Lactation failure

Lactation failure
Classification and external resources
Specialty obstetrics
ICD-10 O92.3
ICD-9-CM 676.4

Lactation failure or deficiency, also known as agalactia or agalactorrhea, as well as hypogalactia or hypogalactorrhea, is a medical condition in which lactation is insufficient or fails completely due to an inadequacy of breast milk production and/or a failure of the milk let-down reflex in response to suckling following childbirth, resulting in an inability to properly breastfeed.[1][2]


The most important cause of lactation failure is an insufficient secretion of prolactin from the pituitary gland.[3][4] D2 receptor antagonists, which are used to treat lactation failure, correct this insufficiency by blocking D2 receptors in the anterior pituitary, which in turn disinhibits prolactin release.[5] Differential diagnosis of lactation failure when prolactin levels are normal or high includes lymphocytic hypophysitis (inflammation of the pituitary gland due to autoimmunity), Sheehan's syndrome (postpartum hypopituitarism due to ischemic necrosis from blood loss and hypovolemia during and after childbirth), and adult growth hormone deficiency, all of which may cause lactation failure in part or full by lack of sufficient GH secretion.[4][6] Hypopituitarism in general can impair secretion of pituitary hormones such as prolactin and growth hormone (GH) and in turn result in lactation failure.[3][4]

"Tobacco-Smoke Inhalation Delays Suckling-Induced Prolactin Release in the Rat" (Title) These results show that tobacco-smoke inhalation delays the suckling induced release of prolactin and provide the first evidence that smoke inhalation (nicotine?) can interfere with neuroendocrine reflexes associated with reproduction. [7] and therefore, lactation [8]

Insufficient glandular tissue of the breasts, or breast hypoplasia, caused by a lack of normal mammary gland growth and maturation during puberty and/or pregnancy, is another cause of lactation failure, albeit relatively rarely so.[9][10][11] Overweightness/obesity can result in early lactation failure, because it inhibits the amount of prolactin secreted in response to suckling in the first week after childbirth.[12] Certain drugs, such as D2 receptor agonists like bromocriptine and pergolide, as well as indirect D2 receptor activators like amphetamines, can suppress prolactin secretion from the pituitary gland and thereby cause lactation failure.[5]:24


Lactation failure can be treated with a galactagogue (lactation-promoting agent) such as a D2 receptor antagonist like domperidone, metoclopramide, or certain antipsychotics like chlorpromazine, haloperidol, sulpiride, or risperidone, an oxytocic such as oxytocin or an analogue like carbetocin or demoxytocin, with GH (or potentially with a growth hormone secretagogue, alternatively), or with thyrotropin-releasing hormone (TRH) or thyroid-stimulating hormone (TSH).[2][13][14][15]

Merotocin (FE-202767), an oxytocin receptor agonist, is under development specifically for the treatment of lactation failure in preterm mothers.[16]

See also


  1. Mathur GP, Chitranshi S, Mathur S, Singh SB, Bhalla M (1992). "Lactation failure". Indian Pediatr. 29 (12): 1541–4. PMID 1291500.
  2. 1 2 Zuppa AA, Sindico P, Orchi C, Carducci C, Cardiello V, Romagnoli C (2010). "Safety and efficacy of galactogogues: substances that induce, maintain and increase breast milk production" (PDF). J Pharm Pharm Sci. 13 (2): 162–74. PMID 20816003.
  3. 1 2 Prabhakar VK, Shalet SM (2006). "Aetiology, diagnosis, and management of hypopituitarism in adult life". Postgrad Med J. 82 (966): 259–66. doi:10.1136/pgmj.2005.039768. PMC 2585697Freely accessible. PMID 16597813.
  4. 1 2 3 Robert F. Dons; Frank H. Wians, Jr. (17 June 2009). Endocrine and Metabolic Disorders: Clinical Lab Testing Manual, Fourth Edition. CRC Press. pp. 103–. ISBN 978-1-4200-7936-4.
  5. 1 2 P. N. Bennett; Allan A. Jensen (1996). Drugs and Human Lactation: A Comprehensive Guide to the Content and Consequences of Drugs, Micronutrients, Radiopharmaceuticals, and Environmental and Occupational Chemicals in Human Milk. Elsevier. pp. 23–. ISBN 978-0-444-81981-9.
  6. Unlühizarci K, Bayram F, Colak R, Oztürk F, Selçuklu A, Durak AC, Keleştimur F (2001). "Distinct radiological and clinical appearance of lymphocytic hypophysitis". J. Clin. Endocrinol. Metab. 86 (5): 1861–4. doi:10.1210/jcem.86.5.7440. PMID 11344171.
  7. J. D. Ferry, B. K. McLeanM. B. Nikitovitch-Winer, Department of Anatomy, University of Kentucky Medical Center, Lexington, Kentucky 4056,
  8. editor, truthmeme
  9. Karen Wambach; University of Kansas School of Nursing Karen Wambach; Jan Riordan (26 November 2014). Breastfeeding and Human Lactation. Jones & Bartlett Publishers. pp. 387–. ISBN 978-1-4496-9729-7.
  10. Executive Director National Alliance for Breastfeeding Advocacy Marsha Walker; Marsha Walker (15 September 2010). Breastfeeding Management for the Clinician: Using the Evidence. Jones & Bartlett Publishers. pp. 587–. ISBN 978-1-4496-1136-1.
  11. Jane Coad; Melvyn Dunstall (2011). Anatomy and Physiology for Midwives,with Pageburst online access,3: Anatomy and Physiology for Midwives. Elsevier Health Sciences. pp. 413–. ISBN 0-7020-3489-4.
  12. Nancy J. Peckenpaugh (13 August 2013). Nutrition Essentials and Diet Therapy. Elsevier Health Sciences. pp. 436–. ISBN 978-0-323-26693-2.
  13. Forinash AB, Yancey AM, Barnes KN, Myles TD (2012). "The use of galactogogues in the breastfeeding mother". Ann Pharmacother. 46 (10): 1392–404. doi:10.1345/aph.1R167. PMID 23012383.
  14. Gunn AJ, Gunn TR, Rabone DL, Breier BH, Blum WF, Gluckman PD (1996). "Growth hormone increases breast milk volumes in mothers of preterm infants". Pediatrics. 98 (2 Pt 1): 279–82. PMID 8692630.
  15. Marsha Walker (2002). Core Curriculum for Lactation Consultant Practice. Jones & Bartlett Learning. pp. 225–. ISBN 978-0-7637-1038-5.
  16. Wiśniewski K, Alagarsamy S, Galyean R, Tariga H, Thompson D, Ly B, Wiśniewska H, Qi S, Croston G, Laporte R, Rivière PJ, Schteingart CD (2014). "New, potent, and selective peptidic oxytocin receptor agonists" (PDF). J. Med. Chem. 57 (12): 5306–17. doi:10.1021/jm500365s. PMID 24874785.
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