Robin,
Dr. Charles Glueck has been conducting studies on the use of metformin
during pregnancy and lactation. Do a medline search under his name and PCOS
and you'll find them. The preliminary results look very good. It is my hope
and belief that for at least some PCOS moms, metformin might allow for
better glandular development. Each case is unique, however. Even if it does
not change glandular growth, it does seem to allow what there is to function
better in some women. 

Regarding goat's rue during pregnancy, because there is no info it's always
difficult. I've had a couple of mothers whose midwives gave approval try it
during their last trimester, but they weren't faithful enough to have given
it a good trial. If the health care professional gives approval, probably
worth trying.

On the question of taking goat's rue and metformin together, pharmacist
Frank Nice (on lactnet) and I have discussed this. Metformin was developed
from phenformin, which was derived from the galegin in goat's rue. Goat's
rue has "anti-diabetic" properties.  Frank's feeling is that the overlap is
probably not a problem, but that a mother should monitor herself for any
signs of hypoglycemia. 

Other possibilities for your mom: a couple of moms on MOBI report taking
alfalfa during their pregnancy and experiencing more breast growth and
better milk supplies. And in Sheila Humphrey's book on page 129 is a recipe
for "mega-galactogogue tea" that one of my study subjects sent me. She had
low supply and hence was in my study, but wrote me later to say that she had
taken this homemade herbal tea during pregnancy, added a few more things
postpartum, and had a full supply with her second baby. Most recently
another LC had a client with a dismal milk production record who tried the
tea during pregnancy and made more milk the second time around, enough to be
delighted with the difference. Although the recipe does not say it, I do
believe the mom added goat's rue powder during the last trimester to her
pregnancy recipe.

If the mom has a lot of symptoms of hyperandrogenism, she might consider saw
palmetto after delivery. SP has a historical reputation for agalactia and
hypoplasia of the mammary gland, and is considered a hormone balancer and is
sometimes used to combat hirsutism. 

One other herb that I'm working with more is shatavari. It comes from India
as does fenugreek, and in fact is the main ingredient in Lactare, a
commercial product that has shatavari, ashwagandha, fenugreek, licorice and
garlic.  Shatavari has gastric emptying properties similar to reglan and has
even been tested against reglan, and also may increase prolactin similarly.
The studies comparing it for lactation were negative but were not conducted
very well. A number of women have been trying it recently, and a couple have
actually weaned off their domperidone and over to shatavari. I have not
found any reported toxicities. In the ayurvedic tradition it is considered a
strong female tonic, good for fertility, regulating hormones, stabilizing
pregnancy, preventing premature delivery, increasing mammary gland (there
have been some animal studies showing glandular growth) and increasing milk
production. You can read about shatavari on lowmilksupply.org. 

I hope you find this all useful.

Lisa Marasco MA IBCLC

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