Metformin and Pregnancy, conflicting opinions to sort out

[~Adorkable~]

anyone want to talk to me about wether or not to stay on
Metformin for my IR while preggo?

good studies or medical info would be good, i have done a lot of reading and get too many conflicting issues. today my OB in my first full appointment with her told me to get off it, but was unclear why. she thought it could cause low blood sugar in the babies.

then i also hear that it can help me avoid GD and miscarriage

as for me, i am 36, its my first pregnancy and i am carrying twins, i have moderate insulin resistance and family history of Type II Diabetes, i take 1500mg of extended release daily

[birthangeldoula]

I don't have any studies, but my OB kept me on metformin until 28 weeks with both of my pregnancies with my girls. I took 1500 of the extended release also. Once off metformin I had to monitor my blood sugars a couple times a day and stick to the GD diet. My OB kept me on it because he said it does reduce the incidence of miscarriage, and I had already had 2 so we just stayed the course and kept me on the metformin.

[paintedfire]

I dug up a few links for you. I've never had issues with my blood sugar levels, but my Mom has been on Metformin for years. However she's seventy and well out of her childbearing years, so I know very little about it's effects on pregnancy or women who are still fertile.

1. http://www.ovarian-cysts-pcos.com/gl...rmin-pcos.html
2. http://www.healthline.com/blogs/preg...ption-and.html
3. http://www.fertilityplus.org/faq/metformin.html
4. http://findarticles.com/p/articles/m...9/ai_n6114084/
5. http://www.ivf1.com/metformin-risks/

Hope they help some. There seems to be conflicting opinions - on what isn't there, though? - so your best bet is talking to your midwife or doctor. Even a pharmacist is a good place to go for information like this.

[tinynyota]

I was about to post one of same links Leigh just did (#2 above, from the healthline blog). In it he cites several studies.
You may be familiar with his site already, but in general I have found Dr. Trofatter's blog posts and Q&As to be extremely detailed and informative on lots of tricky pregnancy issues and complications.
Good luck with your decision-making.

[Paeta16]

I don't have any current links as the last time I looked into this was about 4 years ago when I was PG with DD1. I have PCOS and I am insulin resistant but had normal blood sugars b/f getting pregnant. I stayed on Metformin for the first 3 months of my last pregnancy (DD1) and this pregnancy (currently 22 weeks) against my family doctor's recommendation. I had read that it can decrease the risk of miscarriage in women with PCOS...and at the time I had done a lot of research and kept coming to the same conclusion - that the benefits outweighed the risks for me.

That being said, I stopped taking both at 12 weeks and I developed GD with my first pregnancy around 29 weeks and this time at around 17 weeks. Here in Canada they only treat GD with insulin and not pills which I am fine with. Having high blood sugar in your first trimester can cause birth defects but that is not why I stayed on Metformin fwiw.

[momtoafireteam]

I have taken Metformin every single day since I was diagnosed with PCOS almost 6 years ago. I have no idea if I am IR anymore, all I know is that since then I have had 5 children and that I weigh less, my PCOS symptoms are all dramatically less, and when I am not pregnant I have semi-normal cycles (I still need help to get pregnant but its too bad.....).

There is very very little that could persuade me to come off Met.

[Midwesterner04]

I would recommend checking out the work done by Dr. Charles Glueck on use of Metformin in pregnancy, which is one of his primary research interests. He is an endocrinologist who works with women from around the world who are dealing with PCOS and IR issues, and his PCOS and IR patients--who generally continue Metformin throughout their pregnancies--have an unusually high rate of successful uncomplicated pregnancy (and healthy, term babies without blood sugar problems) and very low incidence of gestational diabetes and other metabolic issues. I'm not usually an advocate of the "fix it with drugs first!" approach, but Metformin does seem to bring compelling results.
More anecdotally, I take it myself, and I really feel it has changed my life. Since reaching my current dose 6 years ago, my PCOS has become completely asymptomatic, I have had continual 28-day cycles with ovulation on day 15 of every month, and no fertility problems whatsoever. I have maintained my current dose of Metformin throughout my pregnancy (I am "due" in a few weeks) and have had no complications. My blood sugars are great and the baby is growing well. I may not have been quite as fortunate had I not been taking Metformin.

[~Adorkable~]

Originally Posted by birthangeldoula

I don't have any studies, but my OB kept me on metformin until 28 weeks with both of my pregnancies with my girls.

were you on it just to get preggo or on it full time before hand for general IR issues?

Originally Posted by Paeta16

..and at the time I had done a lot of research and kept coming to the same conclusion - that the benefits outweighed the risks for me.

That being said, I stopped taking both at 12 weeks and I developed GD with my first pregnancy around 29 weeks and this time at around 17 weeks. Here in Canada they only treat GD with insulin and not pills which I am fine with. Having high blood sugar in your first trimester can cause birth defects but that is not why I stayed on Metformin fwiw.

so what was the reasoning that made you decide to stop it and risk the GD? yeah here they do insulin for treatment as well



thanks for the input, please keep it coming, i will go do this additional reading

[umsami]

Hi:

I've had GD for all four of my pregnancies. First one was treated with insulin. Second two with glyburide. This one, I was on metformin ER at first... and now I'm still on metformin (at 32 weeks) as well as some NPH insulin at night. My endocrinologist is very conservative--yet, when I called him up when I found out I was pregnant, he said that all of the recent research showed that it was fine to stay on metformin during pregnancy. The only difference I've noticed is that I've had lower weight gain with this pregnancy--but everything else looks fine. (In the past, I tend to gain a lot.. so that's a plus for me.)

Here's a very recent article:
http://www.ncbi.nlm.nih.gov/pubmed/20542272

http://www.ncbi.nlm.nih.gov/pubmed/20441061

http://www.ncbi.nlm.nih.gov/pubmed/20350646

http://www.medscape.com/viewarticle/560059_2

[splath]

I would definitely stay on it for the first trimester. I really believe not being on it caused my first miscarriage. I have stopped taking it at the second trimester point, but *am* worried that I will end up with GD.

[momtoafireteam]

I thought of something else. I literally cant imagine anything worse than getting back on Metformin when you are postpartum. I had a rough tummy time starting it up, and dont even want to think about having gastro issues like that with a c/s incision or a healing "down there". A little TMI, but there you go!!

[~Adorkable~]

As for postpartum, as I have been reading al mooring I have come across those that say that e en if it might be best to stay on it for the pregnancy, that you shouldn't take it while breastfeeding. So now I'm even more troubled.

It's hard to find good studies that include a large enough group that I trust any results, it's amazing how many studies have less than a hundred or so ladies.

Many studies are dealing with ladies that have type 2 rather than just IR or are dealing with ladies that only took it to get preggo and would not normally be on it for IR or anything.

And lastly what seemed like once of the clearest writings on the subject was published on a page selling replacement products to metformin, so their bias is clear. Now their info may be spot on, but i don't trust anyone that mixes medical studies with product placement as a rule of thumb.


Uuurrrgh

[birthangeldoula]

I was put on metformin for PCOS. I was on it for 6 months before getting pregnant the first time, and will go back on it once I'm done with this pregnancy and done with breastfeeding.

[~Adorkable~]

Yes, and the question is, why did you go off it while preggo?

[Lauren31]

I feel like if you do not NEED to be on it and can manage your insulin with diet and exercise then you should try to do that. Especially if your doctor recommended that. I think it is one of those things that is "safe" but really no none knows for sure HOW safe it is. you know?

[cristeen]

I took Met (among other things) to get pg the first time, and went off it as soon as my RE "allowed" me to - 12 weeks - after the highest risk of m/c was past. I was sick as a dog the entire 12 weeks. I hated that stuff, it seriously whacked out my system. There was no way I could have continued on it throughout the pg. And I will always wonder whether it was a contributing factor in my DS1's CHD.

The second pg, I got pg on my own. No Met involved. I was (and am) still IR, but glucometer tracking during my pg showed that I was not hyperglycemic, I was/am hypoglycemic (which is common with PCOS). I ate sensibly (with the occasional splurge), made sure to always pair my grains with fat and protein, limited sugar, and didn't have a problem. Oh, and I absolutely refused the GTT. I suffered with mild m/s until about 38 wks, but compared to the m/s while on the Met, it was a piece of cake.

I can't speak to Met during BF, but once upon a time there was a (long) thread in the BF forum about it.