Vitamin K

[brookelynne3]

I'm not sure if this is the right venue for this. I am just a mother trying to ask a question about Vitamin K supplementation in breast milk and this is the only thing I found close to being a way to contact anyone knowledgeable on the topic with regards to my question.

In Medications and Mothers' Milk 13th edition by Thomas W. Hale PhD page 766 reads " Although controversial, it is generally recognized that exclusive breastfeeding may not provide sufficient Vitamin k1 to provide normal clotting factors...vitamin K concentration in breast milk is normally low...Although vitamin K is transferred in human milk, the amount may not be sufficient to prevent hemorrhagic disease of the newborn."

but I just read:

"Breastfed infants may benefit from increased maternal vitamin K intake during lactation as well. a supplement of 5mg of vitamin K to lactating mothers increases the concentration of this nutrient in human milk and significantly increases infant plasma vitamin K (Nishiguchi et al., 2002; Greer, 2001a)...The Danish practice of parents providing weekly oral doses of vitamin K for the first 3 months for primarily breastfed infants revealed high parental participation and no reports of hemorrhagic disease in an 8-year period (Hansen et al., 2003)."

Lauwers, Judith, and Anna Swisher. Counseling the Nursing Mother: A Lactation Consultant's Guide. 5th ed. Sudbury, MA: Jones & Bartlett Learning, 2011. 194. Print.

Is there some flaw in the mentioned studies that makes them discredited? Does anyone know of any further studies that I can read to further be educated on this topic?

[admin]

Brook:

The problem with this statement is that virtually all hemorrhagic disease of the newborn occurs within 24 to 48 hours of birth. Even the oral administration of Vitamin K to the infant is not considered fast enough. Thus all the pediatric organizations generally recommend the use of IM injections immediately after birth.

Thereafter, supplementation of the mom would probably help a little, but NOT during this critical 24 hour period.

Below is from my 15th edition of Medications and Mothers Milk, 2012.

Tom Hale Ph.D.


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Vitamin K1 is often used to reverse the effects of oral anticoagulants and to prevent hemorrhagic disease of the newborn (HDN).[1,2,3] The use of vitamin K has long been accepted primarily because it reduces the decline of the vitamin K dependent coagulation factors II, VII, IX, and X. A single IM injection of 0.5 to 1 mg or an oral dose of 1-2 mg during the neonatal period is recommended by the AAP. Although controversial, it is generally recognized that exclusive breastfeeding may not provide sufficient vitamin K1 to provide normal clotting factors, particularly in the premature infant or those with malabsorptive disorders. Vitamin K concentration in breastmilk is normally low (<5-20 ng/mL), and most infants are born with low coagulation factors (30-60 percent) of normal. Although vitamin K is transferred to human milk, the amount may not be sufficient to prevent hemorrhagic disease of the newborn. Vitamin K requires the presence of bile and other factors for absorption, and neonatal absorption may be slow or delayed due to the lack of requisite gut factors.

Vitamin K2 (menaquinones, menatetrenone) is more orally bioavailable Vitamin K. It is derived from various foods including meat, eggs, dairy, and natto. There have been some suggestions that K2 may prevent osteoporosis.

[brookelynne3]

antepartum vitamin K?

Thanks for the quick reply. I am so thankful for all your research and dedication. Could prophylactic supplementation by the mom in the last weeks of pregnancy correct for those critical 24-48 hours after birth? Does Vitamin K pass through the placenta more readily than into the breast milk?

[admin]

Brooke:

The oral use in mom may increase the Vitamin K levels in the infants, but in the article below, the coagulation factors in the infant were not apparently increased.

Because this syndrome is so horrible when it occurs, I don't think you would ever want try oral use over the proven IM used postpartum.

Tom Hale Ph.d



Pediatrics. 1989 Dec;84(6):1045-50.
Maternal administration of vitamin K does not improve the coagulation profile of preterm infants.
Kazzi NJ, Ilagan NB, Liang KC, Kazzi GM, Poland RL, Grietsell LA, Fujii Y, Brans YW.
Source
Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
Abstract
The effect of maternal administration of vitamin K1 on cord blood prothrombin time, activated partial thromboplastin time, activity of factors II, VII, and X, and antigen levels of factors II and X in infants less than 35 weeks' gestation was evaluated. Pregnant women in preterm labor were randomly assigned to receive 10 mg of vitamin K1 intramuscularly or no injection. If delivery did not occur in 4 days, the dose of vitamin K1 was repeated. Women who continued their pregnancy 4 days beyond the second dose received 20 mg of vitamin K1 orally daily until the end of the 34th week of gestation. The birth weights of infants ranged from 370 to 2550 g and gestational age ranged from 22 to 34 weeks. The prothrombin time, activated partial thromboplastin time, factors II, VII, and X activity, and factors II and X antigen levels were not statistically different in either group of infants. Intraventricular hemorrhage occurred in 25 of 51 control infants and 25 of 47 vitamin K-treated infants. More control infants had grade III intraventricular hemorrhage on day 1 (P = .032), but on day 3 and 14 of life, the severity of intraventricular hemorrhage was comparable in both groups. Infants in whom an intraventricular hemorrhage developed were significantly smaller, younger, and more critically ill than infants without intraventricular hemorrhage. Administration of vitamin K1 to pregnant women at less than 35 weeks' gestation does not improve the hemostatic defects nor does it reduce the incidence or severity of intraventricular hemorrhage in their infants.
PMID: 2587133 [PubMed - indexed for MEDLINE]

[brookelynne3]

Coagulation factors?

Thank your for taking your time to explain this. I am still trying to understand it. You say in the 15th edition of Medications and the Mothers' Milk that "most infants are born with low coagulation factors (30-60 percent) of normal."

Where is the normal percentage for the coagulation factors coming from? Is that a normal adult's level or is there some age adjusted table that can be referenced? And where do they draw data to establish a normal level? Are there studies which establish a dangerous level or threshold below which one is at a significantly increased risk for hemorrhagic disease?

[admin]

Brook:

Blood chemistry values are all evaluated according to age. I'm sure that the 30-60 percent was determined in older infants following supplementation with vitamin K.

Tom Hale Ph.D.

[msthomas]

Hi. Since there are three types of vitamin K, do you happen to know which is better for the body - K1, [URL="http://products.mercola.com/vitamin-k/"]K2[/URL] or K3?

[gallorross]

Vitamin K is basically a fat soluble vitamin that human body needs for the process of coagulation, basically it is the vitamin which help in increasing the capability of blood clotting and strengthens the bone density in body.