Early postpartum oral metoclopramide augments lactogenesis II in insulin-dependent mothers with gestational diabetes: a randomized placebo-controlled trial

Abstract Background Mothers with gestational diabetes are at risk of lactogenesis II delayed beyond the third postnatal day and early breastfeeding cessation, which may be overcome by prophylactic intervention. Research aim To evaluate the effect of oral metoclopramide commenced within twelve hours of delivery on lactogenesis II in mothers with insulin-dependent (iGDM) or diet-controlled (dGDM) gestational diabetes. Methods Between July 2006 and January 2009, 73 mothers of term neonates (iGDM, n=20 and dGDM, n=53) were randomized to the metoclopramide (n=37) or placebo groups (n=36). Mothers with gestational diabetes in the intervention group received 30mg of oral metoclopramide daily for the first postnatal week in a randomized double-blinded placebo-controlled study. Primary outcome was lactogenesis II onset by postnatal day 3, while secondary outcomes included expressed human milk volumes (EHM) and exclusive breastfeeding rates and infant weight change.Results 40% more iGDM metoclopramide users achieved lactogenesis II by postnatal day 3 (p=0.01), with 4.8-fold EHM increase over controls (p=0.04); 50% of iGDM mothers perceived lactogenesis II onset by day 2 and more rapid EHM accumulation was observed in all metoclopramide users. Despite this, metoclopramide-users demonstrated less exclusive breastfeeding, earlier cessation and more frequent formula-feeding. Conclusions Short-term metoclopramide uses within the first 12 postnatal hours significantly improved daily EHM production and maternal perception of lactogenesis II onset in iGDM mothers. Treated iGDM mothers did not experience the natural EHM decrease of iGDM placebo-users. The low breastfeeding rate suggested that physiological breastfeeding barriers may not modifiable by metoclopramide or traditional lactation support.