Table 1 Characteristics of included studies.
Author | Country | Participant characteristics | Intervention groupa | Control/ comparator groupa | Study duration | Day postpartum intervention initiated | Primary outcomes | Conflicts of interest/funding reported by study authors |
|---|---|---|---|---|---|---|---|---|
Estrella et al. [58] | Philipin es | Mean gestational age of infants (weeks): 33.7 ± 1.9 (intervention) 33.1 ± 2.3 (control) Mean age of mothers (years): 25.8 ± 5.1 (intervention) 30.9 ± 15.7 (control) | N = 31 One Moringa oleifera leaf capsules containing 250 mg of the leaves—orally twice daily. Total daily dose = 500 mg | Placebo—identical flour capsules (n = 37) | 5 days (galactagogue and placebo given from day 3 to 5 of study) | Day 3 | To determine if there is a significant difference in volume of breastmilk on postpartum days 3 to 5 between those given the placebo and the intervention | Not reported |
Reeder et al. [53] | USA | Mean gestational age of infants (weeks): 28.0 (intervention), 28.1 (control) Mean age of mothers (years): 25.8 (intervention) 27.4 (control) | N = 14 3 capsules of 575 mg fenugreek orally 3 times daily. Total daily dose = 5175 mg | Placebo—starch capsules (n = 12) | 21 days | Day 5 | Increase in breastmilk volume (no units stated) Increase in prolactin levels in ng/ml Adverse effects | Not reported |
Peila et al. [52] | Italy | Mean gestational age of infants (weeks): 29.0 (both intervention and control) Mean age of mothers (years): 35.0 (intervention) 33.0 (control) | N = 25 One BIO-C® sachet containing 252 mg micronised silymarin (corresponding to a dose of 420 mg Silybum marianum) orally twice daily. Total daily dose = 504 mg of silymarin | Placebo—maltodextrin sachet (n = 25) | 28 days | Day 10 ± 1 | Difference between mean milk production after 26, 27 and 28 days of administration and basal production in g/day | The authors received financial support from Milte Italia S.r.l.—the manufacturer of the herbal product used |
Zecca et al. [50] | Italy | Mean gestational age of infants (weeks): 31.5 (intervention) 30.6 (control) Mean age of mothers (years): 34.0 (intervention and control) | N = 50 Piùlatte® 5 g sachet containing silymarin- phosphatidylserine (400 mg phytosomes containing 130 mg silymarin and 130 mg phosphatidylserine) with 150 mg galega orally once dailyTotal daily dose = 5 g | Placebo—5 g of lactose (n = 25) | 25 days | Day 3 | Daily volume of milk produced (ml) | The authors declare no conflict of interest |
Demirci et al. [49] | USA | Five women delivered between 36 ± 0 and 36 ± 6 weeks, and 6 delivered between 37 ± 0 and 37 ± 6 weeks Participants ranged in age from 23 to 35 years | N = 6 Commercially available alcohol-free tincture herbal supplement (Motherlove®: More Milk Plus Alcohol Free containing fenugreek (Trigonella foenum- graecum), blessed thistle (Cnicus benedictus), nettle (Urtica dioica), and fennel (Foeniculum vulgare)) Participants were instructed to add the tincture to a palatable liquid <1 oz and drink it 3–4 times per day. The precise dosage was based on the mother’s weight, as advised by the manufacturer. | Meditation intervention via an Apple iPod Shuffle© (n = 5) There was a choice of three guided meditations lasting 5–8 min. Participants were instructed to listen to the meditations at least twice each day. | 9 days | Days 9–16 | Difference between infant weight pre and post intervention (g) Difference between volume of expressed milk pre and post intervention (ml) | The authors declare no conflict of interest |
Ozalkaya et al. [51] | Turkey | Mean gestational age of infants (weeks): 30.1 (intervention), 29.1 (control 1), 29.2 (control 2) Mean age of mothers (years): 28.8 (intervention), 29.7 (control 1), 27.7 (control 2) | N = 32 8 g orally twice daily of commercially available tea granules (Hipp Natal®) containing 1.0% nettle (Urtica dioica) and six other herbs (Melissa (Melisa officinalis L.), caraway (Carum carvi L.), anise (Pimpinella anisum), fennel (Foeniculum vulgare), goat’s rue (Galega officinalis), and lemon grass (Cymbopogon citratus)). Total daily dose = 16 g | Control group 1: placebo—8 g fruit tea (containing hibiscus, rosehip fruit powder, lemon, orange and apple aroma, vitamin C) (n = 32) Control group 2: advice on supportive measures (n = 21) | 7 days | Participants included ranged from a minimum of 3 to a maximum of 47 days postpartum, with a mean of 14–16 days between the three study arms | Daily breastmilk volumes in ml/day Weight gain of preterm infants in g Serum prolactin levels in ng/ml | The authors declare no conflicts of interest. |
Ranade and Mudgalkar [54] | India | Mean gestational age of infants (weeks): 31.2 (intervention), 30.2 (control) Mean age of mothers (years): 23.2 (intervention), 24.2 (control) | N = 23 2.5 g of Lepidium sativum seeds soaked in warm water for 30 min (n = 23) orally once daily. | No medication (n = 23) | 28 days | Not specified | The difference in milk production between the two groups at 28 days (ml) Adverse drug effects | The authors declare no conflict of interest. |
Wesolowska et al. [55] | Poland | Mean gestational age of infants (weeks): 31.8 (intervention), 31.4 (control) Mean age of mothers (years): 30.9 (intervention), 31.6 (control) | Femaltiker® sachet (80 mg powdered lemon balm leaves (Melissa officinalis L.); 5 g barley malt (Hordeum vulgare Linn) enriched with 70% barley beta-glucan—minimum 300 mg beta-glucans from barley per sachet) (n = 40) orally twice daily. Total daily dose = 2 sachets | Placebo—a blend of sucrose, apple fibre and natural aroma caramel (n = 40) | 14 days | Day 2 | Total volume of milk expressed by participants from the second to the 14th postnatal day (ml) Safety of the intervention | Nutropharma LLC sponsored the clinical trial—the manufacturer of Femaltiker®. Medela Ltd, Poland, rented the lactation equipment to the study authors free of charge |
Khalili et al. [56] | Iran | Mean gestational age of infants (weeks): 30.0(intervention), 30.0 (control 1), 29.0 (control 2) Mean age of mothers (years): 30.7 (intervention), 29.8 (control 1), 32.3 (control 2) | N = 45 3 g Pimpinella anisum seed herbal tea (2 g of dried anise seeds plus 1 g of black tea) orally 3x daily Total daily dose = 6 g of Pimpinella anisum seeds | Control group 1: placebo—3 g of dried black tea (n = 45) Control group 2: no treatment (n = 39) | 7 days | Day 3 | Daily milk volume (cc) Infant’s weight at day 3 and day 7 (g) | The authors declare no conflict of interest |
Izaddoost et al. [57] | Iran | Gestational age of infants (weeks): 29.91 ± 1.26 (intervention), 29.72 ± 1.25 (control group 1), 29.55 ± 1.03 (control group 2) Mean age of mothers (years): 30.17 ± 5.94 (intervention), 30.43 ± 6.78 (control group 1), 29.66 ± 7.49 (control group 2) | N = 50 10 ml orally of Lactuca sativa (lettuce) syrup divided 3× daily (syrup standardised based on total phenol content, containing at least 10 mg per 10 g of syrup). Total daily dose = 30 ml | Control group 1: Placebo—sugar syrup (n = 50) Control group 2: No intervention (n = 50) | 8 days | Day 3 | Primary outcomes: Time spent pumping milk Frequency of using the pump Time spent skin-to-skin with the infant (kangaroo care), Type and amount of any serums injected into the infant | The authors declare no conflict of interest |
Volume of pumped milk at the end of each day Infant weight at day 1 (before the intervention), day 3, day 5, and day 7 Secondary outcomes: Medication side effects |
