Moringa oleifera as a Galactagogue.

Moringa is an herbal galactagogue that has been widely used in the Philippines and some parts of the world. Recent systematic reviews on herbal galactagogues have appraised the use of several herbs but failed to include Moringa. Dr. E. Quisumbing was the first scientist in the Philippines to do a study on its lactogenic properties in 1987. In 1996, Yabes-Almirante and Lim further determined a causal relationship of Moringa capsule intake with increased milk production by demonstrating increased serum prolactin levels. 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. Thirty-three titles and abstracts were retrieved from electronic databases (Medline, HERDIN, 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.’’ Six randomized, placebo-controlled, blinded, clinical trials were included in the analyses, five of which were published in the Philippines. All studies were done among Filipinos. Two were done in a community, and four were done in tertiary hospitals. Pooling of studies revealed a significant mean increase in milk volume on Day 7 (Fig. 1) among mothers who received Moringa by 124 mL (95% confidence interval, 90–159 mL; heterogeneity I = 0%; p = 0.32). Milk volume on Days 4 and 5 also favored the Moringa group as well, but the comparison showed significant heterogeneity, probably because of differences in postnatal age of infant, timing of breastmilk collection, and maternal age difference. Of particular interest is the difference in study designs between preterm and term infants. Milk collection for preterm infants involved breastmilk expression either by hand or by machine, and the infants were fed through gavage. For term infants, on the other hand, milk expression and measurement of outcome were done after breastfeeding. This resulted to measurement of residual volume after initial emptying by the baby. The reported milk volume for term infants may therefore be an underestimate. Pooled analysis of the two studies with a total of 73 patients showed a significant increase in the weight of infants during week 4 with a mean difference of 11.9% (95% confidence interval, 5.5–18.2%; heterogeneity I = 0%; p= 0.61), which favors the experimental group. The lactogenic effect of Moringa is hypothesized to be the induction of prolactin production in the anterior pituitary gland. The two studies (Fig. 2) that reported on prolactin levels showed that patients in the Moringa group had higher levels with a statistically significant mean increase of 19.5 · 10 mIU/L (95% confidence interval, 16.8–22.2 · 10 mIU/L; heterogeneity I = 44%; p = 0.18). Timing of outcome measurement is indeed an important variable because growth of infants is dependent on their postnatal age, and prolactin serum levels have varying levels across postpartum days. Safety profile was merely obtained through self-report, of which no adverse event was seen among the six studies. There were no studies that investigated exclusive breastfeeding as an outcome. Overall, these six randomized controlled trials suggest that Moringa can result in a significant increase in breastmilk volume on Day 7. It also results in improvement in the infants’ weight gain. This herbal galactagogue also shows a