Endocrine Abstracts

The benefits of breastfeeding for infant and lactating mother are undisputed. Lactation induction is increasingly sought by women with endocrine conditions or by parents who have not been pregnant themselves. We developed a protocol for breastfeeding support and lactation induction in women under the care of our tertiary antenatal endocrine clinic. These women typically have premature ovarian insufficiency on HRT, or hypopituitarism. A separate cohort of women who do not have an endocrine condition (surrogate mothers, or the non-pregnant woman in a same-sex couple) seek referral for lactation induction. Lactation induction uses medication to stimulate breast milk production in individuals lacking the physiological capacity to produce colostrum and mature breast milk. In surrogate and adoptive mothers and non-pregnant mothers, the objective is to facilitate physiological changes akin to pregnancy, enabling women to breastfeed their child. Women with hormonal deficiencies have the physiological potential to breastfeed, but require bespoke hormonal supplementation. In all cases, women need multi-disciplinary input from the Specialist Infant Feeding Team. We retrospectively reviewed the case series of patients undergoing lactation induction in the preceding 5 years. In this small cohort (10 pregnancies), women received individualised care from an endocrinologist and a specialist midwife. Hormonal treatment with progesterone and/or oestrogen, and treatment with dopamine antagonist domperidone is used. Women follow either a bespoke HRT regimen, or a protocol for lactation induction. This protocol offers an accelerated regimen and a standard protocol, initiated 6 months before baby’s anticipated due date. The majority of women (8/10) did achieve breastmilk production; the duration of feeding varied between 24 hours to > 12 months. 2/10 women could not initiate breastmilk production (> 40 years, non-pregnant and without a preceding endocrine diagnosis). Effective lactation induction and breastfeeding support requires intensive input from a multi-disciplinary team that can provide tailored hormonal treatment and practical support.