Efficacy and safety of Moringa oleifera supplementation for increasing breast milk production in lactating mothers: a systematic review and meta-analysis

Abstract Background Insufficient breast milk production affects 35–90% of lactating mothers globally, representing a critical barrier to WHO exclusive breastfeeding targets. Although Moringa oleifera has traditional galactagogue use across multiple cultures, systematic evidence synthesis remains limited. This meta-analysis evaluates the efficacy and safety of Moringa supplementation for enhancing milk production. Methods We systematically searched PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, CINAHL, and Scopus through November 2025 following PRISMA 2020. Eligible studies included randomized controlled trials and quasi-experimental designs assessing Moringa oleifera in postpartum women. Primary outcomes were breast milk volume and lactation success. Primary outcomes included breast milk volume and related lactation indicators (prolactin levels, milk composition, maternal satisfaction). We performed frequentist and Bayesian meta-analyses with random-effects modeling, trim-and-fill publication bias assessment, and GRADE appraisal. Results Fourteen studies (n = 865) met inclusion criteria. The pooled SMD for breast milk production was 1.010 (95% CI: 0.808–1.212; P < 0.001). Heterogeneity was absent (I²=0.0%), though this should be interpreted cautiously given diverse outcome measures. High-quality randomized trials showed consistent findings (SMD: 0.852; 95% CI: 0.580–1.124; P < 0.001). Heterogeneity was absent (I²=0.0%). Sensitivity analyses yielded similar estimates (SMD = 0.98–1.02). Bayesian analysis showed posterior mean SMD of 1.008 (95% CrI: 0.810–1.206) with 99.8% probability of benefit. Trim-and-fill adjustment-maintained significance (SMD: 0.90; 95% CI: 0.68–1.12). Dose-response analysis revealed a trend toward greater effects at ≥ 500 mg daily. Adverse events were reported in 0.3% of participants (all mild). However, these findings represent short-term safety data, and the predominance of quasi-experimental designs with limited adverse event reporting may underestimate true event rates . Conclusions This review provides moderate-quality evidence suggesting benefits of Moringa oleifera for insufficient milk production (SMD = 1.010; 95% CI: 0.808–1.212), with threshold effects at ≥ 500 mg daily (though limited by comparison of multiple higher-dose studies with a single lower-dose study). However, quasi-experimental design predominance, geographic concentration in Indonesia, and limited long-term safety data warrant caution. Short-term safety appears favorable (0.3% minor events), but long-term data are lacking. Moringa may complement lactation support pending further high-quality RCTs with standardized preparations, diverse representation, and extended follow-up.