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Volume 12, Issue 1 (6-2022)                   cmja 2022, 12(1): 2-13 | Back to browse issues page

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Azimi S, Baraie B, keykhaei R, Vakilian R, Hakimi S. Effect of Milk Thistle Plant on Breast Milk Volume: A Systematic Review. cmja 2022; 12 (1) :2-13
URL: http://cmja.arakmu.ac.ir/article-1-861-en.html
1- Department of Health Education and Health Promotion, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran.
2- Ministry of Health, Treatment and Medical Education, Department of Neonatal Health, Tehran, Iran.
3- Department of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran. , hakimis@tbzmed.ac.ir
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Breastfeeding is one of the most effective ways to ensure a child’s health and survival. It plays a significant role in better speech, higher intelligence, acquiring better developmental and educational skills in the future, proper growth and development, maintaining and promoting health and reducing child mortality. One of the important and common problems of mothers after giving birth is insufficient milk production. To increase it, many chemical drugs are used, but due to their many side effects such as dry mouth syndrome, digestive disorders and cardiac arrhythmia, medicinal plants have become more popular. In Iranian traditional medicine, several medicinal plants have been proposed for fertility, among which is the milk thistle plant, which is rich in flavonoid compounds. Few studies have shown the effects of milk thistle on breastfeeding in humans. Considering the importance of breastfeeding in maintaining and promoting the health of children, the present study aims to review the results of clinical trials on the effect of milk thistle in increasing breast milk volume.
In this systematic review study, the search for the effects of milk thistle in increasing breast milk volume was conducted in Magiran, MedLib, SID, and IranMedex using the keywords milk thistle, silymarin, milky plants. The search for clinical trials was conducted in EMBASE, PubMed, Scopus, Ovid, and ProQuest using the keywords Milk thistle, Silybum marianum, Silymarin Silybin, breast milk production, herbal galactagogues, increase breast milk, and Clinical trial. Moreover, a snowball search was conducted to identify additional studies by searching the reference lists of eligible articles and using Google Scholar to identify and screen them. The publication year was 2005-2020. The criteria for excluding articles were: Unavailability of full texts, irrelevant results, pilot studies, case reports, review studies, and animal studies. Systematic reviews were not included, but were used to identify additional eligible studies. Experimental studies with no control group and those used chemical drug therapy were also excluded. Two researchers independently extracted the details from the studies. The third researcher reviewed data extraction and resolved conflicts. Two researchers independently assessed each trial for potential sources of bias using an adapted version of the CONSORT checklist. In cases of ambiguity, a definitive decision was made by consensus with the senior researcher. Data analysis was done qualitatively.
Initial search yielded 624 records. Of these, 284 were removed due to being duplicate and 340 articles were examined in terms of title and abstract. Finally, 4 articles with a sample size of 294 were reviewed. All studies had been done outside of Iran. In none of them, milk thistle had effect on the main biochemical characteristics of milk (proteins, sugars, lipids, water). The amount of used plant varied from 252 mg in Peila et al.’s study to 5 g in Zecca and Serrao’s studies. Sugar, lactose and maltodextrin were used as placebo in the control groups. Except in Di Pierro’s study, who examined the plant effect at 30 and 63 days after consumptions, other studies measured the effect at 28 to 30 days. Due to the high importance of breastfeeding in the growth and development of premature babies, most of the studies were conducted on mothers with premature babies. All studiers, except Peila et al.’s study, reported a significant difference in the volume of breast milk between the intervention and control groups after consumption (p<0.05). In none of the studies, serious side effects of milk thistle were reported.
The present study was conducted to review the clinical trial studies conducted on the effect of milk thistle on increasing breast milk volume. Many studies had been conducted on the use of medicinal plants in increasing the milk of cows, the results of which showed that the milk production of animals fed with milk supplements increased significantly. According to the results obtained from various studies that showed the positive effect of the milk thistle plant in increasing milk volume in new mothers, and lack of studies in this field in Iran with a long history in traditional medicine and the use of plants for prevention, treatment and improvement of people’s health, it is necessary to conduct clinical trials in this field. It can also lead the policies of the health sector towards the use of herbs due to having fewer side effects.
In the current review study, there were limitations such as the lack of studies on the effect of milk thistle plant on humans and the geographical dispersion of the conducted studies (composition of the elements in the milk thistle may differ from each other). The limitations that affect the validity of the results of clinical trials include a small sample size, insufficient randomization methods, the different dose of milk thistle used at different ages of babies, the different research methodology, and the lack of indication of the breast milk volume measurement index.
Ethical Considerations
Compliance with ethical guidelines

All ethical principles are considered in this article. 
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 
Authors' contributions
All authors equally contributed to preparing this article.
Conflicts of interest
The authors declared no conflict of interest.

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Type of Study: Review Paper | Subject: Medicinal Plants

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