LACTANCIA INDUCIDA Y GALACTOGOGOS

Sr. Director Aunque la lactancia es la norma fisiologica, las normas culturales para la alimentacion infantil han cambiado dramaticamente durante el siglo pasado. El inicio de la lactancia materna cayo de 70% al principio de 1900, a 22% en 1972. En los ultimos 40 anos, los indices han aumentado considerablemente, hasta llegar a 77% en 2010; pero aunque mas mujeres estan iniciando la lactancia materna, muchas informan que no la continuan tanto tiempo como quisieran.[1] Segun la OMS tan solo el 38% de los lactantes menores de 6 meses recibe Lactancia Materna exclusiva.  Entre las estrategias mundiales de la OMS planteadas para 2025 encontramos incrementar hasta al menos un 50% la tasa de lactancia materna exclusiva durante los 6 primeros meses. En las ultimas decadas, el concepto de familia y maternidad ha sufrido modificaciones y han aparecido nuevas formas de maternidad. La adopcion y la gestacion subrrogada son dos de estas formas que inicialmente suponian una barrera para instaurar una lactancia materna. Actualmente la sociedad empieza a hablar de Lactancia Inducida. La mayor parte de los estudios encontrados hablan de relactacion, aunque tambien existen diversos estudios que avalan la viabilidad de la lactancia inducida en madres adoptivas en las que no existio embarazo previo. Despues de  este marco introductorio quisiera hablar de los llamados galactogogos extendidos culturalmente en una sociedad que parece desconocer la fisiologia lactea y una importante desconfianza en la capacidad intrinseca femenina. La evidencia para respaldar el uso de galactogogos es limitada. La dopamina inhibe la liberacion de prolactina, por lo que los antagonistas de la dopamina aumentan los niveles de prolactina.[1] Los galactogogos pueden actuar en dos frentes, bien como bloqueadores de los receptores hipotalamicos de dopamina o inhibiendo neuronas productoras de dopamina. Por tanto, existen muchos farmacos con accion galactogoga, como metoclopramida, domperidona, clorpromazina, oxitocina, la hormona del crecimiento, etc., ademas de otras plantas o sustancias naturales usadas desde hace siglos con este fin, como el fenogreco , la galega , el cardo mariano, etc. [2] [3] Debido a que el estado actual de la investigacion de todos los galactogogos es relativamente poco concluyente y todos los agentes tienen potenciales efectos adversos, la ABM no puede recomendar ningun galactogogo farmacologico o herbal especifico en este momento. [4] Para que el proceso de induccion a la lactancia sea exitoso es necesario tiempo y dedicacion, ademas de una gran motivacion y una buena estimulacion del pezon y pecho. Es fundamental que la madre tenga fuerte deseo de alimentar al nino, siendo la propia madre adoptiva la que desee la lactancia, sin presiones externas. Debera tener confianza en si misma y en su capacidad de producir leche, resultando basico para ello el apoyo de la familia, pareja, entorno social asi como de la comunidad y los servicios de salud. [5] INDUCED BREASTFEEDING AND GALACTOGOGOS Mr Director Although breastfeeding is the physiological norm, cultural norms for infant feeding have changed dramatically during the past century. The beginning of breastfeeding fell from 70% at the beginning of 1900, to 22% in 1972. In the last 40 years, the rates have increased considerably, reaching 77% in 2010; but although more women are initiating breastfeeding, many report that they do not continue it as long as they would like. [1] According to the WHO, only 38% of infants under 6 months receive exclusive breastfeeding. Among the WHO global strategies proposed for 2025, we find that the rate of exclusive breastfeeding during the first 6 months is increased to at least 50%. In recent decades, the concept of family and motherhood has undergone changes and new forms of motherhood have appeared. Adoption and surrogacy are two of these forms that initially constituted a barrier to establish breastfeeding. Currently the society starts talking about Induced Lactation. Most of the studies that are found mention relactation, although there are also several studies that support the viability of induced lactation in adoptive mothers in which there was no previous pregnancy. After this introductory framework, I would like to talk about the so-called galactogogues culturally extended in a society that seems to be unaware of milk physiology and an important distrust of female intrinsic capacity.  The evidence to support the use of galactogogues is limited. Dopamine inhibits the release of prolactin, which is why dopamine antagonists increase prolactin levels. [1] Galactogogues can act on two fronts, either as blockers of hypothalamic dopamine receptors or by inhibiting dopamine-producing neurons. Therefore, there are many drugs with galactogoga action, such as metoclopramide, domperidone, chlorpromazine, oxytocin, growth hormone, etc., in addition to other plants or natural substances used for centuries for this purpose, such as fenugreek, galician, Milk thistle, etc. [2. 3] Because the current state of research of all galactogogues is relatively inconclusive and all agents have potential adverse effects, the ABM can not recommend any specific pharmacological or herbal galactogogo at this time. [4] For the process of induction to breastfeeding to be successful, time and dedication are necessary, as well as great motivation and good nipple and breast stimulation. It is essential that the mother has a strong desire to feed the child, being the adoptive mother herself who wants breastfeeding, without external pressures. She must have confidence in herself and in her capacity to produce milk, the support of the family, couple, social environment as well as the community and health services being basic. [5]