The Effect of Galactagogue Herbal Tea on Breast Milk Production and Short-Term Catch-Up of Birth Weight in the First Week of Life

Abstract

Objectives:

The aim of this study was to evaluate whether consumption of maternal herbal tea containing fenugreek had any effects on breast milk production and infants' weight gain pattern in the early postnatal period.

Design and subjects:

Sixty-six (66) mother–infant pairs were randomly assigned to 3 groups. Group 1 (n = 22) consisted of mothers who were receiving herbal tea containing fenugreek every day. Group 2 (n = 22) and group 3 (n = 22) were assigned as placebo and controls, respectively.

Outcome measures:

Birth weight, loss of birth weight, time of regain of birth weight, amount of breast milk assessed on the third day after delivery were determined.

Results:

Maximum weight loss was significantly lower in infants in group 1 compared to both the placebo and control groups (p < 0.05). Infants in group 1 regained their birth weight earlier than those in control and placebo groups (p < 0.05). The mean measured breast milk volume of the mothers who received galactagogue tea was significantly higher than the placebo and control groups (p < 0.05).

Conclusions:

Maternal galactagogue herbal tea supplementation seems to be useful for enhancing breast milk production and facilitating infant birth weight regain in early postnatal days.

Introduction

B reastfeeding is the best type of nutrition for infants, but there are some problems in promoting, enhancing, and supporting it, especially in early weeks of life. In addition, excessive neonatal weight loss and late birth weight catch-up are emerging problems in exclusively breastfed infants in the first few days of life. Lactation failure caused by inadequate start of breastfeeding and reduced breast milk production can cause several serious problems such as reduced caloric intake for the infant, dehydration, hypernatremia, and hyperbilirubinemia, in the first days of life. Therefore, it is advised to follow up both the infants for monitoring the feeding status and mothers regarding breastfeeding success in pairs depending exclusively on breastfeeding in this critical period. Postnatal weight loss and age on regaining birth weight are two frequently used clinical parameters for monitoring infant's feeding status in the first few weeks in many studies. Moreover, the American Academy of Pediatrics recommends that every infant be weighed between the third and fifth days after birth. Indeed, weight loss greater than 7% of birth weight in the infant indicates possible breastfeeding problems. This requires more intensive evaluation of breastfeeding and intervention to solve problems and improve milk production and its transfer to the infant, if necessary.^{1

–12}

Galactagogues are substances or medications believed to stimulate initiation, maintenance, and augmentation of maternal milk production.^5,13

–16 Fenugreek (Trigonella foenum-graecum), an herb from the pea family, is the most commonly utilized herbal galactagogue in the world.^5,14

–17 Although its exact mechanisms of action are still unknown, this herb may increase milk flow by its phytoestrogens and diosgenin contents. In terms of milk production, fenugreek is suggested to stimulate sweat production, which would enhance milk secretion because the breast is a kind of sweat gland.^5,14
–16 Few data only as anecdotal reports are found in the literature on its effectiveness as a galactogogue.⁵ This report is the first in the related literature that evaluates the galactogogue effects of fenugreek tea. Fenugreek is listed as GRAS (generally regarded as safe) by the U.S. Food and Drug Administration.⁵ Tablet/capsule forms of fenugreek are recommended for enhancing breast milk in many countries. Various fenugreek preparations are mentioned in some of the websites on breastfeeding on the Internet.^18,19 There is no medication licenced as a galactagogue in Turkey; however, licenced herbal tea containing fenugreek (Still tea, Humana^®) has recently been presented in the market.

The aim of this study was to evaluate whether maternal consumption of fenugreek herbal tea had any effects on breast milk production and on the recovery of pattern of weight gain infants in early postnatal period.

Materials and Methods

Informed consent was obtained from all subjects and the study was approved by the local ethical committee.

Sixty-six (66) mother–infant pairs were enrolled in this placebo-controlled, randomized, double-blind study between November 2006 and April 2007 in the maternity unit of Gazi University Hospital in Ankara, Turkey. Our hospital has a certificate of Baby Friendly Hospital Initiative. All infants enrolled into the study were term and healthy neonates. Infants with low birth weight, low Apgar scores, intrauterine growth retardation, and any illnesses or congenital abnormalities were excluded. Inclusion criteria for mothers were as follows: (1) having been willing to exclusively breastfeed their infants, (2) having consented to follow-up visits until infants catch-up their birth weight following a period of postnatal weight loss, and (3) having agreed to pump the breast by electrical pump on the third day following delivery. Mothers who had any chronic illness such as diabetes, hypertension, bronchial asthma, any allergies, and any breast problems such as inverted nipples, mastitis, and a history of smoking, alcohol, or any drug use were excluded.

All women were supported by the same lactation consultant nurse during the study period and were educated similarly on proper positioning, latch-on, and breastfeeding techniques.

Two (2) kinds of granule herbal teas were used in the study. One of them contained the galactagogue fenugreek and the other, which was used as a placebo, contained apple.

The mother–infant pairs were randomly assigned to 3 groups. Group 1 consisted of 22 mothers who were encouraged to receive at least three cups of herbal tea containing fenugreek (Still tea, Humana^®) every day. Average volume of a cup is approximately 200 mL. Group 2 (placebo group) consisted of 22 mothers receiving the same amount of granule apple tea as placebo. Group 3 (control group) consisted of 22 mothers without any recommendations except routine advises. One (1) of two kinds of herbal teas was recommended to the mothers enrolled into the study by a different physician other than the staff following the study subjects. She informed the mothers about the study, documented the patients' data, and interviewed them after each of the follow-up procedures. She queried about the compliance of mothers and noted the amount of tea intake. No mother was required to be excluded from the study due to noncompliance.

All mother–infant pairs were followed by the same nurse and pediatrician blinded to the study. Infants were weighed by the same scale (Salter^®) every day until they reached their birth weight following a period of postnatal weight loss. The same model of electrical breast pump (Medela^® Lactiana^® Select Switzerland) was used to pump both breasts consecutively for 15 minutes to measure breast milk volume on the third day after delivery.

Statistical studies were done by using SPSS version 10.5 for Windows software (SPSS Inc., Chicago, IL). Groups were compared by Kruskal–Wallis and Mann–Whitney U tests. Categorical variables were compared by χ² test.

Results

Maternal age, rate of primiparity, delivery mode, maternal anesthesia, gender, gestational age, and birth weight of the subjects were similar in all three groups.

Demographic characteristics of mother–infant pairs are shown in Table 1.

Table 1.

Demographic Characteristics of the Groups

	Group 1 (galactagogue tea) (n = 22)	Group 2 (placebo) (n = 22)	Group 3 (control) (n = 22)	p-Value
Primiparity^a	10/22	9/22	9/22	p = 0.25
Gender^a
Male/female	12/10	11/11	10/12	p = 0.28
Birth type^a
Cesarean/vaginal	11/11	13/9	12/10	p = 0.27
Type of anesthesia^a
Epidural/total	7/22	8/22	7/22	p = 0.16
Birth weight (g)^b
(Mean ± SD)	3320 ± 291	3211 ± 189	3305 ± 343	p = 0.45
Gestational age (week)^b
(Mean ± SD)	39.2 ± 1.1	39.6 ± 0.8	39.1 ± 1.1	p = 0.48

χ² test was used for comparisons.

Kruskal-Wallis test was used for comparisons.

SD, standard deviation.

Maximum weight loss was significantly lower in infants in group 1 compared to both the placebo and control groups (p < 0.05). Infants in group 1 regained their birth weight earlier than placebo and control groups (p < 0.05). The mean pumped breast milk volume of the mothers who received galactagogue tea was significantly higher than that of the placebo and control groups (p < 0.05) (Table 2). There were no maternal or neonatal adverse effects of herbal tea reported by mothers.

Table 2.

Postnatal Neonatal Weight Loss, Time of Catch-Up Birth Weight and Maternal Pumping Breast Milk Volume of the Groups

	Group 1 (galactagogue tea) (n = 22)	Group 2 (placebo) (n = 22)	Group 3 (control) (n = 20)	p-Values
Breast milk volume (mL)	73.2 ± 53.5	38.8 ± 16.3^**	31.1 ± 12.9^***	p = 0.004^*
Maximum weight loss (% of birth weight)	5.7 ± 2.6	6.6 ± 2.2^#	8.3 ± 2.2^##	p = 0.003^*
Time to regain birth weight (day)	6.7 ± 3.2	7.3 ± 2.7^§	9.9 ± 3.5^§§	p = 0.007^*

Kruskal-Wallis was used for comparison of the three groups.

Mann–Whitney U used for following comparisons:

p = 0.003; (group 1 vs control).

***

p = 0.050; (group 1 vs control).

p = 0.001; (group 1 vs control).

p = 0.02; (group 1 vs control).

p = 0.004; (group 1 vs control).

§§

p = 0.01; (group 1 vs control).

Discussion

We found that the galactagogue tea supplementation resulted in a significant increase in breast milk volumes in the first days following delivery compared to placebo. Infants of galactagogue tea–supplemented mothers had lower weight loss in the first week of life and they also regained their original birth weights earlier than infants in placebo and control groups.

It is suggested that galactagogue herbal tea may support exclusive breastfeeding by enhancing the production of breast milk in the first week.

The amount of postnatal weight loss that is normally observed in the first week and timing of regaining the birth weight might be related to the sufficiency of oral intake in exclusively breastfed infants. Thus, these parameters are used frequently in the assesment of breastfeeding success.^6

–12 Although the results of this study cannot prove a direct relationship between galactagogue supplementation and improved infant weight gain, our results suggest that galactagogue herbal tea may support exclusive breastfeeding by increasing the amount of breast milk in the first week.

There are other factors than amount of breast milk, which affects weight loss and the time of regaining birth weight in the first weeks of life. Parity, events during labor and delivery, and demographic characteristics of the mother and infant are reported factors that have strong effects on delayed onset of lactogenesis and excess infant weight loss.¹² Our study groups were similar with regard to those factors; therefore, we consider that the positive effect of herbal tea was convincing.

We used apple tea as placebo, which is the same color and form as galactagogue tea. In addition, the fact that placebo and control groups had statistically similar results while Group 1 had superior results compared with these two groups with regard to breast milk volume, birth weight loss, and time to regain birth weight suggests a supportive effect of the galactogogue. Thus, we consider that observed effects of fenugreek tea on milk production could be independent of placebo effect. On the other hand, the present study was designed as a double-blind study to reduce error, self-deception, and conscious or unconscious bias.

As a limitation of the study, the size of the groups are small. However, this study's results are very promising, so it is worthwhile to perform further studies to investigate the effects and exact mechanisms of fenugreek on lactation.

Conclusions

Maternal galactagogue herbal tea supplementation seems to be useful for promoting and increasing breast milk production in early postnatal days. However, use of any galactogogue should never replace lactation evaluation and counseling. Close follow-up of both mother and baby is essential even in instances of galactagogue support.

Footnotes

Disclosure Statement

No financial conflicts exist.

References

American Academy of Pediatrics. Policy statement: Breastfeeding and the use of human milk. Pediatrics, 1997; 100:1035–1039.

American Academy of Family Physicians. Breastfeeding (position paper), 2002Cited January 15, 2004www.aafp.org/x6633.xmlwww.aafp.org/x6633.xml. 2009 December 10.

Manganaro

, Mamì

, Marrone

et al. Incidence of dehydration and hypernatremia in exclusively breast-fed infants. J Pediatr, 2001; 139:673–675.

Konetzny

, Bucher

, Arlettaz

. Prevention of hypernatraemic dehydration in breastfed newborn infants by daily weighing. Eur J Pediatr, 2009; 168:815–818.

Lawrence

, Lawrence

. Breastfeeding: A Guide for the Medical Profession. Philadelphia: Elsevier Mosby, 2005.

Gartner

, Morton

, Lawrence

. Breastfeeding and the use of human milk. Pediatrics, 2005; 115:496–506.

Zuppa

, Sindico

, Antichi

et al. Weight loss and jaundice in healthy term newborns in partial and full rooming-in. J Matern Fetal Neonatal Med, 2009; 22:801–805.

Salas

, Salazar

, Burgoa

et al. Significant weight loss in breastfed term infants readmitted for hyperbilirubinemia. BMC Pediatrics, 2009; 9:82.

Macdonald

, Ross

SRM

, Grant

, Young

. Neonatal weight loss in breast and formula fed infants. Arch Dis Child Fetal Neonatal Ed, 2003; 88:F472–F476.

10.

Harding

, Cairns

, Gupta

et al.

Hypernatraemia: Why bother weighing breastfed babies?

Arch Dis Child Fetal Neonatal Ed, 2001; 85:F145.

11.

Bystrova

, Matthiesen

, Widström

et al. The effect of Russian Maternity Home routines on breastfeeding and neonatal weight loss with special reference to swaddling. Early Hum Dev, 2007; 83:29–39.

12.

Dewey

, Nommsen-Rivers

, Heinig

, Cohen

. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics, 2003; 112,3pt1:607–619.

13.

La Leche League International. The Womanly Art of Breastfeeding. New York: First Plum Printing, 2004.

14.

Gabay

. Galactogogues: Medications that induce lactation. J Hum Lactation, 2002; 18:274–279.

15.

Christine

, Betzold

. Resource for clinician, galactagogue. J Midwifery Womens Health, 2004; 49:151–154.

16.

Tiran

. The use of fenugreek for breast feeding women. Complement Ther Nurs Midwifery, 2003; 9:155–156.

17.

Bryant

. Nursing the adopted infant. J Am Board Fam Med, 2006; 19:374–379.

18.

Natural Medicines Comprehensive Database [database on the Internet]. Therapeutic Research Faculty. www.naturaldatabase.com. 2009 December 11.

19.

Curtis

, Fenugreek

FAQ

www.breastfeedingonline.com/fenugreek.shtml. 2009 December 12.