Patterns and Determinants of Prolonged Galactagogue use among Mothers of Preterm Infants: A Secondary Analysis of the FILM Trial

Abstract

Galactagogues are substances used to enhance breastmilk production in lactating mothers. They can be categorized into oral pharmaceutical drugs and powdered lactation supplements. While intended for short-term use, concerns arise regarding prolonged intake, particularly when prescribed on an asneeded basis. This study examines the prevalence, prescribing patterns, and factors influencing prolonged galactagogue use among mothers of preterm infants (27–34 weeks gestation).This study is a secondary analysis of data from the FILM trial (CTRI/2022/10/046204), focusing on control group participants. A prospective observational approach was used to collect data between January 2022 and September 2024 in a tertiary care hospital. A total of 110 mothers of singleton preterm infants (27–336 weeks GA) were included. Data on galactagogue type (oral drug vs. powder form), initiation timing, dosage, prescribing patterns (routine vs. if necessary), and duration of use were analyzed. Logistic regression was performed to assess predictors of prolonged use, with results reported as adjusted odds ratios (AOR) and 95% confidence intervals (CI).Among 110 participants, 69 (62.7%) reported galactagogue use. Oral drugs were initiated at a median of 3 postnatal days (IQR: 2–5), while powdered supplements were commonly consumed once or twice daily. 31 (45.2%) of galactagogue users continued intake beyond prescription, and 20 (28.9%) used them without medical consultation. 27 (39.1%) of mothers who received SOS (if necessary) prescriptions transitioned to continuous use, citing concerns about milk supply. 45(65.3%) of galactagogue users inquired about discontinuation guidance. Mothers who received SOS prescriptions were 2.8 times more likely to continue using galactagogues beyond the prescribed duration (AOR 1.84, 95% CI: 1.32–6.10, p = 0.011). Additionally, mothers who perceived their milk supply as low were 3.2 times more likely to prolong use (AOR 2.21, 95% CI: 1.45–7.12, p = 0.004). Galactagogue use was common among preterm mothers, with a significant proportion continuing beyond prescription, particularly when prescribed on an SOS order. Uncertainty regarding discontinuation and maternal perceived low milk supply played key roles in prolonged use. Strengthening lactation counseling and clearer prescribing guidelines may help optimize galactagogue use and support maternal confidence in breastfeeding.