Specialty obstetrics ICD-9-CM 676.4 | ICD-10 O92.3 | |
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.
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Causes
The most important cause of lactation failure is an insufficient secretion of prolactin from the pituitary gland. 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. 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. Hypopituitarism in general can impair secretion of pituitary hormones such as prolactin and growth hormone (GH) and in turn result in lactation failure.
"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. and therefore, lactation
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. 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. 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.
Treatment
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).
Merotocin (FE-202767), an oxytocin receptor agonist, is under development specifically for the treatment of lactation failure in preterm mothers.