PANTOTHENIC ACID

Fetal Risk Summary

Pantothenic acid, a water-soluble B complex vitamin, acts as a coenzyme in the metabolism or synthesis of a number of carbohydrates, proteins, lipids, and steroid hormones (1). The U.S. recommended daily allowance (RDA) for pantothenic acid or its derivatives (dexpanthenol and calcium pantothenate) in pregnancy is 10.0 mg (2).

No reports of maternal or fetal complications associated with pantothenic acid have been located. Deficiency of this vitamin was not found in two studies evaluating maternal vitamin levels during pregnancy (3,4). Like other B complex vitamins, newborn pantothenic acid levels are significantly greater than maternal levels (3,4,5 and 6). At term, mean pantothenate levels in 174 mothers were 430 ng/mL (range 250–710 ng/mL) and in their newborns 780 ng/mL (range 400–1480 ng/mL) (3). Placental transfer of pantothenate to the fetus is by active transport, but it is slower than transfer of other B complex vitamins (7,8). In one report, low-birth-weight infants had significantly lower levels of pantothenic acid than did normal weight infants (6).

[*Risk Factor C if used in doses above the RDA.]

Breast Feeding Summary

Pantothenic acid is excreted in human breast milk with concentrations directly proportional to intake (9,10). With a dietary intake of 8–15 mg/day, mean milk concentrations average 1.93–2.35 µg/mL (9). In a group of mothers who had delivered premature babies (28–34 weeks' gestational age), pantothenic acid milk levels were significantly greater than a comparable group with term babies (39–41 weeks) (10). Milk levels in the preterm group averaged 3.91 µg/mL up to 40 weeks' gestational age and then fell to 3.16 µg/mL. For the term group, levels at 2 and 12 weeks postpartum were 2.57 and 2.55 µg/mL, respectively. A 1983 English study measured pantothenic acid levels in pooled human milk obtained from preterm (26 mothers: 29–34 weeks) and term (35 mothers: 39 weeks or longer) patients (11). Milk from mothers of preterm infants rose from 1.29 µg/mL (colostrum) to 2.27 µg/mL (16–196 days), whereas milk from mothers of term infants increased during the same period from 1.26 µg/mL to 2.61 µg/mL.

An RDA for pantothenic acid during lactation has not been established. However, because this vitamin is required for good health, amounts at least equal to the RDA for pregnancy are recommended. If the diet of the lactating woman adequately supplies this amount, maternal supplementation with pantothenic acid is probably not required. Supplementation with the pregnancy RDA for pantothenic acid is recommended for those women with inadequate nutritional intake.

References

1. American Hospital Formulary Service. Drug Information 1997. Bethesda, MD:American Society of Health-System Pharmacists, 1997:2813–5.
2. Recommended Dietary Allowances. 9th ed. Washington, D.C.: National Academy of Sciences, 1980:122–4.
3. Baker H, Frank O, Thomson AD, Langer A, Munves ED, De Angelis B, Kaminetzky HA. Vitamin profile of 174 mothers and newborns at parturition. Am J Clin Nutr 1975;28:59–65.
4. Baker H, Frank O, Deangelis B, Feingold S, Kaminetzky HA. Role of placenta in maternal-fetal vitamin transfer in humans. Am J Obstet Gynecol 1981;141:792–6.
5. Cohenour SH, Calloway DH. Blood, urine, and dietary pantothenic acid levels of pregnant teenagers. Am J Clin Nutr 1972;25:512–7.
6. Baker H, Thind IS, Frank O, DeAngelis B, Caterini H, Louria DB. Vitamin levels in low-birth-weight newborn infants and their mothers. Am J Obstet Gynecol 1977;129:521–4.
7. Hill EP, Longo LD. Dynamics of maternal-fetal nutrient transfer. Fed Proc 1980;39:239–44.
8. Kaminetsky HA, Baker H, Frank O, Langer A. The effects of intravenously administered water-soluble vitamins during labor in normovitaminemic and hypovitaminemic gravidas on maternal and neonatal blood vitamin levels at delivery. Am J Obstet Gynecol 1974;120:697–703.
9. Deodhar AD, Rajalakshmi R, Ramakrishnan CV. Studies on human lactation. Part III. Effect of dietary vitamin supplementation on vitamin contents of breast milk. Acta Paediatr Scand 1964;53:42–8.
10. Song WO, Chan GM, Wyse BW, Hansen RG. Effect of pantothenic acid status on the content of the vitamin in human milk. Am J Clin Nutr 1984;40:317–24.
11. Ford JE, Zechalko A, Murphy J, Brooke OG. Comparison of the B vitamin composition of milk from mothers of preterm and term babies. Arch Dis Child 1983;58:367–72.