Papaya and Breastfeeding

Summary of use during lactation

Papaya (Carica papaya) fruit contains the proteolytic enzymes papain and chymopapain before ripening, but they are not present in the ripe fruit. Cooked, unripe papaya fruit has been used orally in India, Melanesia and Angola, and papaya leaves have been used in Indonesia as galactogogues, possibly by increasing prolactin.[1-6] No scientifically valid clinical trials support the use of papaya fruit or leaves as a galactogogue. Galactogogues should never replace evaluation and counseling on modifiable factors that affect milk production.[7,8] No data exist on the excretion of any components of papaya into breastmilk or on the safety and efficacy of papaya in nursing mothers or infants. Papaya fruit is "generally recognized as safe" (GRAS) as a food by the U.S. Food and Drug Administration. Papaya also contains carotenoids and can improve beta-carotene and vitamin A status in nursing mothers.[9] Allergic reactions to papaya, such as asthma and skin rashes are not uncommon and cross-reactions with other substances such as latex and kiwi have occurred. Those with allergies to papaya or cross reacting substances should avoid papaya.

Drug levels in milk and infant serum

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.

Effects in breastfed infants

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

Effects on lactation and breastmilk

A small study compared papaya leaf extract in various doses to placebo in nursing mothers. It found that a dose of 800 mg daily was more effective than a dose of 600 mg daily or a placebo in raising serum prolactin levels after 8 days of treatment.[10] A randomized, but not placebo-controlled trial gave postpartum mothers (n = 30) a mixture containing Sauropus androgynus extract, papaya leaves, mung beans, tamarind and sugar. One bottle of 400 mL of the mixture was taken daily for 4 weeks postpartum. A control group (n = 30) received breastfeeding counseling only. The amount of breastmilk produced was estimated weekly for 4 weeks by weighing mothers before and after feeding, although it is unclear how this was done and by whom. Daily milk production in the third week (801 vs 656 mL) and fourth week postpartum (909 vs 757 mL) was greater in the women who consumed the galactogogue mixture.[11] A nonblinded study in Indonesia randomized postpartum women with perceived low milk supply to either an herbal decoction containing 25 grams Sauropus androgynus (katuk) leaves, 10 grams Coleus amboinicus (torbangun) leaves and 5 grams papaya leaves (n = 60) or to 500 mg Sauropus androgynus extract (CV Al-Ghuroba, Indonesia; n = 60). Patients were to take the product and weigh their infant twice daily for 28 days. Maternal serum prolactin was measured on day 14 and 28. Breast milk volume and infant’s weight increased on days 14 and 28, and serum prolactin levels decreased in both groups; however, the changes were not statistically significant. Mean infant weights increased, with no difference between the two treatments. Two mothers in the combination group and 3 in the extract group had increases in aspartate aminotransferase and/or alanine aminotransferase.[12]

References

1. Sayed NZ, Deo R, Mukundan U. Herbal remedies used by Warlis of Dahanu to induce lactation in nursing mothers. Indian J Tradit Knowl 2007;6:602-5. https://nopr.niscpr.res.in/handle/123456789/1009
2. Bourdy G, Walter A. Maternity and medicinal plants in Vanuatu. I. The cycle of reproduction. J Ethnopharmacol 1992;37:179-96.1453707 PubMed
3. Rasiya Beegam A, Nayar TS. Plants used for natal healthcare in folk medicine of Kerala, India. Indian J Tradit Knowl 2011;10:523-7.
4. Jendras G, Monizi M, Neinhuis C, et al. Plants, food and treatments used by BaKongo tribes in Uíge (northern Angola) to affect the quality and quantity of human breast milk. Int Breastfeed J 2020;15:88.33097071 PubMed
5. Sayuti NA, Atikah N. The pattern of herbal medicines use for breastfeeding mother in Jogonalan, Klaten, Indonesia: A mini survey. BMC Complement Med Ther 2023;23:399.37936188 PubMed
6. Herawati Y, Kalsum U, Arsana IW, et al. Molecular docking analysis of Carica papaya leaf's bioactive components as prolactin production modulator. J Appl Biol Biotechnol 2024;12:117-27. doi:10.7324/jabb.2024.155147
7. Brodribb W. ABM Clinical Protocol #9: Use of galactogogues in initiating or augmenting maternal milk production, second revision 2018. Breastfeed Med 2018;13:307-14.29902083 PubMed
8. Breastfeeding challenges: ACOG Committee Opinion, Number 820. Obstet Gynecol 2021;137:e42-e53.33481531 PubMed
9. Ncube TN, Greiner T, Malaba LC, et al. Supplementing lactating women with pureed papaya and grated carrots improved vitamin A status in a placebo-controlled trial. J Nutr 2001;131:1497-502.11340106 PubMed
10. Pratiwi TE, Suwondo A. Exclusive breastfeeding improvement program using Carica papaya leaf extract on the levels of prolactin hormones. International Journal of Science and Research (IJSR) 2018;7:548-51.
11. Ngadiarti I, Agestika L, Srimiati M, et al. Sauropus androgynus, papaya leaves, and mung beans as mixed galactagogue drink for urban postpartum mothers. Jurnal Gizi Dan Pangan 2021;16:101-8. doi:10.25182/jgp.2021.16.2.101-108
12. Zulkarnain Z, Fitriani U, Ardiyanto D, et al. Galactagogue activity of poly-herbal decoction from Indonesia: A randomized open label controlled trial. J Complement Integr Med 2024;21:532-9.38644615 PubMed