Summary of Use during Lactation

Ginger (Zingiber officinale) root contains the pungent principles or gingerols that are considered to be responsible for its pharmacological activity. Ginger is commonly used for nausea and motion sickness. It has no specific lactation-related uses in Western medicine, but is reportedly used as a galactogogue in Turkey, Indonesia and some parts of Asia.[1-3] Ginger is reportedly used as part of a topical herbal mixture to shorten the time to full lactation and or alone or as part of a topical herbal mixture used for breast engorgement.[4-6] A systemic review of 5 studies on ginger as a galactogogue alone or in combinations with other herbals found weak evidence that ginger may increase milk supply in mothers who had a natural delivery, but not in mothers who had a cesarean section.[7] Galactogogues should never replace evaluation and counseling on modifiable factors that affect milk production.[8,9] Very limited data exist on the safety and efficacy of ginger in nursing mothers or infants. However, ginger has a long history of use as a food and medicine and is "generally recognized as safe" (GRAS) as a food flavoring by the U.S. Food and Drug Administration, including during lactation.[10] When used as a medicinal, ginger is generally well tolerated in adults, but mild side effects such as bad taste, heartburn, abdominal discomfort, weight gain, headache, dry mouth and nausea are reported occasionally.

Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information about dietary supplements is available elsewhere on the LactMed Web site.

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

A woman was treated with a number of Ayruvedic treatments for rheumatoid arthritis postpartum. One of the products used was ginger 250 mg orally twice daily for 3 months. She reportedly breastfed her infant (extent not stated) throughout treatment and the infant had normal growth and development.[11]

In a study of exclusively nursing mothers receiving fenugreek seed 200 mg, turmeric 100 mg and ginger 120 mg (Fenucaps; Herbal Acharn's Home Co. Ltd., Thailand) 3 times daily for 4 weeks, no adverse events were reported in their infants, although the method used to determine this finding were not reported.[12]

Effects on Lactation and Breastmilk

A study in Japan compared the use of a mixture of 13 herbs, including ginger, to ergonovine for their effects on lactation and serum prolactin in postpartum women. The herbal mixture, called Xiong-gui-tiao-xue-yin, was given in a randomized fashion to 41 women in a dose of 2 grams of a dried aqueous extract 3 times daily. A comparable group of 41 women were randomized to receive methylergonovine 0.375 mg daily. Therapy was started on the day of delivery, but the duration of therapy was not specified. Plasma oxytocin and prolactin were measured on days 1 and 6; milk volumes were measured daily, although the method of measuring milk volume was not specified. Serum prolactin was higher on days 1 and 6 in the women who received the herbals; plasma oxytocin was lower on day 1 in the women who received the herbal, but not different on day 6. Milk volumes were greater on days 4, 5, and 6 in women who received the herbal mixture.[13] This study has serious flaws that make its interpretation impossible. First, milk volume measurement is subject to considerable variability depending on the measurement method used, but the method was not specified. Second, methylergonovine has caused decreases in serum prolactin and milk production in some studies.[14,15] Because of the lack of a placebo group, the differences found could be a negative effect of methylergonovine rather than a positive effect of the herbal preparation. Because this study used a multi-ingredient combination products in which ginger was only one component, the results might be different from studies in which ginger was used alone.

Studies of Thai herbal compresses containing ginger, turmeric and camphor have evaluated the effect of application of the compresses to the breasts on lactation. The studies showed that the compresses shortened the time to lactation postpartum compared to routine clinical care for enhancing lactation.[4]

A randomized, double-blind study in Thailand compared the milk output of mothers taking either dried ginger 500 mg or placebo twice daily starting within 2 hours after delivery. On day 3, mothers receiving ginger produced a statistically significantly greater volume of milk than those receiving placebo, 191 mL per 24 hours compared to 135 mL per 24 hours. On day 7 postpartum, the ginger group produced an average of 80 mL/hour of milk compared to 112 mL/hour in the placebo group, although the difference was not statistically significant. No significant difference in serum prolactin was found between the two groups on day 3 postpartum.[16]

A randomized trial in women with breast engorgement compared warm compresses to warm compresses containing a mixture of dried herbs, including ginger, lemon grass, Stapf leaves and leaf sheaths, Acacia concinna leaves, tamarind leaves, Citrus hystrix (kaffir lime) peels, Blumea balsamifera (sambong) leaves, salt and camphor. Both treatments relived the pain of engorgement, but women who received the compress with herbs (n = 250) had greater pain relief than those who received the warm compress alone. Because of the possible color and odor differences between treatments, the study cannot be considered to be blinded.[5]

Fifty women in Thailand who were 1 month postpartum and exclusively breastfeeding were randomized to receive either a placebo or capsules containing fenugreek seed 200 mg, turmeric 100 mg and ginger 120 mg (Fenucaps; Herbal Acharn's Home Co. Ltd., Thailand) 3 times daily for 4 weeks. Participants pumped milk on 2 days at 0, 2 and 4 weeks of the study. The average milk volumes increased by 49% at 2 weeks and 103% at 4 weeks among participants receiving the active product. The macronutrient composition of the milk did not change in either group over the 4-week period. Growth of infants was not reported.[12]

A randomized, double-bind study of 70 women who delivered by cesarean section in a hospital in Thailand compared 35 who took 5 grams of instant ginger powder in water to 35 who took a placebo with ginger scent, but no ginger. The products were taken every 12 hours up to 72 hours postpartum, starting at 24 hours postpartum. Breastmilk volumes were measured by test weighing of their infants. Total milk volume between 48 and 72 hours postpartum were compared. The median total breast milk volumes during this time were 80 mL in the ginger group and 100 mL in the placebo group. The difference was not statistically significant.[17]

A randomized study compared nursing mothers with breast engorgement who received either a hot compress (n = 38) or hot ginger compress (n = 38) three times daily for 2 days. The women who received the ginger compresses had a greater decrease in breast pain than those who received the hot compresses.[6]

In a survey of nursing mothers in Australia, 52 mothers were taking ginger as a galactogogue. On average, mothers rated ginger as “slightly effective” on a Likert scale. Six percent of mothers taking ginger reported experiencing adverse reactions, such as weight gain, headache, dry mouth and nausea.[18]

A randomized study of women who delivered a single infant vaginally compared domperidone 10 mg to the Thai herbal product, Plook-Fire-Thatu and placebo, each given three times daily starting on the first day postpartum. Plook-Fire-Thatu contains several herbs from the genus Piper (pepper) and piperine may be the active ingredient. Piperine also enhances the bioavailability of some chemicals. Ginger, which is a purported galactogogue, is also included in the formula. Milk output was measured by test weighing of infants three times daily. On day 3 of treatment, the herbal product resulted in a greater increase in milk production than placebo or domperidone, but there was no difference in infant weights between groups. Maternal temperatures were greater in the herbal group, which is in accord with the Chinese theory of increasing heat to improve lactation.[19]

References

1.

Lamxay V, de Boer HJ, Bjork L. Traditions and plant use during pregnancy, childbirth and postpartum recovery by the Kry ethnic group in Lao PDR. J Ethnobiol Ethnomed 2011;7:14. [PMC free article: PMC3120637] [PubMed: 21569234]

2.

Kaygusuz M, Gümüştakım RŞ, Kuş C, et al. TCM use in pregnant women and nursing mothers: A study from Turkey. Complement Ther Clin Pract 2021;42:101300. [PubMed: 33412511]

3.

Sayuti NA, Atikah N. The pattern of herbal medicines use for breastfeeding mother in Jogonalan, Klaten, Indonesia: a mini survey. BMC Complement Med Ther 2023;23:399. [PMC free article: PMC10629069] [PubMed: 37936188]

4.

Dhippayom T, Kongkaew C, Chaiyakunapruk N, et al. Clinical effects of Thai herbal compress: A systematic review and meta-analysis. Evid Based Complement Alternat Med 2015;2015:942378. [PMC free article: PMC4377500] [PubMed: 25861373]

5.

Ketsuwan S, Baiya N, Paritakul P, et al. Effect of herbal compresses for maternal breast engorgement at postpartum: A randomized controlled trial. Breastfeed Med 2018;13:361-5. [PubMed: 29688768]

6.

Monazzami M., Yousefzadeh S., Rakhshandeh H., Esmaily H. Comparing the effects of hot compress and hot ginger compress on pain associated with breast engorgement. Nursing and Midwifery Studies 2021;10:73-8.

7.

Dilokthornsakul W, Rinta A, Dhippayom T, Dilokthornsakul P. Efficacy and safety of ginger regarding human milk volume and related clinical outcomes: A systematic review of randomized controlled trials. Complement Med Res 2022;29:67-73. [PubMed: 33789272]

8.

Brodribb W. ABM Clinical Protocol #9: Use of galactogogues in initiating or augmenting maternal milk production, second revision 2018. Breastfeed Med 2018;13:307-14. [PubMed: 29902083]

9.

Breastfeeding challenges: ACOG Committee Opinion, Number 820. Obstet Gynecol 2021;137:e42-e53. [PubMed: 33481531]

10.

O'Hara M, Kiefer D, Farrell K, Kemper K. A review of 12 commonly used medicinal herbs. Arch Fam Med 1998;7:523-36. [PubMed: 9821826]

11.

Deshpande SV, Deshpande VS, Potdar SS. Effect of panchakarma and Ayurvedic treatment in postpartum rheumatoid arthritis (amavata): A case study. J Ayurveda Integr Med 2017;8:42-4. [PMC free article: PMC5377475] [PubMed: 28302414]

12.

Bumrungpert A, Somboonpanyakul P, Pavadhgul P, Thaninthranon S. Effects of fenugreek, ginger, and turmeric supplementation on human milk volume and nutrient content in breastfeeding mothers: A randomized double-blind controlled trial. Breastfeed Med 2018;13:645-50. [PubMed: 30411974]

13.

Ushiroyama T, Sakuma K, Souen H, et al. Xiong-gui-tiao-xue-yin (Kyuki-chouketsu-in), a traditional herbal medicine, stimulates lactation with increase in secretion of prolactin but not oxytocin in the postpartum period. Am J Chin Med 2007;35:195-202. [PubMed: 17436360]

14.

Peters F, Lummerich M, Breckwoldt M. Inhibition of prolactin and lactation by methylergometrine hydrogenmaleate. Acta Endocrinol (Copenh) 1979;91:213-6. [PubMed: 463447]

15.

Arabin B, Ruttgers H, Kubli F. [Effects of routine administration of methylergometrine during puerperium on involution, maternal morbidity and lactation]. Geburtshilfe Frauenheilkd 1986;46:215-20. [PubMed: 3519353]

16.

Paritakul P, Ruangrongmorakot K, Laosooksathit W, et al. The effect of ginger on breast milk volume in the early postpartum period: A randomized, double-blind controlled trial. Breastfeed Med 2016;11:361-5. [PubMed: 27505611]

17.

Sassanarakkit S, Kaiwong S, Chittacharoen A. A study on instant ginger drink effect in enhancing postpartum breastfeeding in immediate post cesarean delivery. J Med Assoc Thai 2019;102:259-63.

18.

McBride GM, Stevenson R, Zizzo G, et al. Use and experiences of galactagogues while breastfeeding among Australian women. PLoS One 2021;16:e0254049. [PMC free article: PMC8248610] [PubMed: 34197558]

19.

Krungkraipetch K, Kwanchainon C. The use of Thai herbal galactogogue, 'Plook-Fire-Thatu', for postpartum heat re-balancing. Afr J Reprod Health 2023;27:85-98. [PubMed: 37742337]

Substance Name

Ginger

Scientific Name

Zingiber officinale

Drug Class

Breast Feeding

Lactation

Milk, Human

Complementary Therapies

Phytotherapy

Plants, Medicinal