What do you recommend to increase milk production in mothers?

From the Guidelines

To increase milk production in mothers, I recommend a combination of frequent breastfeeding or pumping, proper hydration, adequate nutrition, and rest, as well as considering galactagogues like domperidone (10-20mg three to four times daily) or metoclopramide (10mg three times daily for 7-14 days) under medical supervision, as supported by the most recent evidence 1.

Key Recommendations

• Aim to breastfeed or pump every 2-3 hours (at least 8-12 times per day), including overnight, to stimulate milk production based on supply and demand.
• Stay well-hydrated by drinking water whenever thirsty and with each feeding session, with a recommended intake of approximately 2.0 L/day for females, and an additional 700 mL/day for lactating women 1.
• Consume an additional 300-500 calories daily from nutritious foods, particularly those traditionally associated with milk production such as oatmeal, fenugreek, fennel, and leafy greens, with a recommended daily intake of 2,000–2,100 kJ per day over the recommended daily intake for women 1.
• Ensure adequate intake of essential nutrients, including protein (19 g/day during the first six months, and 13 g/day after six months) 1, and vitamins such as vitamin D (10 mg/day) 1.
• Consider galactagogues like domperidone or metoclopramide under medical supervision for significant supply issues, as they may increase milk supply 1.
• Stress reduction and adequate rest are also important, as stress hormones can inhibit milk production, and skin-to-skin contact with the baby stimulates hormones that promote milk production.

Rationale

The recommended approaches work by either increasing prolactin (the milk-making hormone), improving milk removal (which signals the body to produce more), or creating optimal physiological conditions for lactation. The use of galactagogues like domperidone or metoclopramide under medical supervision can also help increase milk supply, as supported by the evidence 1. Additionally, ensuring adequate nutrition and hydration is crucial for maintaining optimal milk production, as supported by the guidelines 1.

From the FDA Drug Label

EFFECTIVENESS A randomized, masked, controlled, laboratory effectiveness study evaluated the effectiveness of 1. 1 mg/kg EQUIDONE Gel administered once daily beginning 10 to 15 days prior to the expected foaling date Table 3 Gestation Length, Milk Production and Mammary Gland Development Treatment Group(number mares)Mean gestation length in daysPercent adequate milk production at foalingPercent adequate mammary gland development at foaling EQUIDONE Gel (13)337100% (13 / 13)100% (13 / 13)

The drug domperidone is prescribed to increase milk production in mothers, as it has been shown to have a significant effect on milk production and mammary gland development in mares 2.

• Key benefits of domperidone include:
  • Increased milk production
  • Improved mammary gland development However, it is essential to note that this information is based on a study involving mares, and its application to human mothers may not be directly equivalent.

From the Research

Recommendations to Increase Milk Production

To increase milk production in mothers, several options are available, including:

• Galactogogues, which are medications that aid in initiating and maintaining adequate milk production 3
• Frequent and effective milk removal, which is essential for milk production 4
• Use of galactagogues such as metoclopramide, domperidone, and fenugreek, which have been shown to be effective in increasing milk production 3, 5, 6

Galactogogues

Galactogogues work by interacting with dopamine receptors, resulting in increased prolactin levels and thereby augmenting milk supply 3. Some common galactogogues include:

• Metoclopramide, which is considered the galactogogue of choice due to its documented record of efficacy and safety in women and infants 3
• Domperidone, which crosses the blood-brain barrier and into the breast milk to a lesser extent than metoclopramide, decreasing the risk of toxicity to both mother and infant 3, 7, 6
• Fenugreek, which has been purported to be effective in anecdotal reports, but its use may be warranted after considering risks versus benefits 3, 5

Safety and Efficacy

The safety and efficacy of galactogogues vary, and more research is needed to inform breastfeeding support 4, 7, 5, 6. For example:

• Domperidone is associated with serious cardiac arrhythmias and is not approved for any human use in the United States 7
• Metoclopramide has been shown to be effective in increasing milk production, but its use may be limited by side effects such as diarrhea and drowsiness 3, 6
• Fenugreek has been shown to be effective in increasing milk production, but its use may be limited by side effects such as gastrointestinal upset 5