Effect of Acupuncture on Hypogalactia

The specific aims are (1) to assess the feasibility of a RCT studying acupuncture's impact on breast milk production, and (2) to compare the difference of milk production between acupuncture and power pumping. The study approach will be a two-site prospective, non-blinded, two-arm randomized clinical trial conducted in Lubbock and Amarillo as a collaborative effort between researchers and clinicians in the departments of Family Medicine, Pediatrics and Ob/Gyn. An estimated 60 eligible mothers will be recruited and enrolled in the study from both sites. The participants will be randomized 1:1 into either the intervention group or the comparison group. The intervention group will receive three standardized acupuncture sessions, based on previous studies done in China and investigators' practice protocol, in 5 days and the comparison group will perform power pumping in 5 days per provided manual and guidance. The primary outcome is changes of breast milk production and it will be measured by weighing the grams/volume of milk expressed with an electric breast pump over time. The secondary outcome is changes of plasma prolactin and it will be measured by immunoassay. Data will be collected at baseline, right after interventions and two week after interventions to compare the difference of the outcomes. The findings of this study will provide insight to establish a RCT protocol to assess acupuncture's impact on hypogalactia. It may also help establish evidence of acupuncture use for hypogalactia.

As important and beneficial as breastfeeding is to infants and mothers, physicians often feel lack resources to support breast milk production. Reduced breast milk production (called hypogalactia) is the most frequent cause of breastfeeding failure, but no evidenced-based standard care in conventional medicine is established to help mothers face the challenge. The most frequently used natural galactogogues products including galega and silymarin are not FDA approved. Lactation education on general breastfeeding and lactation management may help mothers who are experiencing reduced milk supply. Complementary and alternative medicine (CAM) including acupuncture has been used to address hypogalactia. However, there remains an overall lack of evidence regarding the effectiveness, safety, and acceptability of many CAM therapies including acupuncture for hypogalactia. Although several clinical observational studies showed that acupuncture was related to the increased prolactin level and mother's breast milk production, there are several gaps in those studies. First, most studies were done in China and are mainly observational, hence are subject to various biases and do not establish a causal relationship. Secondly, most of the studies only reported success rates without reporting changes of milk volume or biomarkers. To truly assess the effect of acupuncture on breast milk production and relevant hormone changes, a randomized clinical trial (RCT) with better measurements is warranted.

The feasibility of an acupuncture protocol for hypogalactia is supported by the acupuncture practice in the Family medicine clinic. The goal of this study is to establish the feasibility of a RCT to compare the difference of breast milk production between acupuncture and power pumping, a popular lactation practice recommended to mothers who experience hypogalactia, using established measurement of breast milk production. Both acupuncture and power pumping stimulate the breasts which may lead to the increased secretion of prolactin hence increase milk production. Previous study findings and investigators' clinical experiences indicate that a short period of acupuncture treatment may increase milk production for several weeks. It is hypothesized that acupuncture will have equal or a greater impact on milk production and last longer than power pumping. The study special aims are:

1. To assess the feasibility of a RCT studying acupuncture's impact on breast milk production. A two-arm RCT will be conducted at one site. Recruitment, enrollment, intervention and compliance, safety and adverse events will be documented and evaluated to assess this trial design is appropriate for further testing. Study feasibility is defined as the successful recruitment and retention of study participants, adherence to the intervention, identification of barriers to the intervention, and the rigorous collection of outcome data.
2. To compare the effect difference of breast milk production between acupuncture and power pumping. The primary outcome the changes of breast milk production will be measured by weighing the grams/volume of milk expressed with an electric breast pump. The secondary outcome the changes of plasma prolactin will be measured by immunoassay. Data will be collected at baseline, right after interventions and two week after interventions.

Based on investigators' search in PubMed to present, no RCT studies have been done in the U.S. assessing acupuncture and hypogalactia. This study may be the first to provide insights on the feasibility. Moreover, based on investigators's clinical observations and reports from studies done in China, this study to yield positive findings to help establish evidence of acupuncture use for hypogalactia. The preliminary data may also help us apply for grants from the National Center for Complementary and Integrative Health (NCCIH) or NIH Office of Research on Women's Health. More importantly, the evidence will help clinician and mothers make informed decisions in terms of choosing the right approach to increase breast milk production.

Eligibility Criteria:
Inclusion Criteria:

1. Primipara or Multipara woman who had normal pregnancy (gestation ≥ 37 weeks gestation) and gave birth vaginally or by Caesarean section to a single child without complications and who are 2 weeks to 6 months postpartum.
2. Estimated milk production of \< 450 g/24 hours (or 450ml/24hours)-by self-report
3. A current body mass index (BMI) equal or above 18 kg/m2 and below 35 kg/ m2
4. Non-smoker. Subjects who have stopped smoking for \>6 months prior to study start may be included.
5. Must be fluent in English conversation, reading and writing.

Exclusion Criteria:

1. Presence or a history of clinically significant diseases of the renal, hepatic, gastrointestinal, cardiovascular, musculoskeletal systems or presence or history of clinically significant psychiatric, immunological, endocrine or metabolic diseases including gestational or pregestational diabetes, and Polycystic Ovarian syndrome.
2. History of breast cancer, breast surgery, or clinically significant abnormalities of the breasts that may affect the milk production and/or flow.
3. Use of typical and atypical antipsychotics, drugs/supplements, and/or other approaches that may increase milk production or prolactin levels in patients.
4. Consumes alcohol during breastfeeding.
5. Current case of infectious mastitis and/or Reynaud's disease of the breast.
6. History within the last two years or current abuse of alcohol or drugs.
7. Current non-smokers with a history of long-term, heavy smoking (\>10 pack-years).