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Synthetic galactagogues such as domperidone and metoclopramide interact with the dopamine system in such a way to increase the production of prolactin; specifically, by blocking the D 2 receptor. [3] There is some evidence to suggest that mothers who are unable to meet their infants' breastfeeding needs may benefit from galactogogues.
Mechanical detection of suckling increases prolactin levels in the body to increase milk synthesis. Excess prolactin may inhibit the menstrual cycle directly, by a suppressive effect on the ovary, or indirectly, by decreasing the release of GnRH. [2] Suckling is a pivotal factor in maintaining lactational amenorrhea postpartum.
Prolactin has a wide variety of effects. It stimulates the mammary glands to produce milk (): increased serum concentrations of prolactin during pregnancy cause enlargement of the mammary glands and prepare for milk production, which normally starts when levels of progesterone fall by the end of pregnancy and a suckling stimulus is present.
The caloric requirement for a non-breastfeeding, non-pregnant woman changes from 1,800-2,000 kcal/day to 2,300 to 2500 kcal/day for the breastfeeding woman. Nutritional supplementation is often prescribed and recommended. In some instances women are encouraged to continue to take pre-natal vitamins. Increasing the intake of fluids is discussed.
High levels of progesterone, which are associated with pregnancy, inhibits prolactin and therefore lactation. [30] Prolactin increases during the initial stages of lactation and can be stimulated by estrogen but not progesterone. [30] Research, however, focuses on the role of prolactin for breastfeeding and less on other behaviors. [30]
During pregnancy, the level of prolactin rises to trigger the development of mammary tissue in the breast to prepare it for milk supply. [17] Yet, due to high levels of progesterone and oestrogen, which are female hormones released from the placenta, milk production is prohibited until the removal of the placenta after labour.