Breastfeeding:  Benefits, challenges, the Covid vaccine and Vitamin D supplementation

August is Women’s month and kicks off with creating awareness around breastfeeding. Throughout this month it is important to empower women and mothers with knowledge. 


Benefits & challenges of breastfeeding.


The World Breastfeeding theme is to Protect and Support Breastfeeding, both two important factors that cannot be dealt with separately. 


PROTECT because of all the benefits

  • Nutrition: from day 1 breastmilk’s composition is complete for your baby’s age, growth and development requirements and changes throughout.
    • Colostrum – these are one of the visible changes we can see. The first days after birth, breastmilk is a thicker yellow liquid, energy dense for the boost your baby requires then with small capacity per feed. 
    • Your baby can feed on demand, adequate for their individual growth and needs.
  • Support the immune system through antibodies and gut protectors such as HMO, a prebiotic to promote healthy bacteria to grow.
  • Prevention of disease for mother and child, acute and chronic diseases.
  • Adequate growth and brain development.


Breastfeeding can be tough and painful at first, but should get easier as the days continue.  If not, it is best to consult a trusted health care professional, such as a Lactation consultant, breastfeeding nurse or dietitian.

This brings us to SUPPORT, your husband or partner and family should support and acknowledge this time.  Although a mother is the only one that can breastfeed or express, emotional and physical support is very important. 

Common challenges that require SUPPORT:

  • Painful nipples and breast, nipple size and shape
  • Low milk supply
  • Engorgement
  • Exhaustion
  • Anxiety
  • Depression
  • Feeling judged

All of the above can be managed or prevented to protect and support your breastfeeding journey. 


As mentioned, breastmilk is nutritionally complete for each stage of development.  However, research has found that it may be low in Vitamin D.  Vitamin D is a fat-soluble vitamin that is provided through our diet and sun exposure, metabolised in the liver and kidneys to an active form known as calcitriol or 1,25-OH vitamin D.  The most important function is the role it plays in calcium absorption in the intestine and prevention of calcium excretion through the kidneys.  It further promotes bone health by the promotion of bone mineralisation and maintaining bone density together with calcium and phosphorus and other hormones.  


Vitamin D deficiency can be caused by the following:

  • ​​Inadequate dietary intake of vitamin D
  • limited exposure to sunlight
  • inability of the kidney to convert vitamin D to its active form
  • inadequate absorption of fat or vitamin D

Vitamin D supplementation is recommended antenatally – this means during and after pregnancy.  Most multivitamin supplements contain Vitamin D.  Although it is not in its active form and still needs to be metabolised by the body.  An antenatal supplement generally contains 400IU and paediatric Vitamin D supplements contain 400IU.  It is advised to continue with your supplements whilst breastfeeding that can aid with a balanced diet to provide adequate Vitamin D for your baby.  Vitamin D supplementation has been linked to increased active vitamin D, but not to overall impact on bone health of the infant.   If you have concerns regarding the adequacy discuss supplementation of Vitamin D with your Paediatrician. 

Please note: Vitamin D is a fat-soluble vitamin and can therefor reach toxicity if taken in too high amounts. 


We cannot speak about breastfeeding and the current global pandemic without discussing vaccination.  Current vaccines administered in South Africa is Pfizer (mRNA) or Johnson&Johnson (viral vector).  Live vaccines should not be taken during pregnancy or breastfeeding since it has the risk of potential infection to the foetus or infants.  The vaccines currently used in our country is not a live vaccine that can replicate.  Current data show unlikely risk to harm to the foetus or infant, however latest research suggest that antibodies may be provided that protect the babies from COVID-19 too. 

Pregnancy on its own is a greater risk for infection that can lead to severe illness. 


Points to help you make a decision about whether to receive a COVID-19 vaccine while pregnant and breastfeeding, consider:

  • Your risk of exposure to COVID-19
  • The risks of severe illness
  • The known benefits of vaccination
  • Although limited, but growing evidence about the safety of vaccinations during pregnancy and breastfeeding.

Weigh your personal risk, discuss it with your health care provider and make an informed decision to get vaccinated.  Don’t wait until it is too late, more and more data indicate the benefit and safety of receiving the jab. 


N J van Rensburg







Tan ML, Abrams SA, Osborn DA.  Vitamin D supplementation for term breastfed infants to prevent vitamin D deficiency and improve bone health (Review).  Cochrane Database of Systematic Reviews. 2020(12): 1-130.

Shimabukuro TT, Kim SY, Myers TR, Moro PL, Oduyebo T, Panagiotakopoulos L, Marquez PL, Olson CK, Lui R, Chang KT, Ellington SR, Burkel VK et al.  Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons.  N Engl J Med 2021; 384:2273-2282