Wild Asparagus use while Breastfeeding

Wild Asparagus Levels and Effects while Breastfeeding

Summary of Use during Lactation

Wild asparagus (Asparagus recemosus) root contains steroidal saponins and flavonoids, although the active components have not been clearly elucidated. It is a different species from the asparagus commonly used as a food (Asparagus officinalis). Wild asparagus, called shatavari, has a long history of use as a galactogogue in India and is included in the official ayurvedic pharmacopoea for this use.[1][2][3][4][5] Results of clinical studies on the galactogogue activity of wild asparagus are mixed and inadequate.[6][7][8] The safety of wild asparagus has not been rigorously studied, but 2 small clinical studies found no adverse effects in mothers or their nursing infants. Galactogogues should never replace evaluation and counseling on modifiable factors that affect milk production.[9]

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Drug Levels

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

Fifteen postpartum women who reported diminished lactation were given Ricalex (Aphali Pharmaceutical, Ltd., Ahmednegar, India) that contained 40 mg of a concentrated extract of wild asparagus, plus dicalcium phosphate 400 mg and 10 mg of ash (suvarnamakshika bhasma). They took 2 tablets twice daily after meals. Eleven of the 15 women reported an increase in milk supply and 4 of these women reported a gradual decrease in milk supply after stopping the preparation and another increase after restarting.[1] Because of a lack of blinding, randomization, and placebo control, this study cannot be considered reliable.

Forty women who complained of an insufficient milk supply at 5 days postpartum were given a combination herbal supplement as 2 capsules of Lactare (Pharma Private Ltd., Madras, India; currently available from TTK Pharma, Chennai, India) 3 times daily. Each capsule contained wild asparagus 200 mg, ashwagandha (Withania somnifera) 100 mg, fenugreek 50 mg, licorice 50 mg, and garlic 20 mg. By day 4 of therapy, no infants required supplementary feeding. Infants were weighed before and after each feeding on the fifth day of maternal therapy to determine the amount of milk ingested. On the day of the test weighing, infants' milk intake averaged 388 mL, and the fluid and caloric intake was considered adequate.[10] This study cannot be considered as valid evidence of a galactogogue effect of these herbs because it lacks randomization, blinding, a placebo control, and maternal instruction in breastfeeding technique. Additionally, infants were breastfed only 6 to 8 times daily, which is insufficient to maximize milk supply at this stage of lactation.

Women who were between 14 and 90 days postpartum and reported lactation failure were given instructions on breastfeeding technique and encouraged to exclusively breastfeed. If their infant had gained less than 15 grams in 1 week, they were randomized to receive either two tablespoonfuls of a mixture containing wild asparagus or an identical placebo for 4 weeks. In each 100 grams, the mixture contained Asparagus racemosus 15 grams, Anethum soiva 1 gram, Ipomea digitata 1 gram, Glycyrrhiza glabra 1 gram, Spinacia oleracea 2.5 grams, Cuminum cyminum 0.5 gram, and Panchatrinamol 1 gram. Of the 64 women randomized, 11 did not complete the trial. Serum prolactin measurements were made before a morning nursing before treatment and after 4 weeks of treatment. Infant weight gains and the number of supplemental feedings were recorded initially and after 4 weeks of therapy. No differences were found in the changes in serum prolactin, infant weight gain or amount of supplementation between the treatment and placebo groups after 4 weeks of therapy. No side effects or changes in liver function tests occurred during the study.[11]

Sixty nursing mothers were randomized to receive either the fresh roots of Asparagus racemosus (verified by botanists) 20 mg/kg 3 times daily or placebo rice powder 3 times daily for 30 days. Women were chosen for the study if they reported diminished milk supply, their infant crying after feeding, breast pain during lactation, maternal loss of appetite, or anxiety disorder. Infants averaged 2.8 months. Women and infants were examined weekly. Mothers who received the active herb had a 33% increase in serum prolactin over baseline compared to a 10% increase in the women who received placebo. The paper does not state when prolactin levels were measured either during the 30-day period or in relation to nursing. Infant weights increased more in the treatment group (16% vs 6%), and treated mothers rated their satisfaction and their infants' happiness greater than those in the placebo group. No side effects were noted in the paper.[12] The nonuniform composition of the mothers' complaints and the lack of optimizing nursing technique before the study detract from an otherwise well-conducted trial.

References

1. Joglekar GV, Ahuja RH, Balwani JH. Galactogogue effect of Asparagus racemosus. Preliminary communication. Indian Med J. 1967;61:165. PMID: 5624301

2. Sayed NZ, Deo R, Mukundan U. Herbal remedies used by Warlis of Dahanu to induce lactation in nursing mothers. Indian J Tradit Knowl. 2007;6:602-5.

3. Chaudhury RR, Tennekoon KH. Plants as galactagogues. In, Jelliffe DB, Jelliffe EF, eds. Advances in international maternal and child health. Oxford. Oxford University Press. 1983;3:20-6.

4. Low Dog T. The use of botanicals during pregnancy and lactation. Altern Ther Health Med. 2009;15:54-8. PMID: 19161049

5. Kumar Meena A, Bansal P, Kumar S. Plants-herbal wealth as a potential source of ayurvedic drugs. Asian J Traditional Med. 2009;4:152-70.

6. Forinash AB , Yancey AM, Barnes KN, Myles TD. The use of galactogogues in the breastfeeding mother. Ann Pharmacother. 2012;46:1392-404. PMID: 23012383

7. Mortel M, Mehta SD. Systematic review of the efficacy of herbal galactogogues. J Hum Lact. 2013;29:154-62. PMID: 23468043

8. Zapantis A, Steinberg JG, Schilit L. Use of herbals as galactagogues. J Pharm Pract. 2012;25:222-31. PMID: 22392841

9. The Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #9: use of galactogogues in initiating or augmenting the rate of maternal milk secretion (First revision January 2011). Breastfeed Med. 2011;6:41-9. PMID: 21332371

10. Sholapurkar ML. 'Lactare' for improving lactation. Indian Pract. 1986;39:1023-6.

11. Sharma S, Ramji S, Kumari S, Bapna JS. Randomized controlled trial of Asparagus racemosus (Shatavari) as a lactogogue in lactational inadequacy. Indian Pediatr. 1996;33:675-7. PMID: 8979551

12. Gupta M, Shaw B. A double-blind randomized clinical trial for evaluation of galactogogue activity of Asparagus racemosus Willd. Iran J Pharm Res. 2011;10:167-72.

Wild Asparagus Identification

Substance Name

Wild Asparagus

Scientific Name

Asparagus racemosus

Drug Class

Complementary Therapies

Galactogogues

Phytotherapy

Plants, Medicinal

Administrative Information

LactMed Record Number

900

Last Revision Date

20130907

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