effectiveness in improving athletic performance, lack of appetite, sores, stress, fatigue or aging.Toxicity linked to excessive consumption of thiamine is not known. WHO List of Essential Medicines 2002: compatible with breastfeeding.American Academy of Pediatrics: usually compatible with breastfeeding

Riboflavin while Breastfeeding


CAS Number: 83-88-5

A balanced and comprehensive diet make it vitamin supplementation useless.

Niacinamide while Breastfeeding


CAS Number: 98-92-0

A balanced and comprehensive diet make it vitamin supplementation useless.

.beta.-carotene while Breastfeeding


CAS Number: 7235-40-7

Natural vitamin A precursor. It is found in vegetables. It has been marketed as ophthalmologic and laxative compounds in Spain which are free of risk.

Zinc oxide while Breastfeeding


CAS Number: 1314-13-2

It is used topically as an astringent and skin protector, very often together with small amounts of Ferric Oxide to form Calamine (see specific info). It is a product compatible with breastfeeding according to WHO Essential Medicine’s List - 2002.It is also used in dental hygiene products and cosmetics. Widely used for skin protection of the diaper area in infants. Because of the small dose used and poor absorption into plasma of most topical dermatological preparations, excretion into breastmilk in significant amount appears to be unlikely. Do not apply on the breast to prevent infant ingestion; otherwise, wash it off thoroughly with water before the next breast feed.

Calcium cation while Breastfeeding


Various calcium salts (Acetate, Carbonate, Chloride, Citrate, Phosphate, Gluceptate, Glucobionato, Lactate, Laxctobionato Pidolate, Silicate) are used in the management of hypocalcemia, supplements for treating calcium deficiency states and antacids ( Carbonate and Silicate) Daily requirement of calcium during lactation are 1 g (1.3 g in children under 20 years).Calcium supplements in the diet does not affect the concentration of calcium in milk.Excessive intake of calcium is not good for health. During lactation, consumption of calcium should not exceed 2.5 g a day. WHO List of Essential Medicines 2002 states that it is compatible with breastfeeding.

Ferrous cation while Breastfeeding


CAS Number: 141-01-5

Several ferrous salts of iron (ascorbate, aspartate, citrate, chloride, fumarate, gluconate, lactate, oxalate, succinate, sulfate, glycine sulfate, etc.) are used in oral administration for treating or preventing iron deficiency anemia.Its molecular weight varies from 170 for the fumarate and succinate, and from 280 for lactate and sulfate to 400 for aspartate and ascorbate. Characteristics of iron metabolism in the body make unlikely that it would be excreted in a significant amount into breast milk.It is a medication used for treatment of Neonatal Anemia in premature babies. Iron is excreted in small amounts in human milk, usually being enough for covering the daily needs of infants due to its high bioavailability. There is no correlation between mother's daily intake of iron and its concentration in breast milk.Iron supplementation to the mother does not increase levels of iron in breast milk or infant plasma significantly. Excessive supplementation can reduce the zinc concentration in milk. WHO List of Essential Medicines 2002: compatible with breastfeeding.

Pyridoxine hydrochloride while Breastfeeding


CAS Number: 58-56-0

Concentration of vitamin B6 in the breast milk is directly related to the amount present in diet with the possibility of a high increment by an excessive consumption through the diet. Daily allowance of vitamin B6 ranges from 2 to 3 mg. A balanced and varied diet is enough without a need for extra supplementation with this vitamin. Vitamin B6 deficiency is extremely rare since it is widely distributed in many foods. In those cases where supplementation is required, it is recommended not to exceed 40 mg a-day. There are controversial data on the capacity of a high dose of Pyridoxine to inhibit the secretion of Prolactin and suppress the milk production. The American Academy of Pediatrics rates it as usually compatible with breastfeeding.

Prenatal Plus Breastfeeding Analsys - 2

Vitamin a while Breastfeeding

CAS Number: 68-26-8 79-81-2

Routine, modest daily supplemental vitamin A results in modest increases in milk vitamin A content and appears to be safe for the infant. Vitamin A (retinol) and provitamin A carotenoids are normal components of human milk.[1] The recommend dietary intake in lactating women is 1300 mcg retinol per day, compared to 770 mcg per day during pregnancy. The recommended daily intake for infants aged 6 months or less is 400 mcg. .[2] Lactating mothers may need to supplement their diet to achieve the recommended daily vitamin A intake. Maternal vitamin A supplementation during pregnancy and lactation has not been shown to reduce mortality or the risk of anemia in breastfed infants living in developing regions, but there may be undiscovered benefits related to improved antioxidant capacity and immune function.[3][4][5] Maternal single doses up to 120,000 mcg or daily doses up to 1500 mcg are not expected to harm the breastfed infant. Daily doses above 3,000 mcg should be avoided in the mother. [2] Vitamin A in milk has antioxidant properties.[6] Holder pasteurization (62.5 degrees C for 30 minutes) does not reduce milk antioxidant capacity.[7]

Cyanocobalamin while Breastfeeding

CAS Number: 68-19-9

Vitamin B12 is a normal component of human milk.[1] The recommended daily intake in lactating women is 2.8 mcg and for infants aged 6 months or less is 0.4 mcg.[2] Lactating mothers may need to supplement their diet to achieve the recommended daily intake or to correct a known deficiency. Low doses of vitamin B12 found in B complex or prenatal vitamins increase milk levels only slightly. Higher daily doses of 50 to 100 mcg or more are needed in cases of maternal deficiency. The breastfed infant is not exposed to excessive vitamin B12 in such cases, and their vitamin B12 status should improve if it was previously inadequate. Poor health outcomes in infants with vitamin B12 deficiency include anemia, abnormal skin and hair development, convulsions, failure to thrive, and mental developmental delay. One well-recognized at risk group are exclusively breastfed infants of mothers with B12 deficiency due to minimal or no dietary intake of animal products.[3][4][5][6][7][8][9] Infant vitamin B12 status can be improved through maternal B12 supplementation during pregnancy and lactation.[10][11][12][13] Deficient mothers who miss the opportunity to supplement during pregnancy should still be encouraged to supplement during early lactation since infant vitamin B12 status correlates with milk vitamin B12 levels in breastfed infants up to 6 months of age.[14][15][16][17] Although there are cases reported of exclusively breastfed infants with vitamin B12 deficiency having biochemical and clinical improvement through adequate maternal supplementation alone,[3] direct supplementation of the infant is recommended when such treatments are available.[18][19][8] Flash heat pasteurization of breastmilk does not reduce milk vitamin B12 concentration.[20]

.beta.-carotene while Breastfeeding

CAS Number: 7235-40-7

Beta-carotene is a plant pigment that is converted into vitamin A in the body. Maternal vitamin A requirements are increased during lactation, but there are no specific guidelines for increased beta-carotene intake or indications for high-dose supplementation in nursing mothers. Typical beta-carotene intake in a Western diet is 6 to 8 mg daily. Beta-carotene is a normal component of human colostrum and mature milk, where it contributes to antioxidant defenses in the neonate.[1] Average concentrations are 1.12 mg/L and 230 mcg/L, respectively, in the Unites States.[2] Beta-carotene supplementation during pregnancy and for 6 months postpartum in nursing mothers with poor diets in a resource-poor setting reduced the number of days of illness in the mothers,[3] but does not reduce infant morbidity or mortality according to another study.[4] The bioavailability of beta-carotene is dependent on the fat content of the meal and the form in which it is administered, with synthetic pharmaceutical forms having the best bioavailability. High-dose beta-carotene supplements lead to a slow increase in breastmilk beta-carotene concentrations, with an accumulation half-life of about 9 days. Levels drop towards baseline slowly over several weeks after discontinuation. In general, beta-carotene is well tolerated, although excessive maternal intake of beta-carotene can lead to a harmless, reversible discoloration of the breastfed infant's skin.[5] In HIV-infected women, high-dose beta-carotene plus vitamin A supplementation increases the rate of HIV viral shedding into breastmilk and increases HIV infection in breastfed infants, although the mortality rate over the first 2 years of life is not increased.[6][7] The viral shedding may be a result of an increase in subclinical mastitis caused by beta-carotene.[8] Beta-carotene concentration in breastmilk is not affected by refrigeration, freezing, or low-temperature microwaving. The concentration does decrease when milk passes through a tube feeding system, regardless of light exposure.[9]Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information #about dietary supplements# is available elsewhere on the LactMed Web site.

I already used Prenatal Plus and meanwhile I breastfed my baby should I be concerned?

Not much study has been done on safety of Prenatal Plus in breastfeeding and its ingredients. Even we do not have complete information about usage of Prenatal Plus in breastfeeding so at this point a trained medical professional could be your best bet. If you observe anything abnormal with your baby please contact 911.

I am nursing mother and my doctor has suggested me to use Prenatal Plus, is it safe?

If your doctor considers Prenatal Plus safe enough to prescribe for you that means its benefits should outweigh its known risks for you.

If I am using Prenatal Plus, will my baby need extra monitoring?

We are not Sure, Please check with your healthcare provider or doctor.

Who can I talk to if I have questions about usage of Prenatal Plus in breastfeeding?

National Womens Health and Breastfeeding Helpline: 800-994-9662 (TDD 888-220-5446) 9 a.m. and 6 p.m. ET, Monday through Friday

National Breastfeeding Helpline: 0300-100-0212 9.30am to 9.30pm, daily
Association of Breastfeeding Mothers: 0300-330-5453
La Leche League: 0345-120-2918
The Breastfeeding Network supporter line in Bengali and Sylheti: 0300-456-2421
National Childbirth Trust (NCT): 0300-330-0700

National Breastfeeding Helpline: 1800-686-268 24 hours a day, 7 days a week

Telehealth Ontario for breastfeeding: 1-866-797-0000 24 hours a day, 7 days a week