Herbal galactagogues to improve breastmilk production and lactation in mothers of preterm babies: a systematic review of clinical trials.

Premature infants suffer from conditions such as necrotising enterocolitis and sepsis, whose risk is reduced by breastmilk. Rates of breastfeeding are lower in premature infants compared to term infants. Insufficient breastmilk is the most commonly cited reason for breastfeeding termination. Herbal medicines are commonly used for promoting breastmilk production, but their safety and efficacy are unclear. We wanted to assess whether specific herbal galactagogues can safely and effectively increase lactation in mothers who delivered prematurely. Six databases were searched (Medline, Embase, CINAHL, AMED, COCHRANE library, ProQuest Dissertations and Theses Global) with no language or date restrictions. We included randomised controlled trials (RCTs) of herbal galactagogue use in preterm infant mothers. Ten RCTs were included, each investigating a different galactagogue or mixture. Two scored 'high' for risk of bias, the remainder scored 'some concerns'. There was low certainty evidence of an increase in milk volumes by day 7 of the intervention period with barley malt and lemon balm (mean difference 149 ml, 95% CI: 38-260); silymarin in combination with phosphatidylserine and Galega (mean difference 105 ml, 95% CI: 27-183); Pimpinella anisum seed tea (mean difference 98 ml, 95% CI: 63-133); and Latuca sativa (lettuce) syrup (mean difference 82 ml, 95% CI: 60-105). There is a lack of high-quality RCTs on herbal galactagogues within the preterm population. There is low certainty evidence that Barley malt with lemon balm, silymarin phytosomes with Galega, Pimpinella anisum seed tea, Moringa oleifera leaf capsules and Latuca sativa (lettuce) syrup increase breastmilk production. Higher-quality trials are needed to confirm this effect.