A Survey of U.S. and Canadian Physicians' Clinical Practices Related to Pharmacologic, Herbal, and Nutritional Substances Used to Increase Milk Production.

Introduction: Physicians may be asked to prescribe, recommend, or discuss foods, herbs, and medications for low milk supply. It is unclear how factors such as education, experience, and regulations influence clinical practice. The objective was to document physicians' clinical practice surrounding pharmacologic, nutritional, and herbal products for the management of low milk supply. Methods: Physicians from two Facebook groups completed an anonymous, online survey about their clinical use of pharmaceutical, supplemental, and nutritional substances perceived to increase milk production. The association between practice patterns and lactation medicine expertise or country for different perceived galactagogues was determined. Results: A total of 307 physicians completed the primary portion of the survey. There was no difference in the proportion of physicians in Canada or the United States (US) who were defined as lactation medicine experts. Canadian physicians were more likely to prescribe metformin, levothyroxine, and domperidone for low milk supply compared to US-based physicians. Canadians and experts were more likely than US-based and non-expert physicians, respectively, to include herbs in their practice. Patient request, personal and clinical experience, and lack of education, research, or access were frequently selected as reasons for or against using a specific substance. Conclusion: The US FDA ban on domperidone affects low milk supply management in North America. Though Canadian physicians prescribed domperidone without limitations, US physicians were less likely to incorporate it into clinical practice. Despite a lack of evidence, physicians in North America frequently used herbs and foods to increase milk production.