Breastfeeding Mothers’ Consumption and Perceived Efficacy of Foods, Beverages, and Herbal Supplements to Increase Milk Supply

Objectives Perceived insufficient milk is a common reason that mothers wean prior to the Academy of Pediatrics recommended 6 months of exclusive breastfeeding with continued breastfeeding through ≥ 12 months. Prior research indicates that mothers modify their dietary intake to address milk supply concerns. The current study fills a gap in the literature regarding the prevalence, perceived efficacy, and predictors of foods, beverages, and herbal supplements that U.S. mothers consume to increase milk supply. Methods Paid Facebook advertisements were used to recruit breastfeeding mothers (≥18 years, living in the U.S.) into an online, cross-sectional survey. Participants self-reported their demographic characteristics, breastfeeding experiences, and consumption and perceived efficacy of 11 foods, 7 beverages, and 9 herbal supplements for increasing milk supply. Descriptive statistics were calculated for all study variables. The association between maternal perceived insufficient milk and consumption of any foods/beverages (yes/no) or any herbal supplements (yes/no) to increase milk supply was examined via Fisher's exact tests. Results Participants (N = 192) primarily identified as white (90%) and married or partnered (94%); 15% were WIC participants. Most (84%) felt they produced enough milk to satisfy their child. Over half (55%) previously or currently consumed foods/beverages to increase milk supply, and 29% consumed herbal supplements. The most commonly consumed foods/beverages were oats (47%), sports drinks (34%), store-bought lactation cookies (26%) and lactation tea (20%). Store-bought lactation cookies were perceived as the most effective at increasing milk supply (50%). The most commonly consumed herbal supplement was a combination supplement (25%), of whom, 40% believed it increased milk supply. Fenugreek was the most commonly consumed single herbal supplement (13%); 42% believed it increased milk supply. Maternal perceived insufficient milk was associated with ever consuming foods/beverages to increase milk supply (p = .04), and herbal supplements (p = .02). Conclusions Many breastfeeding mothers consume foods, beverages and/or herbal supplements to increase milk supply, signaling an urgent need for research on the effects of dietary intake on human milk production, and maternal and child health outcomes. Funding Sources None.

The Development and Evaluation of a Text Message Program to Prevent Perceived Insufficient Milk Among First-Time Mothers: Retrospective Analysis of a Randomized Controlled Trial

Background Several recent trials have examined the feasibility and efficacy of automated SMS text messaging to provide remote breastfeeding support to mothers, but these texting systems vary in terms of design features and outcomes examined. Objective This study examined user engagement with and feedback on a theory-grounded SMS text messaging intervention intended to prevent perceived insufficient milk (PIM)—the single, leading modifiable cause of unintended breastfeeding reduction and cessation. Methods We recruited 250 nulliparous individuals intending to breastfeed between 13 and 25 weeks of pregnancy in southwestern Pennsylvania. Participants were randomly assigned with equal allocation to either an SMS intervention to prevent PIM and unintended breastfeeding reduction or cessation (MILK, a Mobile, semiautomated text message–based Intervention to prevent perceived Low or insufficient milK supply; n=126) or a control group receiving general perinatal SMS text messaging–based support via the national, free Text4Baby system (n=124). Participants in both groups received SMS text messages 3 to 7 times per week from 25 weeks of pregnancy to 8 weeks postpartum. The MILK intervention incorporated several automated interactivity and personalization features (eg, keyword texting for more detailed information on topics and branched response logic) as well as an option to receive one-on-one assistance from an on-call study lactation consultant. We examined participant interactions with the MILK system, including response rates to SMS text messaging queries. We also sought participant feedback on MILK content, delivery preferences, and overall satisfaction with the system via interviews and a remote survey at 8 weeks postpartum. Results Participants randomized to MILK (87/124, 70.2% white and 84/124, 67.7% college educated) reported that MILK texts increased their breastfeeding confidence and helped them persevere through breastfeeding problems. Of 124 participants, 9 (7.3%) elected to stop MILK messages, and 3 (2.4%) opted to reduce message frequency during the course of the study. There were 46 texts through the MILK system for individualized assistance from the study lactation consultant (25/46, 54% on weekends or after-hours). The most commonly texted keywords for more detailed information occurred during weeks 4 to 6 postpartum and addressed milk volume intake and breastfeeding and sleep patterns. MILK participants stated a preference for anticipatory guidance on potential breastfeeding issues and less content addressing the benefits of breastfeeding. Suggested improvements included extending messaging past 8 weeks, providing access to messaging for partners, and tailoring content based on participants’ pre-existing breastfeeding knowledge and unique breastfeeding trajectory. Conclusions Prenatal and postpartum evidence–based breastfeeding support delivered via semiautomated SMS text messaging is a feasible and an acceptable intervention for first-time mothers. To optimize engagement with digital breastfeeding interventions, enhanced customization features should be considered. Trial Registration ClinicalTrials.gov NCT02724969; https://clinicaltrials.gov/ct2/show/NCT02724969