EFFICACY AND SAFETY OF THE GALACTAGOGUES, DOMPERIDONE AND METOCLOPRAMIDE, IN BREASTFEEDING: A SYSTEMATIC REVIEW AND META-ANALYSIS

Problem Statement

Breastfeeding imparts indispensable sustenance to the newborn. The United Nations Children`s Fund reported in 2018 that in lower middle-income countries like the Philippines, 1 in 25 babies are never breastfed. One of the major reasons why mothers are unable to do so is low milk supply. Literature on the use of galactagogues to improve lactation are debatable given the limited evidence-based sources. This study was conducted to evaluate the efficacy and safety of Domperidone and Metoclopramide in breastfeeding.

Method

Academic Databases like PubMed, ProQuest, Cochrane and Google Scholar were utilized to identify eligible studies that investigated the effect of Domperidone and Metoclopramide on breastmilk production, as well as their safety among breastfeeding mothers. Literature search included studies from 1983 to 2022. Systematic review to synthesize qualitative data and meta-analysis to synthesize quantitative data were carried out on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). The meta-analysis was done using MetaXL with a significance level of 0.05. Risk Ratio (RR) for dichotomous variables while Weighted Mean Difference (WMD) for continuous variables were used, both at 95% confidence interval (CI). The Mantel-Haenszel method was utilized to determine the pooled results in a random effect model on the incidental side effects events/cases data. Heterogeneity was analyzed from the Chi-square and I2 statistics results from each of the pooled analysis.

Results

Twelve studies were eligible for qualitative analysis and 9 for quantitative analysis. Data on Domperidone consistently demonstrated a statistically significant increase in breast milk production, with overall pooled outcome showing an increase of 135.87 mL/day (36.81-234.92, 95% CI). Data on Metoclopramide, however, showed conflicting results. In terms of maternal side effects, analysis showed no significant difference among Domperidone, Metoclopramide and placebo.

Conclusion

Domperidone is safe and effective in increasing breast milk volume and there is ample evidence to support its use among lactating mothers. Due to the small number of studies that establish the efficacy of Metoclopramide, and the wide variation in treatment duration among the studies, further investigations are warranted to make the data more conclusive.