Oral metoclopramide boosts lactogenesis II in mothers with preterm infants: a randomized placebo-controlled trial.

Background: Preterm mothers at risk of delayed lactogenesis II may benefit from early pharmcological intervention to initiate breastfeeding onset. Research aim. To evaluate the effect of oral metoclopramide on lactogenesis II in mothers of preterm infants commencing within twelve hours of delivery. Methods: From April 2006 to May 2009,105 women were randomized to metoclopramide (term births, n=36;reterm n=20) or placebo (term,n=33;preterm,n=16). Mothers received 30 mg of oral metoclopramide daily for the first postnatal week in a randomized double-blinded placebo-controlled study. Primary outcome was augmentation of Lactogenesis II onset by postnatal day 3. Secondary outcomes were daily expression of breastmilk and maternal perception of lactogenesis II, breastfeeding practice and infant weight change over 6 months. Results: Metoclopramide achieved 25% augmentation in lactogenesis II onset (p=0.09) with greater expressed human milk volumes in mothers of preterm infants. Daily expressed human milk volumes was higher among preterm mothers on metoclopramide compared to term placebo mothers who served as controls, significant on day 2 (19.9 vs 2.4ml, p=0.04) and day 3 (32.6 vs 8.8ml,p=0.04),and total expressed human milk volumes had increased by 8.2 fold by the end of week one. Most mothers reported first initiation of lactogenesis II by day 6, with 95-100% of term mothers confirmed by day 5 (not significant). Conclusions: Short-term metoclopramide use starting within 12 postnatal hours boosted lactogenesisi II onset in preterm mothers, improving daily expressed human milk production and maternal perception of lactogenesis II onset.