A survey of North American physicians' clinical practices related to pharmacologic, herbal, and nutritional substances used to increase milk production

Abstract

Introduction Patients turn to foods, herbs, and medications to increase milk supply (i.e., galactagogues). Physicians may be asked to prescribe, recommend, or discuss perceived galactagogues despite a lack of evidence for their use. It is unclear how factors such as education, experience, and regulations influence clinical practice. The primary objective of this study was to document Canadian and US-based physicians’ attitudes towards, practice patterns surrounding, and utilization of pharmacologic, nutritional, and herbal products for the management of low milk supply. A secondary objective of this study was to determine factors that influence physicians’ decision-making with respect to the use of pharmacologic agents, foods, and vitamin, mineral, and herbal supplements for the treatment of low milk supply. Methods Physicians were recruited from two Facebook groups to complete 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, despite limited evidence of their effectiveness as galactagogues. Experts used all of the pharmacologic galactagogues. Canadians and experts were more likely than US-based and non-expert physicians, respectively, to include herbs in their practice. Numerous reasons for recommending or not recommending a given agent were cited, including patient request, personal and clinical experience, and lack of education, research, or access. Discussion The US FDA ban on domperidone affects which pharmacologic agents physicians in North America prescribe for low milk production. Despite having access to domperidone and limited evidence of their effectiveness, Canadian physicians are more likely than US physicians to also discuss, recommend, or prescribe herbal supplements as galactagogues. Conclusion In this online survey about medications, herbs, and foods commonly used in an effort to increase milk supply, Canadian and US-based physicians with and without lactation medicine expertise described their practice patterns and reported limitations in knowledge, medication access, and evidence. Though Canadian physicians prescribed domperidone without limitations, US physicians were less likely to incorporate it into clinical practice.