Is Ginger safe while breastfeeding?

Summary of use during breastfeeding

Ginger (Zingiber officinale) root contains the pungent principles or gingerols such as 6-gingerol and 6-shogaol, that are considered to be responsible for its pharmacological activity. Ginger is commonly used for nausea and motion sickness. It is reportedly used as a galactogogue in Türkiye, Indonesia and some parts of Asia, but also thought to decrease milk supply in some cultures.[1-5] Ginger is also reportedly used as part of a topical herbal mixture to shorten the time to full lactation and or alone or as part of a topical herbal mixture used for breast engorgement.[6-8] A systemic review of 5 studies on ginger as a galactogogue alone or in combinations with other herbals found weak evidence that ginger may increase milk supply in mothers who had a natural delivery, but not in mothers who had a cesarean section.[9] Other subsequent studies found steamed ginger extract increased milk flow rate more than placebo at 36 and 48 hours postpartum.[10,11] Galactogogues should never replace evaluation and counseling on modifiable factors that affect milk production.[12,13] Very limited data exist on the safety and efficacy of ginger in nursing mothers or infants. However, ginger has a long history of use as a food and medicine and is "generally recognized as safe" (GRAS) as a food flavoring by the U.S. Food and Drug Administration, including during lactation.[14] When used as a medicinal, ginger is generally well tolerated in adults, but mild side effects such as bad taste, heartburn, abdominal discomfort, weight gain, headache, dry mouth and nausea are reported occasionally. Ginger can increase bleeding risk when taken with warfarin.

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Effects on the breastfed infant

A woman was treated with a number of Ayruvedic treatments for rheumatoid arthritis postpartum. One of the products used was ginger 250 mg orally twice daily for 3 months. She reportedly breastfed her infant (extent not stated) throughout treatment and the infant had normal growth and development.[15]

In a study of exclusively nursing mothers receiving fenugreek seed 200 mg, turmeric 100 mg and ginger 120 mg (Fenucaps; Herbal Acharn's Home Co. Ltd., Thailand) 3 times daily for 4 weeks, no adverse events were reported in their infants, although the method used to determine this finding were not reported.[16]

Effects on milk supply

A study in Japan compared the use of a mixture of 13 herbs, including ginger, to ergonovine for their effects on lactation and serum prolactin in postpartum women. The herbal mixture, called Xiong-gui-tiao-xue-yin, was given in a randomized fashion to 41 women in a dose of 2 grams of a dried aqueous extract 3 times daily. A comparable group of 41 women were randomized to receive methylergonovine 0.375 mg daily. Therapy started on the day of delivery, but the duration of therapy was not specified. Plasma oxytocin and prolactin were measured on days 1 and 6; milk volumes were measured daily, although the method of measuring milk volume was not specified. Serum prolactin was higher on days 1 and 6 in the women who received the herbals; plasma oxytocin was lower on day 1 in the women who received the herbal, but not different on day 6. Milk volumes were greater on days 4, 5, and 6 in women who received the herbal mixture.[17] This study has serious flaws that make its interpretation impossible. First, milk volume measurement is subject to considerable variability depending on the measurement method used, but the method was not specified. Second, methylergonovine has caused decreases in serum prolactin and milk production in some studies.[18,19] Because of the lack of a placebo group, the differences found could be a negative effect of methylergonovine rather than a positive effect of the herbal preparation. Because this study used a multi-ingredient combination product in which ginger was only one component, the results might be different from studies in which ginger was used alone.

Studies of Thai herbal compresses containing ginger, turmeric and camphor have evaluated the effect of application of the compresses to the breasts on lactation. The studies showed that the compresses shortened the time to lactation postpartum compared to routine clinical care for enhancing lactation.[6]

A randomized, double-blind study in Thailand compared the milk output of mothers taking either dried ginger 500 mg or placebo twice daily starting within 2 hours after delivery. On day 3, mothers receiving ginger produced a statistically significantly greater volume of milk than those receiving placebo, 191 mL per 24 hours compared to 135 mL per 24 hours. On day 7 postpartum, the ginger group produced an average of 80 mL/hour of milk compared to 112 mL/hour in the placebo group, although the difference was not statistically significant. No significant difference in serum prolactin was found between the two groups on day 3 postpartum.[20]

A randomized trial in women with breast engorgement compared warm compresses to warm compresses containing a mixture of dried herbs, including ginger, lemon grass, Stapf leaves and leaf sheaths, Acacia concinna leaves, tamarind leaves, Citrus hystrix (kaffir lime) peels, Blumea balsamifera (sambong) leaves, salt and camphor. Both treatments relived the pain of engorgement, but women who received the compress with herbs (n = 250) had greater pain relief than those who received the warm compress alone. Because of the possible color and odor differences between treatments, the study cannot be considered to be blinded.[7]

Fifty women in Thailand who were 1 month postpartum and exclusively breastfeeding were randomized to receive either a placebo or capsules containing fenugreek seed 200 mg, turmeric 100 mg and ginger 120 mg (Fenucaps; Herbal Acharn's Home Co. Ltd., Thailand) 3 times daily for 4 weeks. Participants pumped milk on 2 days at 0, 2 and 4 weeks of the study. The average milk volumes increased by 49% at 2 weeks and 103% at 4 weeks among participants receiving the active product. The macronutrient composition of the milk did not change in either group over the 4-week period. Growth of infants was not reported.[16]

A randomized, double-bind study of 70 women who delivered by cesarean section in a hospital in Thailand compared 35 who took 5 grams of instant ginger powder in water to 35 who took a placebo with ginger scent, but no ginger. The products were taken every 12 hours up to 72 hours postpartum, starting at 24 hours postpartum. Breastmilk volumes were measured by test weighing their infants. Total milk volume between 48 and 72 hours postpartum were compared. The median total breast milk volumes during this time were 80 mL in the ginger group and 100 mL in the placebo group. The difference was not statistically significant.[21]

A randomized study compared nursing mothers with breast engorgement who received either a hot compress (n = 38) or hot ginger compress (n = 38) three times daily for 2 days. The women who received the ginger compresses had a greater decrease in breast pain than those who received the hot compresses.[8]

In a survey of nursing mothers in Australia, 52 mothers were taking ginger as a galactogogue. On average, mothers rated ginger as “slightly effective” on a Likert scale. Six percent of mothers taking ginger reported experiencing adverse reactions, such as weight gain, headache, dry mouth and nausea.[22]

A randomized study of women who delivered a single infant vaginally compared domperidone 10 mg to the Thai herbal product, Plook-Fire-Thatu and placebo, each given three times daily starting on the first day postpartum. Plook-Fire-Thatu contains several herbs from the genus Piper (pepper) and piperine may be the active ingredient. Piperine also enhances the bioavailability of some chemicals. Ginger, which is a purported galactogogue, is also included in the formula. Milk output was measured by test weighing infants three times daily. On day 3 of treatment, the herbal product resulted in a greater increase in milk production than placebo or domperidone, but there was no difference in infant weights between groups. Maternal temperatures were greater in the herbal group, which is in accord with the Chinese theory of increasing heat to improve lactation.[23]

A randomized study compared capsules containing steamed ginger extract 200 mg (n = 33) to placebo (n = 33) three times daily for two days starting at two to six hours after her delivery in primiparous mothers who delivered an infant of at least 37 weeks gestational age. The ginger extract contained 6-gingerol at 77.4 mg/gram and 6-shogaol at 26.2 mg/gram. Milk flow was rated on a 4-point scale according to predetermined criteria by an investigator. At 36 and 48 hours postpartum, milk flow was greater in ginger than placebo patients.[10]

A non-blinded, randomized study in Ghana compared the milk volume and serum prolactin among postpartum women who drank a ginger-spiced beverage containing 74% millet, 25% soy, 1% ginger to women who were given breastfeeding education alone and those who received no education (25 women in each group). Milk volume was determined from a single pumped sample and serum prolactin was collected between 9 am and 10 am. Measurements were made on days 1, 7 and 14. In the control group, there was little difference in milk volume and serum prolactin between day 1 and days 7 or 14. Both the education group and ginger-containing drink had higher milk volumes and serum prolactin levels on days 7 and 14, with those receiving the drink having the highest volumes and prolactin levels.[24] It is not possible to determine the contribution of ginger to increased milk production in this study.

A randomized, controlled study compared capsules containing 200 mg of steamed ginger powder to placebo, given 3 times daily for 3 days. Postpartum primiparous women started taking the capsules within 2 hours postpartum. The amount of milk that was expressed from each breast by compressing the nipple at 24 and 48 hours postpartum was compared between groups. Little difference was found between the groups at 24 hours postpartum, but at 48 hours postpartum, the women in the ginger group had about double the amount of milk expression. However, the amounts of milk expressed (1.8 mL vs 3.6 mL) were small and no further follow-up was reported.[11]

Levels in milk

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.