Summary of Use during Lactation

Moringa (Moringa oleifera, Moringa pterygosperma) leaves contain vitamins, minerals, and essential amino acids as well as a number of glycosides. It has been used as a galactogogue in Asia,[1] particularly in the Philippines where it is called malunggay. Many published studies are of very poor quality. Small studies indicate that Moringa might have some activity as a galactogogue in mothers of preterm infants by increasing maternal serum prolactin and milk volume. A reasonably well-conducted study found no evidence of galactogogue activity in the first 3 days postpartum among mothers of full-term infants in a Baby Friendly hospital. Mixed results from several small studies found that Moringa either did or did not improve milk quality. Moringa oleifera leaves are widely used as a food and medicine in Asia and Africa and studies have found no adverse effects in nursing mothers who ingested Moringa leaves.[2,3] Moringa may stimulate blood clotting, so caution is advisable in anyone at risk for blood clots.[4] One study found no safety concerns of Moringa in nursing infants.[3] Galactogogues should never replace evaluation and counseling on modifiable factors that affect milk production.[5,6]

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 double-blind study in Indonesia compared the growth of breastfed infants whose mothers were given either Moringa leaf powder or Moringa leaf extract, both in a dose of 3.2 grams daily. After 3 months, the infants’ growth in weight or length did not differ between the two groups.[7]

Preliminary results of a randomized study in Kenyan mothers. compared maternal supplementation with Moringa 20 grams daily (n = 23) to placebo (n = 21). At the end of the 3-month study, the mean infant IGF-1 and hemoglobin concentrations were significantly higher in the Moringa group, but no differences in infant growth, serum iron, or vitamin A status were found between groups.[8]

Effects on Lactation and Breastmilk

Two meta-analyses by the same group analyzed the outcomes of 6 studies of Moringa olifera as a galactogogue. Two studies with 73 patients reported maternal serum prolactin levels and found that patients in the Moringa groups had a statistically significant average increase of 1950 milliIU/L. and also found that weight gain at week 4 was 11.9% greater in the infants in the Moringa group. Pooling of two studies with a total of 51 patients revealed a significant mean increase of milk volume on Day 7 in the Moringa groups of 124 mL.[9,10] One of the studies compared the effect of domperidone and metoclopramide to Moringa. On days 7 and 14, milk volume in all of the treatment groups was greater than in the placebo group. The highest volume was in the domperidone group, followed by metoclopramide, and Moringa oliefera. No correlation was found between serum prolactin and milk volume.[11]

A longitudinal study of 64 breastfeeding mothers given Moringa leaves powder 500 mg (n = 23), Moringa leaves extract 500 mg (n = 21), or iron-folic acid 60 mg or iron (n = 20) twice was conducted in a poor region of Indonesia. Mothers’ milk was analyzed for docosahexaenoic acid (DHA) and arachidonic acid at 6 months postpartum. No difference was found among the groups.[12]

A small study compared the milk quality of 10 mothers nursing infants between 1 and 4 months of age who ate one cookie containing 3.5 grams of Moringa flour daily to 7 mothers who did not eat the cookies. No difference was found after one month in the nutritional content of the milk of the two groups.[13]

A small, randomized study in Indonesia compared the infants of women given Moringa flour capsules (n = 18) to those of mothers given an iron and folate supplement (n = 18). At the end of 3 months, infants of mothers given Moringa flour were less likely to have been sick in the prior 3 months at 3 and 6 months of age. So many critical facts were left out of the reporting of the study, such as supplement doses, blinding, concealment, adherence, drop-outs, extent of breastfeeding, and infant evaluation methods that it is impossible to evaluate this study’s validity.[14]

A study in Indonesia compared the infants of mothers given supplements of either Moringa leaf powder, Moringa leaf extract or iron and folate during pregnancy and while breastfeeding. The end-point was social-personal development between 18 and 23 months of infant age. No differences were found between the groups. The report of methodology was lacking in many details such as dosage, blinding, concealment, adherence, extent of breastfeeding and intention-to-treat analysis so the results cannot be validated.[15]

An unblinded, nonrandomized study compared 23 postpartum mothers given Moringa-containing cookies, iron and vitamin A to 23 postpartum mothers who received iron and vitamin A only, both for 14 days, beginning on the first day postpartum. The infants of the treated mothers had a greater weight gain on day 14 than those in the control group. The study did not mention the extent of breastfeeding or any supplementation that took place.[16]

A randomized, double-blinded, placebo-controlled trial compared capsules containing 450 mg Moringa oleifera leaf powder (n = 44) or an identical placebo (n = 44) twice a day before a meal in mothers with full-term, uncomplicated deliveries. Mothers were encouraged to breastfeed their infants and milk volume was determined by infant weighing. At 3 days postpartum, there was a 47% higher volume of milk in the Moringa group, but the difference was not statistically significant. At 6 months postpartum, 52% of women in the Moringa group were exclusively breastfeeding, which met the World Health Organization’s goal of 50% by 2025. The placebo group had a 46% exclusive breastfeeding rate at 6 months, which was not statistically different from the Moringa group.[3]

Preliminary results of a randomized study in Kenyan mothers compared maternal supplementation with Moringa 20 grams daily (n = 23) to placebo (n = 21) found a median daily pumped milk volume of 1005 mL in the Moringa group compared to 540 mL in the placebo group. Milk lipid and protein concentrations were not different.[8]

References

1.

Mollik AH. Plants from Sundarbans to the diet of lactating mothers during puerperium of Barguna district of Bangladesh. Pediatr Nephrol 2010;25:1904. doi:10.1007/s00467-010-1577-z [CrossRef]

2.

Estrella, MC, Mantaring JB, David GZ, Taup MA. A double-blind, randomized controlled trial on the use of malunggay (Moringa oleifera) for augmentation of the volume of breastmilk among non-nursing mothers of preterm infants. Philipp J Pediatr 2000;49:3-6.

3.

Fungtammasan S, Phupong V. The effect of Moringa oleifera capsule in increasing breast milk volume in early postpartum patients: A double-blind, randomized controlled trial. Eur J Obstet Gynecol Reprod Biol X 2022;16:100171. [PMC free article: PMC9684698] [PubMed: 36440058]

4.

Ebhohon E, Miller D. Moringa oleifera leaf extract induced pulmonary embolism-a case report. Int J Emerg Med 2022;15:16. doi:10.1186/s12245-022-00419-3 [PMC free article: PMC9004112] [PubMed: 35413819] [CrossRef]

5.

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]

6.

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

7.

Zakaria, Sirajuddin, Veni H, et al. Linear growth of infants aged 0-6 months in breastfeeding mothers who consume Moringa oleifera leaf extract capsules: Randomized controlled double-blind design. Food Res 2022;6:135-43.

8.

Attia S, Iii GF, Odhiambo S, et al. Maternal Moringa oleifera leaf supplementation increases milk output, infant hemoglobin, and infant IGF-1: A pilot RCT in breastfeeding Kenyan dyads. J Pediatr Gastroenterol Nutr 2023;76:1333. doi:10.1097/MPG.0000000000003823 [CrossRef]

9.

King JS, Raguindin PF, Dans LF. Moringa oleifera (Malunggay) as a galactagogue for breastfeeding mothers: A systematic review and meta-analysis of randomized controlled trials. Philipp J Pediatr 2013;61:34-42.

10.

Raguindin PF, Dans LF, King JF. Moringa oleifera as a galactagogue. Breastfeed Med 2014;9:323-4. [PubMed: 24892837]

11.

Co MM, Hernandez EA, Co BG. A comparative study on the efficacy of the different galactogogues among mothers with lactational insufficiency. Philipp J Pediatr 2002;51:88-93.

12.

Sarih K, Siradjuddin S, Maddepungeng M, et al. Moringa oleifera intake during pregnancy and breastfeeding toward docosahexaenoic acid and arachidonic acid levels in breast milk. Open Access Macedonian J Med Sci 2020;8:757-61. doi:10.3889/oamjms.2020.4614 [CrossRef]

13.

Sumarni, Puspasari I, Mallongi A, et al. Effect of Moringa oleifera cookies to improve quality of breastmilk. Enferm Clin 2020;30 (Suppl 4):99-103.

14.

Suhartatik, V Hadju, M Muis, et al. The effect of Moringa oleifera flour given for mothers breastfeeding against morbidity of baby ages 0-6 months in Jeneponto District. Indian J Public Health Res Dev 2020;11:1760-5. doi:10.37506/v11/i1/2020/ijphrd/194106 [CrossRef]

15.

Hastuti H, Veni Hadju V, Citrakesumasari C, et al. The effect of Moringa oleifera on pregnant women and breastfeeding mothers toward social-personal development of children aged 18–23 months in Jeneponto, South Sulawesi. Open Access Maced J Med Sci 2020:747-51. doi:10.3889/oamjms.2020.4607 [CrossRef]

16.

Pujiastuti RSE, Salsabila DIB, Anwar MC. Potential of Moringa leaf cookies to increast breastmilk production in postpartum mothers. Open Access Maced J Med Sci 2022;10:207-10. doi:10.3889/oamjms.2022.9494 [CrossRef]

Substance Name

Moringa

CAS Registry Number

93165-54-9

Scientific Name

Moringa oleifera

Drug Class

Breast Feeding

Lactation

Milk, Human

Complementary Therapies

Food

Galactogogues

Phytotherapy

Plants, Medicinal