奶量不足，可以用催乳剂吗？Galactagogues

催乳剂是可以小幅度至中度增加产奶量的药物、草药或食物。如果你产奶量不足，催乳剂可能会有帮助。如果产后初期就含乳含得好、含得深并且吸出乳汁很有效，那么无需任何催乳剂，往往就能保证充足的奶量供应。如果存在含乳或哺乳姿势的问题，就要先解决掉。请参阅哺乳姿势和含乳姿势。

然而，如果宝宝含乳很好，你也哺乳很频繁，但宝宝仍然体重增长得不好，那么催乳剂可能就有用了。请参阅母乳分泌量减少的原因。如果你考虑要用药物类或草药类催乳剂，请先咨询医疗保健人员。

被认为是催乳剂的食物

每种文化都有传统上用来增加奶量的食物。这些食物都没有很强的科学依据。然而食物提供的营养会让你感觉更好，进而促进产奶量。可以考虑把你喜欢吃的这类食物加到饮食当中。以下这些常见的食物被认为是催乳剂：

燕麦片
深色、绿叶蔬菜(紫苜蓿、羽衣甘蓝、菠菜、西兰花)
球茎茴香
大蒜
鹰嘴豆
坚果和种子，尤其是杏仁
姜
木瓜
香料，如茴香籽、葛缕子干籽、香菜、孜然籽、莳萝、小茴香、葫芦巴、姜黄

草药类催乳剂

草药和草本类催乳剂历史上已经在很多文化中使用了，然而关于这些植物对产奶量的有效性的科学研究却很少。不同草药制剂的剂量没有标准化。草药可以和西药一样功效强大，也有严重的副作用。尽管如此，许多母亲已经安全地使用草药来增加她们的产奶量了。开始使用任何新的药物或草药之前，请和你的医疗保健专家讨论一下。国际母乳会的哺乳辅导可以提供相关的信息供你分享给医护人员。

一些最常用的草药类催乳剂有：葫芦巴、洋飞廉、茴香、紫苜蓿、刺荨麻、山羊豆、水飞蓟以及辣木。草药类催乳剂可以制成茶、粉末、胶囊或食物来食用。

药物类催乳剂

多潘立酮（商品名：吗丁啉）是一种处方药，用于治疗胃肠道问题，如恶心和反流。这个药物的一个副作用是通过提高哺乳期女性的催乳素水平来增加产奶量。一些医护人员选择开这个药物来治疗产奶量不足，这就是“超说明书用药”(即未经批准用药)。国家卫健委尚未批准将此药物用于低产奶量的增加【译者注：多潘立酮在全球任何国家和地区（包括中国）都未被批准用于治疗产奶量不足。仅在加拿大等某些国家被作为“超说明书用药”】。药品生产企业对“超说明书用药”产生的不良副作用不承担责任。

多潘立酮被认为对母乳宝宝是安全的，因为仅极少量药物进入母乳中。然而，加拿大卫生部担心它会给母亲带来潜在的风险。

如果你考虑要服用多潘立酮，请先与医护人员讨论以下问题：

可能的不良副作用，如口干、头痛、头晕、腹部痉挛、呼吸困难、心跳加速、胸痛。
需要的话，做心电图来确保你的心脏健康。
与其它药物产生相互作用。多潘立酮会抑制多巴胺，并能与一些药物相互作用，比如会增加多巴胺分泌的抗焦虑药物。
与食物产生相互作用，如葡萄柚和葡萄柚提取物。
如何知道它是否有效。多潘立酮通常在服用48小时内起效。如果你在一周内没有注意到任何不同，很可能它对增加你的奶量没起作用。多潘立酮通常在服用2~4周内达到有效性的峰值。
当你准备停止服用此药时，缓慢减少剂量非常之重要。过快停药可能会导致严重的不良副作用，如失眠、心悸、焦虑和抑郁。如果你有这些症状，请联系医护人员。

盐酸甲氧氯普胺片(商品名：胃复安、灭吐灵)也被认为可以增加产奶量，但是它会产生很多副作用，导致无法接受将它用于母乳妈妈。这些副作用包括疲劳、易怒、抑郁、迟发性运动障碍(无意识的重复性身体运动)、眼动危象(眼球痉挛性运动)。此药物在加拿大很少被用来增加产奶量。

如果你对产奶量或其它母乳喂养的挑战有任何疑问，请联系你当地的国际母乳会哺乳辅导。她们也可以分享更多关于催乳剂的信息。

Galactagogues

Galactagogues are medications, herbs or foods which can provide a small to moderate increase in milk production. A galactagogue may be helpful if you are not producing enough milk. A good, deep latch and effective milk removal from the start usually ensures a full milk supply without any need for galactagogues. If there are latch or positioning issues, these should be addressed first. See Positioning and Latching.

However if your baby is not gaining well even though he is latching well and you are breastfeeding frequently, a galactagogue might be helpful. See Low Milk Production. If you are considering using a pharmaceutical or herbal galactagogue, consult with your healthcare professional.

Foods considered to be Galactagogues

Every culture has foods that have been traditionally used to increase milk production. There is no strong scientific evidence for any of these foods. However good nutrition will make you feel better and support milk production. Consider adding these foods that you enjoy eating to your diet. Some of the common foods which are considered galactagogues are:

Oatmeal
Dark, leafy greens (alfalfa, kale, spinach, broccoli)
Fennel
Garlic
Chickpeas
Nuts and seeds, especially almonds
Ginger
Papaya
Spices like anise seeds, caraway, coriander, cumin seeds, dill, fennel seeds, fenugreek, turmeric

Herbal Galactagogues

Herbs and plant-based galactagogues have been used in many cultures throughout history. However, there has been little scientific research about the effectiveness of these plants on milk production. The doses of different herbal preparations are not standardized. Herbs can be as powerful as manufactured drugs. They can also have serious side effects. That said, many mothers have safely used herbs to increase their milk production. Discuss any new medication or herb with your health care professional before starting it. La Leche League Leaders can provide you with information that you can share with your healthcare provider.

Some of the most commonly used herbal galactagogues are: fenugreek, blessed thistle, fennel, alfalfa, stinging nettle, goat’s rue, milk thistle, and moringa. Herbal galactagogues can be consumed as teas, powders, or capsules or as foods.

Pharmaceutical Galactagogues

Domperidone (Motilium™) is a prescription drug used to treat gastrointestinal issues such as nausea and reflux. A side effect of this drug is to increase milk production by boosting the prolactin level in breastfeeding women. Some healthcare providers choose to prescribe this drug for a low supply. This is an “off-label” (not approved) use. Health Canada has not authorized this medication for increasing a low milk supply. The drug manufacturer is not responsible for negative side effects that occur as a result of ‘off-label’ use.

Domperidone is considered safe for a breastfeeding baby, because very little of the drug passes into the milk. However, Health Canada has concerns about possible risks for the mother.

If you are considering taking domperidone, discuss the following with your healthcare provider.

Possible negative side effects such as dry mouth, headaches, dizziness, abdominal cramps, shortness of breath, rapid heart beat, chest pain.
If an electrocardiogram (ECG or EKG) is needed to confirm your heart health.
Interactions with other drugs. Domperidone inhibits the hormone dopamine and can interact with some medications, like anti-anxiety medications, which increase dopamine.
Interactions with foods such as grapefruit and grapefruit extract.
How to know if it’s working. Domperidone usually begins to work within 48 hours. If you do not notice any difference within one week, it is likely not working to increase your milk supply. Domperidone usually reaches peak level of effectiveness between two and four weeks.
The importance of reducing the dosage very slowly when you are ready to stop taking it. Stopping this drug too quickly may result in serious negative side effects such as insomnia, heart palpitations, anxiety and depression. If you experience any of these symptoms, contact your healthcare provider.

Metoclopramide (Maxeran™, Reglan™) is also known to increase milk production, but it has frequent side effects which have made its use for breastfeeding mothers unacceptable. These include fatigue, irritability, depression, tardive dyskinesia (involuntary repetitive body movements), oculogyric crisis (spasmodic movement of the eyeball). This is rarely prescribed in Canada to increase milk production.

If you have questions about your milk supply, or other breastfeeding challenges, please contact your local La Leche League Leader. LLL Leaders can also share additional information about galactagogues.

资料来源：https://www.lllc.ca/galactagogues

References 参考文献

Academy of Breastfeeding Medicine: ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Production, Second Revision 2018.

Health Canada. (Updated 2022). New Health Product Safety Information: Domperidone and serious ventricular arrhythmias, QT interval prolongation and sudden cardiac death.

Mohrbacher, Nancy. (2020). Breastfeeding Answers: A Guide for Helping Families, Second Edition. Nancy Mohrbacher Solutions, Inc., 449-456.

National Library of Medicine. (2022, September 19). Domperidone. Drugs and Lactation Database (Lactmed).

National Library of Medicine. (2022, September 19). Metoclopramide. Drugs and Lactation Database (Lactmed).

更新于2023年4月 Updated April 2023