Background: Therapeutic approaches to addressing insufficient lactation are available but remain poorly understood. Current trends in maternal health, such as increasing rates of obesity, delayed age at childbearing, and high rates of cesarean section, may be associated with physiological challenges for lactation that cannot be managed by counseling alone. Women who have not had success with counseling alone, including adoptive mothers seeking to induce lactation, may use galactagogues (pharmaceutical and herbal compounds used to increase lactation). We present a review of selected studies of galactagogues and data indicating popular demand for such products.
Methods: A systematic search was conducted for published studies on the use of galactagogues for breast-feeding. The following databases were searched: MEDLINE (PubMed), EBSCO (Academic Search Complete), and EMBASE. The search was conducted between July 15, 2015, and August 18, 2015; only English language articles were included, and we imposed no restrictions on publication date. Two authors independently reviewed the studies and extracted data.
Results: Blinded, placebo-controlled clinical trials of 2 pharmaceutical galactagogues (domperidone and metoclopramide) and 5 popular herbal galactagogues (shatavari, fenugreek, silymarin, garlic, and malunggay) were identified. All of the studies identified for domperidone showed a significant difference in milk production between the treatment and placebo groups. Of the 6 trials of metoclopramide, only 1 study showed a significant difference in milk production compared to placebo. Results of the clinical trials on herbal galactagogues were mixed. Our review of the evidence for the efficacy of popular pharmaceutical and herbal galactagogues revealed a dearth of high-quality clinical trials and mixed results.
Conclusion: Health providers face the challenge of prescribing or recommending galactagogues without the benefit of robust evidence. Given the suboptimal rates of exclusive breast-feeding worldwide and the availability and demand for medical and herbal lactation therapies, controlled trials and analyses investigating these medicines are urgently warranted.
Keywords: Breast feeding; galactogogues; health policy; lactation.
Phone Calls to an Australian Pregnancy and Lactation Counselling Service Regarding Use of Galactagogues During Lactation - The MotherSafe ExperienceLE Grzeskowiak et al. Aust N Z J Obstet Gynaecol 58 (2), 251-254. PMID 29057459.Galactagogues represent substances used to enhance breast milk production. Between 2001 and 2014 we identified 2034 phone calls regarding the use of galactagogues made to …
What Evidence Do We Have for Pharmaceutical Galactagogues in the Treatment of Lactation Insufficiency?-A Narrative ReviewLE Grzeskowiak et al. Nutrients 11 (5). PMID 31035376. - ReviewInadequate breast milk supply is a frequently reported reason for early discontinuation of breastfeeding and represents a critical opportunity for intervening to improve …
The Use of Galactogogues in the Breastfeeding MotherAB Forinash et al. Ann Pharmacother 46 (10), 1392-404. PMID 23012383. - ReviewNonpharmacologic recommendations should be exhausted before adding therapy. Although anecdotal evidence encourages the use of metoclopramide, fenugreek, asparagus, and mi …
Use of Herbals as GalactagoguesA Zapantis et al. J Pharm Pract 25 (2), 222-31. PMID 22392841. - ReviewWith a substantial number of women using herbal products to augment their milk production, this article will review available literature illustrating efficacy and adverse …
Health Provider Experiences With Galactagogues to Support Breastfeeding: A Cross-Sectional SurveyAN Bazzano et al. J Multidiscip Healthc 9, 623-630. PMID 27895489.More than 70% of respondents reported to recommend galactagogues. The most frequently recommended galactagogue was fenugreek with respondents indicating that they recomme …
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Which Benefits and Harms of Using Fenugreek as a Galactogogue Need to Be Discussed During Clinical Consultations? A Delphi Study Among Breastfeeding Women, Gynecologists, Pediatricians, Family Physicians, Lactation Consultants, and PharmacistsR Shawahna et al. Evid Based Complement Alternat Med 2018, 2418673. PMID 29849697.Probably, potential harms and benefits of recommending fenugreek as herbal galactogogue for breastfeeding women seeking recommendations to increase their human milk suppl …
Drugs Affecting Milk Supply During LactationTM McGuire. Aust Prescr 41 (1), 7-9. PMID 29507453. - Review