A survey of North American physicians' clinical practices related to pharmacologic, herbal, and nutritional substances used to increase milk production
Bibliographic record
Abstract
Introduction Patients turn to foods, herbs, and medications to increase milk supply (i.e., galactagogues). Physicians may be asked to prescribe, recommend, or discuss perceived galactagogues despite a lack of evidence for their use. It is unclear how factors such as education, experience, and regulations influence clinical practice. The primary objective of this study was to document Canadian and US-based physicians’ attitudes towards, practice patterns surrounding, and utilization of pharmacologic, nutritional, and herbal products for the management of low milk supply. A secondary objective of this study was to determine factors that influence physicians’ decision-making with respect to the use of pharmacologic agents, foods, and vitamin, mineral, and herbal supplements for the treatment of low milk supply. Methods Physicians were recruited from two Facebook groups to complete an anonymous, online survey about their clinical use of pharmaceutical, supplemental, and nutritional substances perceived to increase milk production. The association between practice patterns and lactation medicine expertise or country for different perceived galactagogues was determined. Results A total of 307 physicians completed the primary portion of the survey. There was no difference in the proportion of physicians in Canada or the United States (US) who were defined as lactation medicine experts. Canadian physicians were more likely to prescribe metformin, levothyroxine, and domperidone, despite limited evidence of their effectiveness as galactagogues. Experts used all of the pharmacologic galactagogues. Canadians and experts were more likely than US-based and non-expert physicians, respectively, to include herbs in their practice. Numerous reasons for recommending or not recommending a given agent were cited, including patient request, personal and clinical experience, and lack of education, research, or access. Discussion The US FDA ban on domperidone affects which pharmacologic agents physicians in North America prescribe for low milk production. Despite having access to domperidone and limited evidence of their effectiveness, Canadian physicians are more likely than US physicians to also discuss, recommend, or prescribe herbal supplements as galactagogues. Conclusion In this online survey about medications, herbs, and foods commonly used in an effort to increase milk supply, Canadian and US-based physicians with and without lactation medicine expertise described their practice patterns and reported limitations in knowledge, medication access, and evidence. Though Canadian physicians prescribed domperidone without limitations, US physicians were less likely to incorporate it into clinical practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".