Stark, MichaelRumbold, Alice (SAHMRI)Grzeskowiak, Luke (Flinders University)McBride, Grace McKenzie2024-07-082024-07-082024https://hdl.handle.net/2440/141558Breastfeeding with mother’s own milk is widely recognised as the best source of nutrition and important immune factors for infants and provides multiple health benefits to the mother. Less than 35% of Australian women exclusively breastfeed until their infant is six months old, despite recommendations from the World Health Organization, most commonly due to a lack (real or perceived) of breast milk. Use of galactagogues – foods, substances, or medications thought to promote breast milk supply – appears to be increasing, regardless of limited high-quality evidence regarding safety and efficacy. The most common pharmaceutical galactagogue, domperidone, has evidence of increasing use since the early 2000’s, despite growing concerns over its safety and efficacy due to the risk of cardiac and neuropsychiatric side effects. It is unknown how these concerns have affected patterns of domperidone use. We performed a cross-sectional survey of women breastfeeding infants born in Australia. This survey included two sections, determining women’s awareness of galactagogues, perceptions of safety and efficacy, and information sources, then women’s use of a range of galactagogues, including the timing, duration, and perceived effectiveness. We used linked maternal and infant clinical data, and hospital pharmacy records, to conduct an audit of domperidone dispensing to mothers of infants born less than 32 weeks gestation, at the Women’s and Children’s Hospital. We completed an interrupted time series analysis to determine the changes in dispensing pre- and post-2014 recommendation changes by the European Medicines Agency to limit use and the associated rates of breastfeeding at infant discharge. Among 2055 survey respondents, 96% recognised one or more galactagogues, most commonly lactation cookies, brewer’s yeast, fenugreek and domperidone. Galactagogues were widely perceived to be safe with the most common information source being the internet. Sixty percent of women reported using one or more galactagogues, with the most common being lactation cookies (47%), brewer's yeast (32%), fenugreek (22%) and domperidone (19%). The mean duration of use for each galactagogue ranged from 2 – 20 weeks, with 1-in-6 women commencing galactagogues within the first week postpartum. Over 23% of domperidone users reported multiple side effects, compared to an average of 3% of women taking herbal galactagogues. Nearly 20% of women commenced domperidone use in the first week postpartum, with a median duration of use of six weeks. Maximum reported doses of domperidone used ranged from 20 – 160 mg/day. Domperidone was dispensed to 41% of mothers of hospitalised preterm infants between 2004 and 2018. The domperidone dispensing rate was stable before 2014, then significantly decreased after 2014. Breast milk feeding rates at infant discharge from hospital remained consistently lower in infants of women dispensed domperidone than those who were not throughout the study period. This thesis demonstrates widespread knowledge and use of galactagogues, particularly domperidone, among Australian breastfeeding mothers and significant variation in use, and domperidone utilisation, at both the community and hospital level. Among mothers of preterm infants, domperidone use has declined and breast milk feeding rates remain lower in those prescribed domperidone than those who were not, suggesting further research is needed to optimise lactation support in this population. Given the high level of awareness and frequency of use, further research is needed to develop evidence-based recommendations about galactagogues' efficacy and safety and target research activities to improve breastfeeding outcomes.enbreastfeedinglactationhuman milk,galactagoguesdomperidonepreterm birthThesis