Metformin - 1st tri only or throughout pregnancy?

[Ophelia]

When I got pg with DS, I took Metformin (for PCOS/infertility) through the first tri on the advice from the CNP at the time.

I am currently 13 weeks and on the Met. I am trying to decide whether to continue to take it the whole pg or quit. I had a miscarriage in March, I had started the Met about 2-3 weeks into the pregnancy. Not sure if not being on the Met from the beginning caused the m/c, or stress from work, or...

Last pg, I gained 50 lbs and at the end I was 'peeing too much sugar' according to the clinic I was going to. I don't know if Met would help for something like that? If it would, I would continue to take it.

Had a scan at 11w5d and everything looked great.
I haven't called the OB clinic yet to ask them, not sure what they would say.
Thanks!

[trimestersdoula]

I know that a friend of mine who had PCOS was on Met. and her doctor took her off of it after the first tri. I can't remember why, but from what I understand it isn't recommended to take through pregnancy.

[~Adorkable~]

i was up agaist this decition as well, and with a history of Type II in my family and me having IR i thought i was going to stay on it.

i studied and read everything till i was blue in the face, here is what i gleamed.

most studies are both very small so not very good with their final number and also about women that wither or on it because they have type II or only on it as a fertility aid, the former often needed to stay on it or go over to insulin dosing to get thru anything, the later was usually taken off it. So for me who was kinda in the middle on the scenarios it was hard.

my doc said to go of it because they felt it interfered with the babies natural process of learning how to deal with insulin, i have not seen a ton of study one way or the other with this claim, but i can see it being true

i finally did ween myself off of it at 11 weeks because i learned that it is NOT recommended that you breast feed while on it, in that case it has been shown to disrupt natural development of the babies metabolic insulin receptors. Since i was going to have to go off it at some point i figured that avoiding the possible harm was a good reason to do it sooner rather than later. i have redoubled my nutritional efforts of low simple carb and all meals to have protein and will trust that i can take care of myself that way. i am currently 14w4d and feeling great about my choice and my food intake

hope that helps a little

[Midwesterner04]

Originally Posted by Ophelia

When I got pg with DS, I took Metformin (for PCOS/infertility) through the first tri on the advice from the CNP at the time.

I am currently 13 weeks and on the Met. I am trying to decide whether to continue to take it the whole pg or quit. I had a miscarriage in March, I had started the Met about 2-3 weeks into the pregnancy. Not sure if not being on the Met from the beginning caused the m/c, or stress from work, or...

Last pg, I gained 50 lbs and at the end I was 'peeing too much sugar' according to the clinic I was going to. I don't know if Met would help for something like that? If it would, I would continue to take it.

Had a scan at 11w5d and everything looked great.
I haven't called the OB clinic yet to ask them, not sure what they would say.
Thanks!

Hi,

Congratulations on your pregnancy! I have been taking Metformin for PCOS for the last several years and just completed a healthy full-term pregnancy without the slightest of complications. I attribute some of this to the fact that I continued to take Metformin throughout the full 40 weeks. In addition to significantly reducing risk of first trimester miscarriage, Metformin has also been found to reduce rates of late miscarriage, preterm labor/birth, and gestational diabetes, all of which are more common with PCOS, in later pregnancy. Metformin does help to regulate blood sugar if it is a problem for you, so it could prevent the blood/urine glucose issues you had last time.


Best wishes!

[Ophelia]

Thanks! Something to think about and I will also call the CNP. Mainly concerned with blood sugar and GD, I had a feeling it may help regulate blood sugar. I try so hard to not eat too many sweets, they seem even harder to stay away from now!

Not really a history of Type II Diabetes in my family, my grandma got it but not until her 80's and so far no one else has it.

it is NOT recommended that you breast feed while on it, in that case it has been shown to disrupt natural development of the babies metabolic insulin receptors.

Do you know if this means just for newborns only? I am still nursing DS and was told it was fine.

[jessica_s]

I was at a breastfeeding conference this spring and was at a milk supply session given by Diana West (IBCLC extraordinaire and author of several really really good books and websites) and she had mentioned in the fertility section that mothers who were treated with metformin (and taken off in early pregnancy) were quite often experiencing low supply but those who were treated with it the entire pregnancy were having much better results. I wish I had my notes so I could send references (I have them somewhere if you want to PM me I'll dig them up).
Anyway, from what I know there has not been a full blown study on this but it's something to keep in mind if the metformin was used for fertility purposes!

[Ammaarah]

I have always heard it is safe for pregnancy and nursing, and anecdotally I've heard it can help with milk production. I used it through both pregnancy and two and a half years nursing with my daughter. I'm pregnant again now, about 5 years later, and I'm not on it because I've had a malabsorptive weight loss surgery that kinda has taken the place of Met in regulating my insulin and such. But if I had not had surgery, I would probably take it throughout pregnancy and nursing.

[Midwesterner04]

Originally Posted by jessica_s

I was at a breastfeeding conference this spring and was at a milk supply session given by Diana West (IBCLC extraordinaire and author of several really really good books and websites) and she had mentioned in the fertility section that mothers who were treated with metformin (and taken off in early pregnancy) were quite often experiencing low supply but those who were treated with it the entire pregnancy were having much better results. I wish I had my notes so I could send references (I have them somewhere if you want to PM me I'll dig them up).
Anyway, from what I know there has not been a full blown study on this but it's something to keep in mind if the metformin was used for fertility purposes!

Yes, this. :-)

The IBCLC lactation consultant and breastfeeding researcher Lisa Marasco also has some publications on PCOS and milk supply problems, which metformin often helps with. Thomas Hale, the very pro-breastfeeding pharmacologist (Texas Tech University School of Medicine) and editor of the desk reference Medications and Mothers' Milk (all the LC's I know use it), counts metformin as safe for breastfeeding and also worthwhile in that it can help mothers who otherwise would have supply problems. Information about metformin is available on his website and via his breastfeeding hotline at 1-808-352-2519. I believe the endocrinologist and PCOS researcher Charles Glueck at the Jewish Hospital in Cincinnati also has information about PCOS, metformin, and lactation at his website. I'm sorry not to post links right now, but I don't have them on hand and have to run. I'll try to add them when I am able to get back online.

[Jenne]

Oh, I'm so glad to know that Met has helped with breastfeeding! I was just beginning to think about what preventative things I could do (I have PCOS) to ensure a good start. Thanks for the info and hotline number!

I've been on Met XR for years. I had planned to stay on it throughout pregnancy because there did not seem (although as Adorkable pointed out the studies were *small* samples) an increase in harm from staying on it but the downside of needing it and not being on it seemed to be harmful. So far I'm almost 14 (gasp!) weeks and doing well, feeling fine, and haven't gained any weight. I'm not trying to lose/not gain but maintaining my weight feels right. I think the Met helps with this. I do think the met is fueling some of the intense hunger I'm having. I don't normally get hungry so in a way it is a good reminder to me to eat every 3-4 hours.

I wish you the best with your choice. Due to the lack of longitudinal studies (how do kids whose Mom's took Met during pregnancy fair at age 10, 15?) and the lack of large scale studies, it is a risk. Read the research yourself, talk to women who have made both decisions, talk to nurses and doctors (who are familiar with the research!) and go with what your gut and your brain tell you is right for you, your baby, and your situation. I wish you a healthy and happy pregnancy!

Jenne

[rlandnl]

With my first pregnancy I was on met, and stayed on till 12 weeks when I was weaned off. I ended up with insulin dependent GD. (That was an IVF Pregnancy)

This pregnancy, I am 37 weeks, I was on met, got unexpectedly pregnant as we were told we could never conceive naturally. I was under the care of an endocrinologist, she told me the school of thought now is if you are on met when you get pregnant to stay on it throughout, UNLESS you get GD then go on insulin. My OB wanted me to wean off it at 12 weeks. But she defered to the endocrinologist on the matter. So i have stayed on 2000mg daily (1000mg 2X). I do not have GD this time, I do have to watch my carb intake or my numbers go up a little too high and I have had some downb weeks with fastings but nothing like last time- preg 1 they were 115-120 this time highest has been 105 and mostly in the 80s and 90s.

The endo does want me to come off it after she's born as she doesn't feel that it's safe during nursing... but now reading some of the other posts here I am going to research that myself since I would like to spontaneously conceive again and I think it was the met combined with the right amount of weight loss that made it possible.... so if anyone has any links that I can have so I can send them to the endo I would greatly appreciate it!!

[Ophelia]

Thanks! When I called the OB office, I could not talk to a nurse about it over the phone, they wanted me to talk to a doctor about it 'at my next prenatal appointment'. Well, I am not going there for prenatal appointments because I will have a HBMW! So I have to figure this out on my own.

All I know is I was told by my original CNP that it was safe to use during nursing, so it would be nice to find out more about that if it is unsafe (DS is 4yo and I'm encouraging weaning right now, have been on the Met since end of Feb. 2010).

I just need to decide quick so I know whether or not to refill the perscription. I'm currently at 15 wks and have gained about 5-6 lbs so far. Not sure if that is normal at this point!

[Stayseeliz]

I was on it with my last pregnancy until around 17-18 weeks when I weaned off. I went back on it when DD2 was 8 months old and nursing. It was fine.

I'm taking a lower dose now (850mg) at 5.5 weeks pregnant. Not sure what I'll do this time around.

I had a friend that took it all the way up through birth and while nursing and she and the baby were fine!

[phoenix78]

I was on Met to conceive both DD#1 and 2. With DD#1, I stayed on all the way through birth because I had ongoing complications (bleeding, PROM) and was concerned about miscarriage/loss. However my pregnancy with DD#2 went so well that I decided to get off the Met after the first tri. No complications with that pregnancy at all and I delivered a VBAC baby who was 7lbs. 8.5 oz. Now with baby #3, my PCOS has surprised me and I conceived unexpectedly on my own, the first time I must have ovulated after weaning baby #2. No met this time, hoping all goes well. I'd say if you hadn't had any problems and feel good, try going off it. Wishing you a blessed pregnancy.

[cristeen]

I took met to conceive my first pg, weaned at 12 wks. I couldnt get off of it fast enough, it made me so sick. I will always wonder whether the met contributed to his congenital defect.

I will say that even w pcos and the years of ART, my 2nd pg i refused treatment for my IR, but i also refused the GTT. I tracked my BS w a glucometer I borrowed from my MW and discovered that I'm hypoglycemic in pg. If i had taken the GTT i have no doubt i would have been labeled GD because all that sugar would have seriously messed w me (and i would have been sick for days). But the GTT is a club, not a precise instrument. Because i knew what my BS was doing, i was able to control it through diet (smaller more frequent meals).

All that to say that the research is insufficient, and no drug is 100% safe during pregnancy. There are other ways of accomplishing what the met does w/o the risks. And that's not a risk I choose to take again, but you have to decide on your comfort level.