Moringa Side Effect Hyperphosphatemia

[Deborah Eveland NNP]

Hi Dr. Hale,
I posted previously but may have done something incorrectly - trying again.
I am an NNP in a NICU caring for an ex 26 week preemie with Philipino parents who MGM started MOB on an over the counter Moringa product post-partum. When infant finally reaching full feeds with MBM, he was noted to have a phosporus of 14-15.3 with normal calcium and alk phos on routine screening. MBM and Prolacta fortification was stopped. With hydration, phosphorus returned to normal within 24 hours.
3 quesitons
1) have you heard of this side effect before
2) we are using MBM again with HMF and have not noted abnormal labs. We had Prolacta retest the donor lot number and they had normal mineral levels
3)tested mom and her labs were normal - other than slightly low PTH
4) would you ever consider it safe for the baby to receive the MBM she had pumped for the first 7 weeks while on Moringa before she stopped taking the supplement?
appreciate your response. debbie

[cpride]

Dear Deborah,

Moringa oleifera Lam (commonly known as malunggay) belongs to the plant family Moringaceae. It is widely cultivated through out the tropics and sub-tropics and has been used for centuries for various medicinal purposes. Moringa is also known for its galactagogue properties. Until more is known of the mechanism of action of malunggay, its transfer into breastmilk and its effectiveness as galactagogues in larger populations, it is recommended malunggay should be used in breastfeeding mothers with caution. Moringa has been reported to have anti-hypertensive, hypoglycemic, anti-thyroid, hypercholesterolemic, antimicrobial and anti-tumor effects. Some of its known side-effects include hepatotoxicity, liver failure, and hepatorenal syndrome. Because this drug reportedly has anti-thyroid effects, that may have contributed to the elevated phosphorus levels although would have expected the calcium level also to be elevated. Dr. Hale recommends that infants should not be exposed to medications unnecessarily via breastmilk. In this case, because of the lack of safety data on Moringa, the stored milk should probably be discarded. This mother may also talk with the neonatalogist.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center