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Moringa oleifera (Malunggay) as a Galactagogue for Breastfeeding Mothers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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King, KS et al
lloringa oleifera (Malunggay) as a Galactagogue for
Breastfeeding Mothers: A Systematic Review and
lleta-Analysis of Randomized Controlled Trials
Iacelie S. King.\ID*,Peter Francis N. Raguindin, MD*, Leonila F. Dans, MDo*
\ bstract
Beckground. \{oringa oleifera (Malunggay) capsules
- j'.; reen prescribed for years by many physicians in the
::,-rrrrtion of breastfeeding. Its efficacy has not been well
:s:aL'lished due to few, small randomized controlled trials.
Objectives. To perform a meta-analysis of the available
data in the medical literature, assessing the effect of intake
oi \loringa (malunggay) by postpartum women, on breast
milk volume and infant's growth.
Data sources: PubMed, Cochrane Controlled Trials Meta-
Register, electronic databases of published, unpublished
and non-english language papers; conference proceedings,
reference lists, and trial authors.
Selection Criteria. Randomized controlled trials (RCTs)
eramining the effect of intake of Moringa on breastmilk
production of postpartum breastfeeding women, were eli-
gible for inclusion.
Data Collection. Absolute and relative changes from
baseline u'ere calculated for individual studies and pooled
using a randor.r-i eftcts rrodel.
\Iain Results. Fii e RCTs including -r66 participanrs rret
il-;: i:.'-t.s:o: .-ri:e:r: Oi the tr'.liCtrntiS rer ieri ed. onlr
;::-'-:..1- .r. . .--ll.; S.. .,.:: : >.-:...::.'...r .:::'.::l;fttt ill-
-::j>a :- ,. '.t. i:.- ::3-::::,3:li -,r, lil-. ]1\-:.:l{: C:ilSL.]eS trn dar
-:. i ":; - T:.; .:-.-'. Sl> rrl !otrled dat: der:t.'rnstrated a
.t=tist:.'-r, '. rt-::'l-:-:,-a;:: :e,:tire lnclease on dar -1 0f],1.09
r1l re5:,, CI f-O f:. 19.,r-i pT:.o6t: dal-< oi ji.-8 61 (9-590
CI l-+.1+. -19.-11 p<.000{,)1t and on da1 7 of 123.87 ml
(95o0 CI 89.-+8. 158.26 p:.32) milk rolume u,ith moringa
capsr-r1es treatrnent cornpared to placebo. Two RCTs re-
ported an increase in infants' weight as an outcome with
the use of morin_qa capsules. No adverse events were ob-
serred in anv of the trials.
Conclusion. Er idence from Randomized Controlled Tri-
-'..s:r.-\e ihat \loringa results in an increase in breast milk
,. - __.:.1:a ._O:ln:red tt plaCebO.
oleit-era. \lalunggal'.
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Prt;i.'ri,ii". .
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Description of the condition
The most recent National Demographic
and Health Survey 2003 of the National Statis-
tics Office showed that of the 7 million children
below 5 years old in the Philippines, only 87%
were breastfed. This includes infants whose
breastfeeding lasted for only one hour, one day
or one week. Nearly 3.4 million children (49%)
were given complementary feeding within 3
days after birth. Barely 6% were exclusively
breastfed. Although B0% of children started
breastfeeding within 24 hours from birth, exclu-
sive breastfeeding only lasted for an average of
24 days. Among mothers who did not breastfeed
their children, 31o reported that they did not
have enou-qh milk.(l) Physicians use several
methods to promote breastfeeding; these include
matelxal edr"rcation, non-separation policy, and
rrnplorin,e the help of a lactation specialist. To
augment the problem in the adequacy of milk
volume, clinicians often use galactagogues.
Description of the intervention
Galactagogues are medications or sub-
stances believed to assist initiation, maintenance
or augmentation of maternal milk production.(2)
Common galactagogues include domperidone
and metoclopramide. Both are deemed to inter-
act with the dopaminergic system which in turn
promotes the release of prolactin. There are sev-
eral other herbal plants that are said to have lac-
togenic effects including anise seeds, Bermuda
grass, fennel seeds and quinoa.(16)
In the Philippines, Moringa leaves
gro\\.n in backyards. usually prepared as a vege-
table inqredient in chicken soup, have been used
br nrothers to enhance milk production.(3,4) It
has been encapsulated. marketed and sold com-
Keruord:: l,i-:-:-:. \lor.nga
Cr-r":.- : --^:. 3::"s:=;Jl:i
of C I i rt i c ctl E p 1 a{ g ni ;,.1,',',,;.
The Philippine Journal of Pediatrics
Vol.61 No.2 December 2013
Kirrg. KS et al
mercially to help increase breast milk
ing mothers. lactat-
How the intervention might work
Lactogenesis is initiated in the postpar-
tum period by a decrease in plasma progester-
one, with coffesponding increase of serum
prolactin 1eve1.(5) According to Hans Selye,
each baby's suckling episode is associated with a
rise in plasma prolactin. Thus frequent nursing
is required to maintain high plasma prolactin
level. However, if standard physiologic meas-
ures (proper attachment and frequent nursing)
are only parttally effective, drugs like reserpine,
metoclopromide, domperidone, and thyrotropin
releasing hormone (TRH) can be utilized to
stimulate prolactin production. (7)
In the Philippines moringa leaves have
been used to enhance milk production with un-
clear mechanism of action. Almirante and Lim
(6) proposed a mechanism for its lactogenic ef-
fects. The study showed that there was a greater
increase in maternal prolactin levels among
breastfeeding mothers who took the leaves.
Why it is important to do this review
Quisumbing l97B first noted the use of
moringa leaves as a galactagogue. This lactation
-enhancing effect of moringa leaves was demon-
strated in a local study done by Almirante and
Lim (1996), wherein moringa leaves in the form
of Natalac capsules were given to pregnant term
Filipino women immediately after birth. The
study showed significantly higher prolactin lev-
els among mothers taking Natalac capsules ac-
"-ompanied by significant weight gain among
their babies. A follow up study done by the
same authors among hypertensive women moth-
ers showed the same result.
In a randomized controlled trial done by
Estrella et. al.(14) the administration of Moringa
;apsules showed an increase in milk production
rn postpartum day 4 to 5 among mothers who
ielivered preterm infants, with no reported side
:I-tects. Another study by Balahibo et at- (12)
:ioted that among breastfed newborns, there was
a significant incrals.' :: ""i3.:.:
newborns u-hose t.t],-'ltiti '.'" Jlr' length of
capsules from binh i,-' : rr.rl-:
noted that lactation st5.::1.=:: '' l lr-''. -'d ln
those taking moringa capsu":s :.:::^. I ::r:tl:
study period.
This study aims to Peri.::: : -: -'-
analysis of the available data in thc ::e; :. :-
erature, assessing the effect of intake .': \1 : : - ti
by postpartum women, on volume of n::"r'. :: *
duction, and infant weight garn.
Criteria for considering studies for this
Types of studies
A11 randomized controiled trials comparing Mor-
inga versus placebo or any other galactagogues
are eligible for inclusion in the review. Search
was not limited by date, language or publication
Types of participants
Post-parlum mothers who have taken raw or
pharmaceuticaliy compounded drug with Mor-
inga oleifera as active ingredient were included.
Mothers who had taken Moringa prior to delir--
ery or as prophylaxis were excluded from the
Types of interventions
Intervention in the included studv should use
Moringa oleifera either as raw o:' pharmaceuti-
cally compounded d*g. We cxcluded studies
that used Moringa for an.v other purpose othe:
than as a galactagogue. Studies u here il'lt-rt:3r:
took Moringa for re-lactation or to prlor lr-r 'j:-
livery were also excluded. Controi rarieb-3 :-::
to be a placebo tablet of similar phrsic:. ;:i::--
teristic as that of the studv drug tlr rr." ::::: '-
cologic agent deemed to har.' g:-.:::' rr;
:,i.rS alSO
The Philippine Journal of pediatrics
Vol. 6l No.2 December 2013
Types of outcome measures
Primary outcomes
The primary outcome was measured
both in-vitro and in-vivo. In-vitro r,easllrernenr
involved measuring the volume of breastmilk in
milliliters (mL) or cubic centimerers rcc, ob-
tained through expression br eitlier han,J or ma-
chine. In-vivo measure,r-,.ni * as rhe adequacy
of milk producrion as er i,Jencerj br- i.nfant
weight gain. This t-rUtCorre \\ as nrearu.Ld using
percentage ri eisht ga;ir I :' r.
secottdot'.' | ):i i( r, tllg _:
.\:lorher t-rutcoflte that was determined
u as the ler el ol maternal prolactin production
nreasured in million International Units per liter
trnlU L t. Ler,'els of prolactin are said to be re_
lated to maternal breastmilk production. Ad_
\ erse drug events related to use of Moringa
\\ ere also noted and documented.
Search methods for identification of studies
We searched the following electronic
databases using the search terms already de_
scribed in Appendix l: Moringa oleifera, Mor_
inga pterygosperma, Moringa , Malungga,
Drumstick tree, Horseradish tree and Ben oil
tree for the intervention. These search terms
were combined with the search terms: breast_
feeding, breastmilk and lactation.
Electronic searches
The following electronic databases were
searched with uniform search strategy.
Controlled Trials MetaRegister
Searching other resources
Citations and reference lists of identified
articles were examined for additional relevant
studies. Conference proceeding and local jour_
nals were hand searched for relevant resear.h.r.
Experts and researchers were queried for ongo_
rng andlor unpublished trials.
King, KS er C
Selection of studies
Two authors independently examined L1E
title, abstracts , and keywords of citations tiom
electronic databases for relevance and sub*-
quently eligibility. The full text of all reler a::m
records were obtained and independ ently a-i_
sessed as to whether each met the predefined
inclusion criterra. The authors used a form for
standardization of appraisal methods. Disagree-
ments were discussed and if consensus was not
reached, it was adjudicated upon by the third
author. Excluded studies and the reason for ex-
clusion were noted and tabulated.
Data extraction and management
The primary and secondary outcomes
were all of continuous variables. The arithmetic
means and standard deviations for the two
groups were determined from the study and
compared. The unit of measurement were ascer-
tained as uniform to ensure consistency.
Assessment of risk of bias in included studies
Methodological quality was assessed in_
dependently by two review authors using the
guidelines in the Cochrane handbook and was
assessed for overall quality of evidence using
the GRADE approach. The parameters to be
used in assessing the risk of bias will included
random allocation, concealment allocation.
blinding and reporting biases.
Measures of treatment effect
The volume of breastmilk was measured
using cubic centimeter (cc) or milliliter (mL).
Infant's percent weight gain was expressed in
percentage. The level of maternal prolactin was
measured in million International units per liter
(mfU/L). A weighted mean difference between
treatment and control groups was determined
using RevMan 5.1. Analysis was based on mean
difference using random effects model.
Dealing with missing data
The authors contacted the original inves-
mL r"
fllllllmr &milil,ppine Journal of Pediatrics
'i\illll*rriltr, ,rr,, \ ,'. I DeCembef 2013
rlililnun. -i :or the missing data in the study. Rea-
h#rlrlnl '" : omission will also be noted. In cases
wrlrrrilu-: . I alue in the study interpretation is miss-
urrril[ - s sroup will derive the said data and the
,ulrrriJ, -* ,,"i be used to complete the analysis.
lDrull * nthesis
t-)nl1l studies with comparable interven-
lllr{iirr -u-:lulations and outcomes were pooled and
irillflilriiiiL :':j. The investigators used RevMan 5.1
,rilililrn :;:iation of mean difference of each out-
lil:un " ":d subsequently compared, pooled and
..llnrllr-r :.C studies of comparable interventions
,illllllr,il,t t, lulation. Inverse variance was computed
r i- -- red effects method as determined by
'iil,- ',1:n 5.1 and reported accordingly.
rrurl'group analysis and investigation of
Mfie il'ogeneity
-\ table of study characteristics u/as com-
q :' ; I br the investigators and \\,as used in as-
uur - - the clinical and methodical hetero_eenein-
",-:i study. Statistical heterogeneity was as-
iuri .,- I using Pearson Chi Squared test as deter-
lnrr+c ription of studies
Xc.,u/r-s o.f the search
-\ total of 32 titles and abstracts were re-
""" : - - through searching databases and refer-
r'- . - ::acking. We obtained the full text of six
,. * - -'i among which one trial was ineligible due
-:: of intervention prior to delivery (Figure
l:e t-inal trial sample consisted of five ran-
- * zed trials for the review. The details of in-
" -.J trials are reported in 'Characteristics of
-- -;ed studies'. The reasons for excluding tri-
.r " ::e stated in 'Characteristics of excluded
,lIL_ i>
King, KS et al
Fisure 1, Fltrs chan ..1'S.'1.'c:;: S:-;:.-.
Included studies
Of the fir'e included trials. four trials
were done in tertiary hospitals(2,12.13.1-+; u hile
one was done in the community setting.(6) Four
trials compared Moringa capsules against pla-
cebo(6,12,13,14) while one trial compared Mor-
inga capsules as well as other galactagogues like
domperidone and metoclopromide against plain
breastfeeding(2) in a randomized manner. A to-
tal of 366 postpartum mothers were recruited
across all trials. Among the participants, 108 of
them were mothers of preterm infants while the
rest of them were mothers of term infants not
suffering from any illness at birth. An informed
consent was obtained from all participants in
four trtals(2,6,13,14) but it was not explicitly
stated in one trial(L2). Reporting of inclusion
and exclusion criteria was similar across trials.
Of the five pooled trials comparing the
efficacy of Moringa as a galactagogue for
breastfeeding mothers, three trtals(2,L3,14)
measured milk volume, two trials(6,12) meas-
ured infant weight, two trrals(2,6) quantified
maternal prolactin level, and all trials reported
adverse outcomes.
Total Number oiRe.-..r.1s I;::ii:led: 3l
Cochrane LiL,::r.. ,
HERDI\ \eO\ r -1',,
MetaRegister of Controiled T:i.:'is , ', t
Number of Records
Excluded: 26
Not related to lactation
Number of Articles Assessed for Eligibility
Number of Articles
Excluded: 1
Capsules taken prior to
Number of Articles included
Eri !\lrml:,: i]r"c J,, r.r r nal of Pediatrics
r-! \ I Dgcember2013 King, KS et al
\.i ik \olume measurement varied from
*; -: :..i-paftum to 4 months, as well as infant
- :-. :.rken tiom birth to 4 months and mater-
:,.:-plrtum to 4 months. No adverse effects
srr' rote d in four trials.(2,6,13,14)
E.rc'lttcled stadies
One study was excluded because Mor-
rnga capsules were taken by mothers prior to
Risk of bias in included studies
A I I o cutio n (s ele ctio n bius)
In only two of the five trials, \\,as ran-
domrzation done using a controlled block desiglr
(2) and table of random numbers (14). Ran-
domrzation details were not specified in two ol
the remaining 3 trials(6,12), while in the last
trral, randomization was done by the researcher
with high risk for bias.(13) Allocation in 3 of
the five trials had low risk for bias with treat-
ment assignment concealed using opaque sealed
envelopes, identical containers which were
coded at the source.(6,1r3,I4) The remaining 2
trials did not specif.v how allocation conceal-
ment was done.{2,12;
Blinding (performance bius und detection
bius) Three of the four trials ensured blinding
of participants and personnel (6,12,i4) while in
the remaining one trial only the participants
\ /ere blinded.(13) One trial did not specifiy any
biinding done.(2) ln all trials. blinded individual
assessors were used. For the assessment of milk
volume, a standardtzed, calibrated breast pump
and container were used. Milk volume was ei-
ther recorded by the subjects themselves or by
:he study personnel. Prolactin level was meas- using the ELISA technique while a check-
irs: of adverse symptoms was provided for the
su:-iects. Infants'weight gains were measured by
'r-rnded doctorst'students but the method was not
stated in .-rne trial.(6)
Incomplete outcome data (uttrition bius)
The intention-to-treat principle was not
mentioned in any of the pooled trials. A11 trials
reported number of dropouts and withdrawals
comectly except one trial which did not assess
this outcome.(12)
Selective reporting (reporting bius)
All pre-specified outcomes like milk vol-
ume, maternal serum prolactin level, infant's
weight and adverse effects were reporled in all
pooled trials.
Other potentiul sources of bius
Eighty percent of the triais were per-
formed before the year 2005 and ZAoh before the
year 2000. The number of patients per trial
ranged between 40 tbr the smallest(2; and 1 16
patients for the largest.(6) Only one tnal enrolied
rnore than 100 patients (61 and only one trial in-
cluded information on sample size calculations.
( 12)
Effects of interventions
Milk Volume
A11 three trials noted milk volume on day
3 postpartum with intake of Moringa capsules
starting on the same day(2,13,14); two trials re-
ported milk volume on day 4 a*d 5 (13, 74); and
two trials on day. 7(2,13) 1 trial each reported
milk volume on day 10(13) and day U.(2) The
comparison regarding the outcome milk volume
enrolled atotal af 171 participants flor day 3, 150
participants each for day 4 and 5, and IA2 par-
ticipants for da1. 7 in the Moringa vs placebo
group. The pooled analysis for du)' 3 showed
heterogeneity of effects (Chi2 : 4.59 df:Z 12 :
56% p:0.1) and faiied to show a significant as-
sociation of Moringa capsules to increase milk
volume against placebo (pooled ratio of the
means of 13.58 (95% CI -1 .67,28.83). On days
4 and 5, pooled analysis show-ed heterogeneity
of effects (cht2: 3.5 df :7 12: 7I% p:0.06,
chtT: 33.88 df :1 12: 97% p<.00001 respec-
tively), there was significant association of
r,, I'hilippine Journal of pediatrics
r | \o. 2 Decemtrer 2013 King, KS et al
:. rga capsules with increase milk volume
.-- nsr placebo (day 4 23.09 {95% CI 16.g5.
- ' :-: l: day5 31.78 {95% CI 24.24,39321 ). On
-",., -. pooled analysis showed homoeeneitr .i
, --'--tS (chi2:0.98 dF1 p:0.32) and sienitlcant
- - :3ase in mean difference of rnilk ,-olti,re ii ith
:'inga capsules against placebo at 123.g7 ml
"- ertraction (95% CI g9.4g , 15g.26). Fig.2
kpcilmraul ftntnl &i$rr 0ilfcrtn{r
,l'r;l [{tan 5D Totil &lean i[ Totll l{crght l!,iired,$5$ll
ilcan Dilftnnn
ll', Fixrd, 95ii il
r*[ 6t !l jj it *j i /$ jj ifr it ii 6f, 5t i]t ?; r*6J4i
.;i f., ;r it ;. .:i t ..i,. ;: ii i .ii j; itr il ,i[ li
51 il 100.0\ lil.$i i8!,{t, 1t8,ifi1
i;vtui: tuiillci iei+in *ttrmitn,r;
- -.:e l. Forest plot of comparison: I Moringa vs placebo, outcome:
..:le of Breastmilk Day 7 "Infants'Weight
Two trials(6,12) studied the efficacy of
moringa capsules versus placebo as a galac_
tagogue by measuring increase in infants,
weight. One trial(6) measured the weight at
birth, at 2 weeks, at 1 month and, at 4 monlths of
age which included 1 1 6 participants in the mor-
irqu versus placebo group. One trial(|2) noted
infants' weight at 2 weeks, 4 weeks, 6 weeks and
8 weeks of age in 30 participants. percentage
weight gain was noted in the moringa group for
both trials. (Table 2)
Table l. Percentase \\'eisht Gain
Froluctin Level
Two trials were carried out to assess the
-:':icacy of moringa capsules versus placebo in
r' increase maternal serum prolactinlevel .(2,6)
':re trial(6) reported on maternar serum prolac-
:r ievel on 1 16 patients, 6 hours imm.diatery
- .'stpartum (first .extraction), 2nd day postpar_
"''r (2nd extraction) and 4 months postpartum
': rd extraction). The median prolactin rwer on
-e first extraction was 4B0B mIU/L in patients
", ho took moringa capsules compared to 5134
^'IIJIL in patients who took pracebo. prolactin
-.'r els were higher in the treatment group on the
-:rd and 3rd extraction and was statistically sig_
'.:t-rcant yielding a ratio of the medians or t-ss+.q
)5% CI 1601.8, 2L6B) and t83B (g5% CI
. it7 3.04, 2602.96), respectively. One trial (2)
,:ported on the prolactin levels on day 3 postpar_
:Lrm, day 7 postpartum and day 14 posipartum
r,,rt did not show any significant difference
:mong all 3 groups. The comparison included a
:.-,tal of 40 patients. (Table 1)
Trllr. L serunt Prolactin Level
5t udr
Treatment Placebo
(n) SD Mean,
mIU/L (n) SD
8.4 5134.0
(58) 2304.4
Dar 3398.0
(,s 8) 1939.5
Day 3Co 2001 :ll 9
l,tr 2189.8
Day 7Co 2002 :0.1 E. -
(lo) l!nri.0
14 Co2002 1229.2
( l0) 1468.6
4 mos Almirante
1996 2389.0
(s8) t019.7 504.1r-sSr
-\loringa Placebo
/o SD \ Iean.
/o SD
BWto 1
week Almirante
1996 r.300 13.27 0.029 2.84
15.649 5.506
weeks Balahibo
2002 120.94 nla 75.36 nla
weeks Balahibo
2002 156.46 n/a 110.41 nJa
BW to l6
weeks Almirante
1996 123.60 6l .51 74.410 3s.726
The Philippine Journal of Pediatrics
Vol.61 No.2 December 2013 King, KS et ul
Adverse Efficts
Only four trtals(2,6,13,14) reported on
adverse effects in the treatment group. All trials
reported no adverse effects. However, in 2 trials
(6,14) the method of reporting adverse effects
was not stated. In the remaining two trials (1.13 r
a checklist was provided to the participants.
Summary of main results
Galactagogues are otten presc:-ibed xtr
breastfeeding mothers to increase the .tfltoilrx[ t-rf
breast milk production. \\-e rer ieu ed elllcacr of
morin_ea capsules as a galactagtrgue br compar-
ing outcontes such as milk rolume. maternal se-
rum prolactin lerel. and intants'u'eight in breast-
t'eeding mothers.
Three randomized controlled trials
( l. I 3. I -1 t reported on increased milk volume
u"ith the use of moringa capsules. The data pre-
sented in this review demonstrate a significant
increasing trend in the volume of milk starting
on day 4,5, and 7. Pooled trials did not show
any significant increase of milk volume on day 3
postpartum. This could be attributed to inade-
quate window of observation from initiation of
therapy. Although pooled analysis both showed
heterogeneity for day 4 and 5, it is noteworthy
that confidence interval of both days are statisti-
cally significant favoring the association of in-
take of Moringa capsules with increase in milk
volume.The quality of reporting of the milk vol-
ume trials showed some methodological defi-
ciencies and had small sample size of less than
100. None mentioned an intention to treat analy-
sis. Methodological quality was moderate in one
trial where the method of random sequence, con-
cealment of random allocation, double blinding
and number of dropouts were reported.(1a) The
two remaining trials showed methodological de-
ficiencies. One trial had high risk of randomiza-
tion bias and single blinding (13) while the re-
maining trial did not state allocation and blind-
ing procedure.
Increased prolactin production is the pre-
vailing theory on how Moringa produces its
lactogenic effects. Two randomized controlled
trials (2,6) reported on increase in maternal se-
rum prolactin level with the use of morin ga cap-
sules. However, both trials reported measure-
ment of prolactin level on different times, such
that no pooling of data cannot be done for com-
parison. Moreover, both studies showed con-
t)icting results. One trial(6) stated that there is
significant increase in maternal serum prolactin
ier el ri ith the use of moringa capsules while
antrther trial(2) stated otherwise. However, both
trials shou'ed methodological deficiencies. Both
trials did not specifl,- method of randomtzation.
In one trial. allocation concealment and double
blinding \\'ere done(6) and in the remaining tnal,
no allocation concealment and blinding were
stated.(2) Both however, noted blinding of as-
sessors by using the ELISA technique to meas-
ure maternal serum prolactin levels. Reporting
of withdrawals was noted in both trials. One
trtalhad a small sample size of 40.(2)
Two randomized controlled trials(6,12)
reported an increase in infants'weight as an out-
come with the use of moringa capsules. Both
trials had moderate methodological quality. Ex-
cept for reporting of double-blinding, none of
the trials properly reported the requested quality
criteria. Although percentage weight gain was
noted in both trials; no pooled analysis was
available for comparison. In one study(12) stan-
dard deviation was not specified, such that no
confidence interval could be derived. Taken sin-
gly, both trials reported increase in percentage
weight gatn with moringa capsules compared to
placebo. However, with no pooled analysis
available, it is unverifiable to report as such.
Overall, evidence from five small RCTs
unanimously concluded that Moringa produces
an increase in breast milk volume compared to
Overall completeness and applicability of
The evidence provided by the review
appears to be widely applicable. Moringa
leaves are easily accessible in the Philippines as
it is found in many backyards. It is commer-
The Phitippine Journal of Pediatrics
Vol.61 No.2 December 2013 King, KS et al
cially available in capsule form. Outcomes such
as milk volume, prolactin level and infants'
weight are also measurable in our setting. As a
galactagogue, it is also well received by Philip-
pine medical societies, in its efforts at promotes
Quality of the evidence
Many important aspects of morin ga cap-
sules as a galactagogue cannot be addressed with
the current evidence. It would be interesting, for
example, to know whether differential drug effi-
cacy exits in term and preterm infants, primigra-
vid and multigravid mothers. Such subgroup
analyses, however, need adequate power or spe-
cific research questions and can not be an-
swered by this meta-analysis.
Potential biases in the revierv process
Most included trials are of small size and
therefore prone to effect overestimation due to
publication bias. Since the number of trials per
comparison was usually very limited, formal as-
sessment of publication bias was was not possi-
Implicutions for practice
Moringa is commonly used in the Philip-
pines as a galactagogue to help breastfeeding
mothers increase milk production. This study has
proven its efficacy in increasing milk volume.
This conclusion is based on small trials with lim-
ited methodological quality compromising the
robustness of its quality. Nevertheless, it is im-
portant to recognrze that all studies favor the ex-
perimental (Moringa) group over the placebo
group. More pharmacodynamic studies need to
be done and other theories need to be explored to
provide information on the mechanism of its lac-
togenic effects. Available data on this is also
based on small trials with limited quality of
Moringa is safe with minimal to no ad-
\ erse effects as reported by all five studies.
Implicutions for reseurch
Further studies should provide sufficient
transparent reporting of allocation, randomtza-
tion. and blinding. Follow up duration should be
adequate and studies should also use uniform
endpoint reporting of outcomes. In addition,
\lrrringa can be compared with other galac-
taStrSucs using a ran-qe of doses. Other surrogate
outctril'r3S , L'e inr estigated such as decreased
incide:rce r.i lc.te gastroenteritis and respiratory
The ::i:,lrS r;\ 3 rtr attlliations with any
d*g ctrll-tp.litt35. T::s :e.elr--h uas not funded
1,1 an1 rns:r: ::ron. Tlr-e g-illtrrs rre members of a
pediatncs ,Jeptarrmenl i:J: :i , ke,. plarer in the
promoti on of brea>tteeCr n g
1. Sokol, Ellen, Thiagarajah. Shanti. -\llain. -{:rne,res
(1998) Breastfeeding by the Numbers. Breakins the
Rules, Stretching the Rules. LINICEF International
Code of Documentation Center
2. Co, Mary Antonette MD, Hernandez, Emilio Jr.
MD, Co, Benjamin MD (2002) A comparative Study
on the Efficacy of the Different Galactagogues
among Mothers with Lactational Insufficiency. The
Philippine Journal of Pediatrics April-June 2002 vol
3. Magat, Severino, Raqepo, Ma. Cecilia, Pabustan
Carmelita (2009). Mineral Macro-Nutrients, Micro-
nutrients and other Elements in Leaves of Malung-
gay plant (Morina Oleifera) sampled in Some Loca-
tions in the Philippines. Phlippine Coconut Author-
ity- CANFARMS Technology-Advisory Notes, Sept
4. Fahey, Jed (2005) Moringa Oleifera: A Review of
the Medical Evidence of Its Nutritional, Therapeu-
tic, and Prophylactic Properties. Trees for Life Jour-
nal 2005, 1:5 http:l/
article.php I 200 5 120 | 12493 I 5 86
5. Neville, Margaret, Allen, Jonathan, Archer Philip,
Casey, Clare, Seacat, Joy, Keller, Ronald, Lukes,
Valerie, Rasbach, Jean, Neifert, Marianne (1991).
Studies in human lactation; milk volume and nutri-
ent composition during weaning and lactogenises
AM J Clinc Nutri 1991; 5481-92 retrieved
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King, KS et al
Yabes- Almirante, Corazon and Lim MD (1996)
Effectiveness of Natalac as a Galactagogue. JPMA
Jan-March 1996 7 l:30 265-272
Osadchy, Alla, Moretti AMyla, Koren, Gideon
(2012). Effect of Domperidone on Insufficient Lac-
tation in Puerperal Women: A systematic review and
Meta-Analysis of Randomrzed Controlled Trials.
Obstetrics and Gynecology International 2012: ppl -
7 doi: 10. 1 1 5120121642893,retrieved (101301 12)
Wan, Elise W-X, Davey, Kaye, Page-Sharp. Madhu-
Hartmann, Peter, Simmer, Karren, Ilett. Kennetil
(2008). Dose-Effect Study of Domperidone as f,
Galactagogue in Preterm Mothers u.ith Insultl''ie::
Milk Supply, and its Transfer into \lilk B::: .:-
Journal of Clinical Pharmacologl'66:l r ':J-'r'r
Horta, Bernardo MD PllD. Bahl. Rrr: \ID P:.f-
Martines" Jose \ID PhD. \ ic:t':.;. C:s.: \iD P:D
(2001). Er idence on the Lc'::-T:::t'. E :t:c:s .ri
Breastfeedins: Sr stent:ti.- Rir reu and \leta-
anah'sis. Genera. Sri itzerland: \\HO
Briton-\ledrano. Glezel \1D. Perez. \'Ia. Lucila MD
(100-t ). The Etticac,v of lvtalunggay (Moringa Oleif-
era) given to near term pregnant women during early
postpartum breastmilk production- A Double Blind
Randomized Controlled Trial, unpublished. Re-
trieved (l0l30l12)
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Lactation and their Management. Journal de Pedia-
trra 2004;80:s 1 47-s 1 54, retriev ed I I 17 I 12
Balahibo, Marlon, Balde, Jennifer, Baldovino, Zea,
Barredo-Carlo, Madarcos, Floro Md. Mendoza, Su-
zette MD (2002) A Randomized Double Blinded
Parallel-Controlled Clinical Trial On the Effective-
ness of Different Doses of Moringa Oleifera
(Malunggay) in Promoting Growth in Infants of
Breastfeeding Mothers from UERMMMC and Dif-
ferent Hospitals In Metro Manila from June 2000-
Jan 2001. UERMMMC Journal of Health Sciences
2002 Jan - April 5(1):21-27
Espinosa-Kuo, Criselda, MD (2005) A Randomized
Controlled Trial on the Use of Malunggay (Moringa
Oleifera) for Augmentation of the volume of Breast-
milk among Mothers of Term Infants. The Fil Fam-
ily Physician 2005 Jan-Mar a3(l): 26-33
Estrella. Ma. Corazon, MD, Mantaring, Jacinto Blas
MD. David. Grace MD. Taup, Michelle MD (2000)
A Double-Blind. Randomized Controlled Trial on
the use of Malunggal' (Nloringa Oleifera_ for Aug-
mentation of the Volume of Breastmilk Among Non
-Nursing Mothers of Preterm Infants. Tlie Philippine
Journal of Pediatrics Jan-Mar 2000 r ol -19 t 1 l: ,1-6
... Moringa is also recognized as an herbal galactagogue due to its high content of macro-and micronutrients that stimulate milk production in lactating mothers [34]. It has been widely studied [28,30,[35][36][37] for its galactogenic properties, and scientific evidence proves its positive effect on the production of breast milk, supporting the growth of newborns. Moringa is considered to be a nutritious food supplement that can save human lives, particularly in countries with poor nutrition. ...
... During the critical period of pregnancy and postpartum, nutrition plays a pivotal role in ensuring optimal health for both the mother and the child. Failing to provide sufficient macronutrients or micronutrients during this time can result in lifelong effects on neurodevelopment, as illustrated the study of King et al. [35]. Therefore, optimizing the nutritional intake of both the mother and baby is crucial to improving maternal and infant health outcomes. ...
Full-text available
Moringa is a plant commonly used for its medical properties. However, studies have shown contradictory results. The aim of this review is to evaluate the possible association between the use of Moringa during pregnancy and breastfeeding in relation to the health status of both the mother and the baby. A search of the PubMed and EMBASE databases on the literature published during the period 2018–2023 was conducted up until March 2023. The population/exposure/comparison/outcome (PECO) approach was used to select studies on pregnant women, mother–child pairs, and the use of Moringa. Out of the 85 studies initially identified, 67 were excluded, leaving 18 for full-text evaluation. After assessment, 12 were finally included in the review. In the articles included in this work, Moringa is administered during pregnancy or in the postnatal period in the form of leaf powder (MOLP), as a leaf extract (MLE), as an ingredient associated with other supplements or in preparations. It appears to influence several variables during pregnancy and in the postnatal period such as the mother’s haematochemical profile, milk production, the child’s socio-personal development and the incidence of morbidity during the first 6 months of life. None of the studies analysed reported contraindications to the use of the supplement during pregnancy and lactation.
... 4,5 Moringa leaves are also rich in phytosterol which has a lactogum effect to increase milk production. 6 Diversification of processed Moringa leaves is very important to facilitate the consumption process considering the very high content of phytopharmaca in the Moringa. 7 Provision of Moringa leaf biscuits as an additional snack for pregnant and lactating mothers is thought to be able to increase milk production. ...
... 7 Provision of Moringa leaf biscuits as an additional snack for pregnant and lactating mothers is thought to be able to increase milk production. 6 From previous studies, it was found that the taste of Moringa biscuits was well accepted at the level of substitution of Moringa flour 5---10%. 8 This study aims to analyze the effect of Moringa leaf biscuits in increasing production and nutrient content in breastmilk. ...
Objective This study aims to analyze the effect of moringa cookies consumption to improve the quality of breastmilk on exclusive breastfeeding mothers. Method This was an experimental study with pre and post control group design. The intervention group consumed 50 grams of moringa cookies for a month. The quality of breast milk was measured by analyzing carbohydrate, protein, fat, and vitamin A level. Data were analyzed using independent T-test. Results There was an increase in the levels of fat, protein, carbohydrate and vitamin A in breast milk in both the intervention and control groups (fat level in intervention group (2.8587 ± 0.1149) vs control group (2.8694 ± 0.1098), p = 0.145; protein level in intervention group (1.5135 ± 0.1566) vs control group (1.5692 ± 0.1343), p = 0.029; vitamin A level in intervention group (0.0067 ± 0.0008) vs control group (0.0067 ± 0.0072), p = 1.000; carbohydrate level in the intervention group (7.1677 ± 0.5205) vs control group (7.2344 ± 0.6831), p = 0.565. Only protein levels increased significantly in the intervention groups compared to the control groups (p < 0.05). Conclusion This study showed that consumption of moringa cookies increase the quality of breast milk especially protein level.
... And the leaves together with the immature seed pods are used as food products [4]. Moringa oleifera leaves increases the volume of breast milk by increasing prolactin and providing essential nutrients [2,5]. It takes about 24 h after ingestion for the Moringa oleifera to work [6,7]. ...
Full-text available
Objectives Moringa oleifera is an herbal galactagogue that is used to increase the volume of breast milk. The objective of this study was to evaluate the efficacy of Moringa oleifera leaves in increasing the volume of breast milk in early postpartum mothers. Methods A randomized, double-blinded, placebo-controlled trial was conducted. Eighty-eight postpartum women were randomized to either the study group receiving oral Moringa oleifera capsules or to the control group receiving oral placebo capsules. Results There was no difference in median breast milk volume on the third day of postpartum between the Moringa oleifera leaf group and the control group (73.5 vs 50 ml, p = 0.19). However, the amount of breast milk in the Moringa oleifera group was 47% more than the one in the control group. The exclusive breastfeeding rate at 6 months in this study was 52.3% in the Moringa oleifera group, which met the goals set by the World Health Organization. Conclusions Even 900 mg/day of the Moringa oleifera leaf could not significantly increase breast milk volume in early postpartum mothers, but the amount of breast milk in the Moringa oleifera group was 47% more than the one in the control group. The exclusive breastfeeding rate at 6 months in the Moringa oleifera group achieved the goals set by the WHO. Therefore, Moringa oleifera leaf may be used as a galactagogue herb to increase the volume of breast milk.
... Drumstick leaves possess the ability to increase prolactin levels and induce milk production in lactating mothers. Ginger is commonly known to stimulate milk supply, most common ingredient used traditionally for lactation mothers (Budzynska et al., 2012;Co et al., 2002;King et al., 2013). Hence, this was used as an important galactagogue concoction component. ...
Dysgalactia is one of the major problems among breastfeeding mothers, where they are unable to produce adequate amount of breast milk. Poor or inadequate milk production with partial failure in lactation initiation or its continuation affects the child’s growth. Decreased secretion of serum prolactin is the major reasons for inadequate milk production. To tackle the problem of insufficient milk production, a study was undertaken with an objective of developing galactagogue products. Herbal ingredients like Moringa leaves, ginger and mint were used to develop moringa herbal tea concoction with different flavours. Further, best accepted product was subjected for macronutrients and minerals estimation. Standard AOAC protocols were used for macronutrients and micronutrients estimation. Total antioxidant activity was also best assessed by standard protocol. Moringa tea concoction containing both ginger and mint flavour recorded the highest acceptability scores by sensory panel members (n=50). Nutritional quality evaluation revealed the presence of good amount of macronutrients and minerals content in best accepted moringa tea concoction with both mint and ginger flavour. It has shown the highest calcium and iron content with the value of 1406±5.56 mg/100 g and 12.33±0.47 mg/100 g respectively. Calcium serves as an important essential mineral in the secretion of prolactin and oxytocin in breast feeding mothers. Where, prolactin has vital role in milk production and oxytocin needed for ejection of breast milk. Therefore, best accepted herbal tea being a rich source of calcium, is proposed to help produce good amount of breast milk and its ejection by enhancing the secretion of prolactin and oxytocin.
... Moringa oleifera capsule intake increased milk production by increasing serum prolactin levels. It caused significant increase in the weight of infants (52)(53)(54)(55) . ...
Full-text available
Milk production is essential for optimal feeding of infants. The most common lactogenic drugs are dopamine 2 antagonists, oxytocin, recombinant bovine somatotropin (rBST), thyrotropin releasing hormone (TRH) and estrogenic drugs. However, many medicinal plants possess lactogenic effects in humans and animals. The current review focused on medicinal plants with lactogenic effect as natural sources of galactogogues characterized by efficacy and safety.
... Moringa oleifera leaves and immature seed pods are used as food products [4]. Moringa oleifera leaves increases breastmilk volume by increasing prolactin and providing essential nutrients [2,5]. It takes about 24 hours after ingestion for the Moringa oleifera to work [6,7]. ...
Full-text available
Moringa oleifera is an herbal galactagogue that has been used to increase the volume of breastmilk. Few studies have evaluated the effect of Moringa oleifera in breastfeeding. There are conflicting data whether it can increase the volume of breastmilk or not. Thus, the objective of this study is to evaluate the efficacy of Moringa oleifera leaves in increasing the volume of breastmilk in early postpartum mothers. A randomized, double-blind, placebo-controlled trial will be conducted. The outcomes of this study will provide the data of Moringa oleifera as an herbal medication to increase the volume of breastmilk. This information will be used to increase the rate of exclusive breastfeeding for the first 6 months as recommended by the World Health Organization. Clinical trial registration This clinical trial was registered at (Clinical trials registration: NCT04487613 ).
... Moringa leaves have certain quality as alactagogum (i.e. increasing breast milk secretion) [4, 54,55] as it contains aphytosterol compound which help in increase of milk production in breastfeeding mothers [56]. Moringa flour is one foodstuff used in the process of making dried noodles as a food improvement that can enhance the productivity of mothers' breast milk. ...
... 39 These results merit more investigation, as malunggay leaves are commonly used among breastfeeding mothers in the Philippines to augment breast milk production, and a pooled analysis of 6 studies on the efficacy of Moringa oleifera (some of which were not identified for this review because of inclusion criteria) demonstrated a significant increase in milk produced 4-7 days after treatment. 74 The change in serum prolactin levels was measured in 1 of the studies of malunggay leaves, and prolactin was significantly higher in the treatment group compared to the placebo group. 39 In a 2015 study by Stohs and Hartman, no adverse events were reported in single doses up to 50 g or when a dose of 8 g/d was sustained for 40 days in human models or at doses up to 2,000 mg/kg body weight in rats. ...
Full-text available
Background: Therapeutic approaches to addressing insufficient lactation are available but remain poorly understood. Current trends in maternal health, such as increasing rates of obesity, delayed age at childbearing, and high rates of cesarean section, may be associated with physiological challenges for lactation that cannot be managed by counseling alone. Women who have not had success with counseling alone, including adoptive mothers seeking to induce lactation, may use galactagogues (pharmaceutical and herbal compounds used to increase lactation). We present a review of selected studies of galactagogues and data indicating popular demand for such products. Methods: A systematic search was conducted for published studies on the use of galactagogues for breast-feeding. The following databases were searched: MEDLINE (PubMed), EBSCO (Academic Search Complete), and EMBASE. The search was conducted between July 15, 2015, and August 18, 2015; only English language articles were included, and we imposed no restrictions on publication date. Two authors independently reviewed the studies and extracted data. Results: Blinded, placebo-controlled clinical trials of 2 pharmaceutical galactagogues (domperidone and metoclopramide) and 5 popular herbal galactagogues (shatavari, fenugreek, silymarin, garlic, and malunggay) were identified. All of the studies identified for domperidone showed a significant difference in milk production between the treatment and placebo groups. Of the 6 trials of metoclopramide, only 1 study showed a significant difference in milk production compared to placebo. Results of the clinical trials on herbal galactagogues were mixed. Our review of the evidence for the efficacy of popular pharmaceutical and herbal galactagogues revealed a dearth of high-quality clinical trials and mixed results. Conclusion: Health providers face the challenge of prescribing or recommending galactagogues without the benefit of robust evidence. Given the suboptimal rates of exclusive breast-feeding worldwide and the availability and demand for medical and herbal lactation therapies, controlled trials and analyses investigating these medicines are urgently warranted.
... We conducted an update on a previously published systematic review on the use of Moringa compared with placebo in increasing breastmilk production, infant's weight gain, serum prolactin levels, success of exclusive breastmilk production, and adverse effects. 5 Thirty-three titles and abstracts were retrieved from electronic databases (Medline, HER-DIN, Scopus, and Google Scholar), hand searching, and reference tracking. The literature search was limited to human clinical trials using the search terms ''Moringa oleifera,'' ''Moringa pterygosperma,'' ''Moringa,'' ''drumstick tree,'' ''horseradish tree,'' and ''Ben oil tree.'' ...
Background: Many women express concern about their ability to produce enough milk, and insufficient milk is frequently cited as the reason for supplementation and early termination of breastfeeding. When addressing this concern, it is important first to consider the influence of maternal and neonatal health, infant suck, proper latch, and feeding frequency on milk production, and that steps be taken to correct or compensate for any contributing issues. Oral galactagogues are substances that stimulate milk production. They may be pharmacological or non-pharmacological (natural). Natural galactagogues are usually botanical or other food agents. The choice between pharmacological or natural galactagogues is often influenced by familiarity and local customs. Evidence for the possible benefits and harms of galactagogues is important for making an informed decision on their use. Objectives: To assess the effect of oral galactagogues for increasing milk production in non-hospitalised breastfeeding mother-term infant pairs. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register,, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), Health Research and Development Network - Phillippines (HERDIN), Natural Products Alert (Napralert), the personal reference collection of author LM, and reference lists of retrieved studies (4 November 2019). Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs (including published abstracts) comparing oral galactagogues with placebo, no treatment, or another oral galactagogue in mothers breastfeeding healthy term infants. We also included cluster-randomised trials but excluded cross-over trials. Data collection and analysis: We used standard Cochrane Pregnancy and Childbirth methods for data collection and analysis. Two to four review authors independently selected the studies, assessed the risk of bias, extracted data for analysis and checked accuracy. Where necessary, we contacted the study authors for clarification. Main results: Forty-one RCTs involving 3005 mothers and 3006 infants from at least 17 countries met the inclusion criteria. Studies were conducted either in hospitals immediately postpartum or in the community. There was considerable variation in mothers, particularly in parity and whether or not they had lactation insufficiency. Infants' ages at commencement of the studies ranged from newborn to 6 months. The overall certainty of evidence was low to very low because of high risk of biases (mainly due to lack of blinding), substantial clinical and statistical heterogeneity, and imprecision of measurements. Pharmacological galactagogues Nine studies compared a pharmacological galactagogue (domperidone, metoclopramide, sulpiride, thyrotropin-releasing hormone) with placebo or no treatment. The primary outcome of proportion of mothers who continued breastfeeding at 3, 4 and 6 months was not reported. Only one study (metoclopramide) reported on the outcome of infant weight, finding little or no difference (mean difference (MD) 23.0 grams, 95% confidence interval (CI) -47.71 to 93.71; 1 study, 20 participants; low-certainty evidence). Three studies (metoclopramide, domperidone, sulpiride) reported on milk volume, finding pharmacological galactagogues may increase milk volume (MD 63.82 mL, 95% CI 25.91 to 101.72; I² = 34%; 3 studies, 151 participants; low-certainty evidence). Subgroup analysis indicates there may be increased milk volume with each drug, but with varying CIs. There was limited reporting of adverse effects, none of which could be meta-analysed. Where reported, they were limited to minor complaints, such as tiredness, nausea, headache and dry mouth (very low-certainty evidence). No adverse effects were reported for infants. Natural galactagogues Twenty-seven studies compared natural oral galactagogues (banana flower, fennel, fenugreek, ginger, ixbut, levant cotton, moringa, palm dates, pork knuckle, shatavari, silymarin, torbangun leaves or other natural mixtures) with placebo or no treatment. One study (Mother's Milk Tea) reported breastfeeding rates at six months with a concluding statement of "no significant difference" (no data and no measure of significance provided, 60 participants, very low-certainty evidence). Three studies (fennel, fenugreek, moringa, mixed botanical tea) reported infant weight but could not be meta-analysed due to substantial clinical and statistical heterogeneity (I2 = 60%, 275 participants, very low-certainty evidence). Subgroup analysis shows we are very uncertain whether fennel or fenugreek improves infant weight, whereas moringa and mixed botanical tea may increase infant weight compared to placebo. Thirteen studies (Bu Xue Sheng Ru, Chanbao, Cui Ru, banana flower, fenugreek, ginger, moringa, fenugreek, ginger and turmeric mix, ixbut, mixed botanical tea, Sheng Ru He Ji, silymarin, Xian Tong Ru, palm dates; 962 participants) reported on milk volume, but meta-analysis was not possible due to substantial heterogeneity (I2 = 99%). The subgroup analysis for each intervention suggested either benefit or little or no difference (very low-certainty evidence). There was limited reporting of adverse effects, none of which could be meta-analysed. Where reported, they were limited to minor complaints such as mothers with urine that smelled like maple syrup and urticaria in infants (very low-certainty evidence). Galactagogue versus galactagogue Eight studies (Chanbao; Bue Xue Sheng Ru, domperidone, moringa, fenugreek, palm dates, torbangun, moloco, Mu Er Wu You, Kun Yuan Tong Ru) compared one oral galactagogue with another. We were unable to perform meta-analysis because there was only one small study for each match-up, so we do not know if one galactagogue is better than another for any outcome. Authors' conclusions: Due to extremely limited, very low certainty evidence, we do not know whether galactagogues have any effect on proportion of mothers who continued breastfeeding at 3, 4 and 6 months. There is low-certainty evidence that pharmacological galactagogues may increase milk volume. There is some evidence from subgroup analyses that natural galactagogues may benefit infant weight and milk volume in mothers with healthy, term infants, but due to substantial heterogeneity of the studies, imprecision of measurements and incomplete reporting, we are very uncertain about the magnitude of the effect. We are also uncertain if one galactagogue performs better than another. With limited data on adverse effects, we are uncertain if there are any concerning adverse effects with any particular galactagogue; those reported were minor complaints. High-quality RCTs on the efficacy and safety of galactagogues are urgently needed. A set of core outcomes to standardise infant weight and milk volume measurement is also needed, as well as a strong basis for the dose and dosage form used.
Full-text available
OBJECTIVES: To determine if there is a significant difference in the volume of breastmilk on postpartum days 3 to 5 among mothers with preterm infants who were randomized to take malunggay (Moringa oleifera) leaves compared to those who were given placebo. SETTING: Tertiary government hospital STUDY DESIGN: Double-blind, randomized controlled trial PATIENTS AND METHODS: A total of 68 postpartum mothers admitted in a tertiary government hospital and whose infants had pediatric ages of less than 37 weeks and admitted to the NICU for tube feedings were included in the study. The mothers were randomized to receive Moringa oleifera(encapsulated in a commercial preparation containing 250 mg of leaves) or an identical capsule containing flour as placebo. Participants were asked to express milk using a standardized breastpump from day 1 to day 5 postpartum. The mothers were given capsules on postpartum days 3 to 5 . The contents of the capsules were unknown to both Investigator and subjects. T-test was used to determine differences in quantitative baseline variables. Chi-square was used to determine difference in baseline proportions. One- way ANOVA was used to determine if there were significant differences in the volume of breastmilk between treatment and control groups. A p-value of <0.05 was considered significant. RESULTS: There was a trend towards increased milk production among those on Moringa oleifera leaves (Day 3: 114.1 ml ± 62.9 vs. 87.2 ± 49.1; Day 4: 190 ml ± 103.5 vs. 128.8 ± 84.9; Day 5: 319.7 ml ± 154.10 vs. 120.2 ±54.7). This was statistically significant on Day 4 (p =0.007) and on Day 5 (p = 0.000). CONCLUSION: Moringa oleifera leaves increase milk production on postpartum days 4 to 5 among mothers who delivered preterm infants. KEYWORDS: breastmilk, malunggay
Full-text available
Moringa oleifera, or the horseradish tree, is a pan-tropical species that is known by such regional names as benzolive, drumstick tree, kelor, marango, mlonge, mulangay, nébéday, saijhan, and sajna. Over the past two decades, many reports have appeared in mainstream scientific journals describing its nutritional and medicinal properties. Its utility as a non-food product has also been extensively described, but will not be discussed herein, (e.g. lumber, charcoal, fencing, water clarification, lubricating oil). As with many reports of the nutritional or medicinal value of a natural product, there are an alarming number of purveyors of "healthful" food who are now promoting M. oleifera as a panacea. While much of this recent enthusiasm indeed appears to be justified, it is critical to separate rigorous scientific evidence from anecdote. Those who charge a premium for products containing Moringa spp. must be held to a high standard. Those who promote the cultivation and use of Moringa spp. in regions where hope is in short supply must be provided with the best available evidence, so as not to raise false hopes and to encourage the most fruitful use of scarce research capital. It is the purpose of this series of brief reviews to: (a) critically evaluate the published scientific evidence on M. oleifera, (b) highlight claims from the traditional and tribal medicinal lore and from non-peer reviewed sources that would benefit from further, rigorous scientific evaluation, and (c) suggest directions for future clinical research that could be carried out by local investigators in developing regions. This is the first of four planned papers on the nutritional, therapeutic, and prophylactic properties of Moringa oleifera. In this introductory paper, the scientific evidence for health effects are summarized in tabular format, and the strength of evidence is discussed in very general terms. A second paper will address a select few uses of Moringa in greater detail than they can be dealt with in the context of this paper. A third paper will probe the phytochemical components of Moringa in more depth. A fourth paper will lay out a number of suggested research projects that can be initiated at a very small scale and with very limited resources, in geographic regions which are suitable for Moringa cultivation and utilization. In advance of this fourth paper in the series, the author solicits suggestions and will gladly acknowledge contributions that are incorporated into the final manuscript. It is the intent and hope of the journal's editors that such a network of small-scale, locally executed investigations might be successfully woven into a greater fabric which will have enhanced scientific power over similar small studies conducted and reported in isolation. Such an approach will have the added benefit that statistically sound planning, peer review, and multi-center coordination brings to a scientific investigation.
Full-text available
Background. There is a controversy within the medical community regarding the role of domperidone as a galactagogue and the drug has been removed from the US market owing to safety concerns. Objective. To perform a systematic review and meta-analysis of the available data assessing the effect of domperidone on breast milk production in women experiencing insufficient lactation. Study Selection. Randomized controlled trials (RCTs) examining the effect of domperidone on breast milk production of puerperal women were eligible for inclusion. Data Analysis. Absolute and relative changes from baseline were calculated for individual studies and pooled using a random effects model. Results. Three RCTs including 78 participants met the inclusion criteria. All showed a statistically significant increase in breast milk production following treatment with domperidone. The analysis of pooled data demonstrated a statistically significant relative increase of 74.72% (95%  CI = 54.57; 94.86, P < 0.00001) in daily milk production with domperidone treatment compared to placebo. No maternal or neonatal adverse events were observed in any of the trials. Conclusions. Evidence from a few small RCTs of moderate to high quality suggests that domperidone produces a greater increase in breast milk supply than placebo.
Full-text available
Concentrations and secretion rates of macronutrients and major ions in human milk during lactogenesis (birth to 8 d) and late lactation (greater than 6 mo postpartum) are reported. Postpartum changes in lactose, sodium, and chloride concentrations signalled closure of the paracellular pathway during days 1-2. From days 2 to 4 postpartum, initiation of copious milk secretion was accompanied by significant increases in citrate, free phosphate, glucose, and calcium concentrations and a decrease in pH. During weaning, significant changes in milk protein, lactose, chloride, and sodium concentrations were observed only when milk volume fell below 400 mL/d; more than one feed per day was necessary to maintain milk secretion. Temporal changes in the concentration of other milk components, except glucose and magnesium, were not different in weaning and non-weaning women. Differences between the relation of milk volume and composition during lactogenesis and weaning suggest that volume is differently regulated in the two periods.
To present an updated review on common problems associated with breastfeeding and their management. A comprehensive bibliographic review on the issue was performed by searching publications from the MEDLINE database and from national and international organizations. Books and some key articles cited in other sources were also selected. Several common problems that may arise during the breastfeeding period, such as breast engorgement, plugged milk duct, breast infection and insufficient milk supply, originate from conditions that lead the mother to inadequate empty the breasts. Incorrect techniques, not frequent breastfeeding and breastfeeding on scheduled times, pacifiers and food suppliers are important risk factors that can predispose to lactation problems. The adequate management of those conditions is fundamental, as if not treated they frequently lead to early weaning. There are specific measures that should be taken to empty the breasts effectively. Besides, the emotional support and actions that yield more comfort to the lactating mother can not be neglected. Most common problems associated with breastfeeding can be prevented if the mother empties her breasts effectively. If they occur, they should be carefully and adequately approached, thus avoiding the early weaning resultant from painful and stressing situations the mother may face.
Effectiveness of Natalac as a Galactagogue
  • Corazon Yabes-Almirante
  • M D Lim
Yabes-Almirante, Corazon and Lim MD (1996) Effectiveness of Natalac as a Galactagogue. JPMA Jan-March 1996 7 l:30 265-272
A Randomized Controlled Trial on the Use of Malunggay (Moringa Oleifera) for Augmentation of the volume of Breastmilk among Mothers of Term Infants. The Fil Family Physician
  • Criselda Espinosa-Kuo
  • Md
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Mineral Macro-Nutrients, Micronutrients and other Elements in Leaves of Malunggay plant (Morina Oleifera) sampled in Some Locations in the Philippines
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