METOCLOPRAMIDE FOR BREAST-MILK PRODUCTION

The efficacy of a dopamine antagonist-metoclopramide to recommend for healthy mothers with lactational insufficiency was evaluated in health y mothers with lactational insufficiency. Thirty-two mothers with babi es 10 days to 120 days of age who had inadequate lactation confirmed b y failure to gain weight of their babies and two consecutive measureme nts of breast milk by pump that proved to be less than the daily requi rements of the baby. The drug was started to the mothers with lactatio nal insufficiency only after a brief educational period to make sure t he proper technique for breast feeding being used and a second measure ment one week later that was still less than the requirements of the b aby. Mothers were given 300-500 mu gr/kg of metoclopramide (10 mg x 3) in 3 divided doses orally. A control group of 32 mothers with adequat e lactation was also included in the study. A 'true control group' of women with lactational failure that placebo should be given was not ap proved by the ethical committee. The therapy group and control group w ere comparable in parity, socioeconomic status, age of the mothers and the age of the babies. About half of the babies were premature in eac h group. The amount, (twice in the initial measurement) and the osmola lity of breast milk, the blood pressure, prolactin and aldosterone lev els of the mothers, and maternal blood counts, ferritin and serum iron and iron binding capacity were determined. The laboratory analyses we re repeated after 15 days both in the drug therapy and control groups. Daily milk production increased by 82.5% (from 378+/-28(SD) ml to 690 +/-37ml) which was statistically significant (P<0.001). An increase of 34% in prolactin levels were also recorded from 69.5SI(2293 mu IU/ml) to 93.3 SI (3079 mu IU/ml) which was also significant(P<0.05). Aldost erone levels were also increased in the therapy group but did not exce ed the mean levels of the control group. Blood pressure levels of the mothers and the osmolality of breast milk did not differ significantly after the drug. However in mothers of term babies an increase in the osmolality of breast milk was noted. This effect was not recorded in t he mothers of premature infants. The elevation of the osmolality of mi lk was most evident in subjects who had higher blood pressures initial ly. Initial prolactin levels were inversely correlated with initial di astolic pressures. The increase of daily milk production significantly and inversely correlated with the age of the mothers(P<0.01, r = -.47 ). No significant side effects were recorded in the mothers or babies. 25 of 32 (78%) mothers had a sufficient response(meeting the daily ca lorie and liquid requirements of the infant) to metoclopramide. In sev en treated mothers daily milk production was still below the infants' daily requirements. These mothers were relatively older in age, no oth er factors were associated with failure of response to metoclopramide. Metoclopramide seems to be a safe and effective drug for the treatmen t of lactational failure especially in young mothers and is worth a tr ial before recommending formula feeding even in mothers of premature b abies.