Pregnant with PCOS & Metformin.

[gingergrltea]

I have pcos I WAS overweight.I lost my weight without taking the metformin.I am worried though that I might need to take it.I eat a paleo style diet,and will be adding more fruits & veggies to the mix now.My dr didn't act like I needed to take it.I have read that it helps women with PCOS not have complications.

[msmiranda]

Yes, from what I have read, it does three things: (1) reduces the risk of miscarriage; (2) reduces the risk of gestational diabetes; and (3) reduces the risk of low milk supply (some PCOS mamas, maybe 25%, have low supply issues).  I have PCOS and would totally be taking Metformin right now if I hadn't been so freaking sick during this pregnancy.  I hope to be able to start taking it soon.  The "old school" advice was that not enough was known about its safety, but some studies  (like this one) have come out in the past few years that show no increased risk of adverse neonatal outcomes with use of metformin to treat GD. 

[dakotablue]

Well...do you have insulin resistance? Having PCOS does not mean you will, just that you might.

I had, have? PCOS tests wouldn't show it now though...I did not have insulin resistance and I was told there was not enough evidence to warrant safe used of metformin in someone who didn't have that end of it.

Its kinda like they picked one of the side effects and found success treating it to balance some women, but PCOS is an umbrella diagnosis. 

Personally I would get a referral to an endocrinologist and have my levels checked, (also do GTT test with them, they can do an A1c instead of 1 hour which is more accurate and not as gross)I wouldn't just start a med without knowing for sure its needed.

I will say I had no issue breastfeeding (if anything an over supply) but with DS I did have low progesterone, but with this pregnancy I was great (27.5 at 9 weeks)

[Jenne]

I was on met xr prior to conceiving and have stayed on it the entire pregnancy. I will continue on it for the foreseeable future...mainly because of the new research showing that it can help breastfeeding.

I think it is great that it is available and think if you want to start it you should talk with either an RE or OB about it...

Good luck!
Jenne

[MarineWife]

I have PCOS, have not historically been overweight (I have kept an extra 15-20 lbs on since my last baby) and am not IR. I have taked 1500 mg metformin XR as recommended by my RE for 3 months before conception and through the first trimester for 3 pregnancies now. I do have RPL and the only time I seem to be able to have a pregnancy that makes it past the 1st trimester is if I take metformin and low dose aspirin. Just one or the other does not work. I have to take both. I'm 13w6d and just stopped taking metformin last Sunday. Yay! I'm so glad to be off it. The MFM doc requested that I get a 1 hour GTT 3 days after stopping it just to make sure my blood sugars don't go haywire. I did that yesterday. Not sure when I'll get the results.

I've heard conflicting opinions on whether or not metformin is helpful for the entire pregnancy. I've had some docs tell me I shouldn't be on it at all. Most say to stop it after the 1st trimester. Some say it may help prevent GD if taken throughout pregnancy. Some say every woman with PCOS should take it while TTC. Others say only if you have IR. The latest, from the MFM doc I've been seeing with this pg whom everyone says is always up on the latest info and research, is that metformin is not the preferred oral insulin regulating medication during pregnancy. He told me the name of the other one but I can't remember what it is.

I have never had GD but I was considered borderline GD with my 2nd child. I failed the 1 hour GTT and barely passed the 3 hour GTT. My 1 hour blood glucose level was high. The 2 hour was right on the upper limit and the 3 hour as low. You have to have at least 2 high numbers to be considered GD. However, because I have PCOS and had been taking metformin, the OB I was seeing at the time wanted to treat me as if I did have GD, which meant following a GD diet and checking my blood sugars 4 times a day. My blood sugars were always very good and I didn't have any problems with that pregnancy.

[msmiranda]

Oops, I didn't read your post carefully -- I thought you were taking metformin before and wanted to know if you should stay on it during pregnancy.  Since you have not been on it in the past, and presumably got pregnant without taking it, it might not be necessary for you to take it right now.  I guess my question would be, why were you diagnosed with PCOS?  And, second, like one of the PPs asked, do you have any insulin resistance issues?  If so, taking metformin could be beneficial in preventing GD. 

I would not worry much about the safety of metformin either during pregnancy or at any other time.  It has been used in the United States for at least forty years and has a terrific safety profile.  Like I said before, doctors have traditionally been shy about prescribing it during pregnancy (or they say go off it after the first trimester), but that is based on the fact that there had not been many studies done on its use in pregnant women until the past few years.  However, it has been used during pregnancy in other countries for years, and recent studies here have shown it to be safe in pregnancy.  Doctors tend to be slow to change their practices based on new information sometimes ... also, some of them may not know about the newer studies. The other drug used to treat GD is glyburide.  This study showed that glyburide works for more women than metformin in achieving glycemic control once GD has already been diagnosed, but metformin has been established to reduce the incidence of GD diagnosis if taken throughout pregnancy. 

FWIW, I have PCOS but am neither obese/overweight nor have I ever had any insulin resistance issues when I am not pregnant.  Nonetheless, I have had GD with all of my pregnancies and know that I am at risk for developing type 2 diabetes later in life (my father has it and was diagnosed in his early 30s).  As soon as I am finished breastfeeding this LO, I will be taking metformin preventatively.  Normally I am not one to take medication or to like the idea of being on a medication for life, but I honestly believe that metformin is safe and that it works, so given my risk factors, if it (in addition to healthy lifestyle of course) can help me stave off diabetes longer, I'm all over that. 

[gingergrltea]

Yes last year I got a blood test that showed I had PCOS.I later had to go get a Insulin Resistance test.I was severly IR.I never took the Met.I am very leary of pharma meds.So I lost my weight by diet alone.Now that I am pregnant or by what the preg test says (didn't see anything on Ultrasound today) my lining was thick though I guess a good sign.My last menses was Dec 10 but I do ovulate late I think....I don't want to risk taking met,at the same time I don't want to miscarry.I am having some crazy carb cravings lately as well.

The midwife said I could take it,and start at a half tab,and work myself up.At this point though I don't know what to do.

[javilu]

I don't know about during pregnancy, so you'd have to research it further, but alpha lipoic acid was being studied as a possible alternative to drugs like metformin for increasing insulin receptivity (there was a clinical trial going on at UCSF the last time I read about it, so you could start with that info in a search).  Cinnamon has also been used to modulate blood sugar.  But like I said, I don't know about their use in pregnancy specifically. 

[MarineWife]

I have never heard of metformin helping to prevent miscarriage if it's started after being pregnant. You usually have to take the full dose for about 3 months before it is fully effective. That's how it worked for me. It was almost like clockwork. As soon as I had been on the full dose for 3 months I'd get and stay pregnant. If I was taking it but not up to the full dose for 3 months, I'd miscarry. That's a different problem than needing specifically for IR or diabetes. I don't know how that works since I've always stopped taking it once I get to the 2nd trimester.

[Autoemesiss]

I have PCOS but without the PC... My hormones on day 3 of my cycles is off a bit. But since I have had two children and never have had a full milk supply, started losing my hair, my PCP felt it might not hurt to see if the metformin would help. It definately has, my breast would hurt for a week prior to periods and now 10week pregnant (got pregnant on first try) my breast are tender, already up a full cup size and I've lost 5lbs. I am hopeful this will help my supply with this baby, and for repeat LMSers like myself, hope... even the tiniest bit... is hope.

[gingergrltea]

Is it ok to just start the Metformin as I have not taken it really ever.I asked my endo & midwife,they both said its ok to take it.I just have the script for it.But really is it even worth the effort to start in to my pregnancy?

[msmiranda]

Given that you had insulin resistance before, I think it's definitely worth the effort because you are at elevated risk for GD.  Taking metformin could prevent having to shoot up with insulin, which would definitely be a good thing in my book!  When you first start, it does cause some people some gastrointestinal symptoms (for me it was nausea, for some people it's diarrhea I think) but you can mitigate that by starting with 500mg (one pill) for one week, then add another 500mg the second week, etc. until you reach the full prescribed dose -- mine was 1500mg, but that's considered the lowest effective dose, a lot of people take 2000mg and I think some take up to 2500mg.  (Some people do not have side effects, but it's good to be aware of the possibilities).    Oh, another thing, I don't know how your prescription is written, but if you can, get the XR (extended release) version, that way you can take it all at once before bed -- that also helps to mitigate any side effects.  

As for whether you're comfortable taking it, that's a personal decision.  Like I said, I try to maintain a healthy skepticism of pharmaceuticals and only use them when it seems like the benefits clearly outweigh the risks ... different people draw that line in different places.  Metformin helped me conceive twice, so I've been favorably predisposed to it for that reason, but I'm also persuaded that it is safe because it has been around for such a long time and has been extensively studied.  Given that there are multiple potential benefits for a PCOS mama in taking it and no risks that any study has been able to discern, I personally feel comfortable taking it during pregnancy.  Good luck whatever you decide! :)

[MarineWife]

Originally Posted by msmiranda 

Given that you had insulin resistance before, I think it's definitely worth the effort because you are at elevated risk for GD.  Taking metformin could prevent having to shoot up with insulin, which would definitely be a good thing in my book!

While this may be true, I think it's always better to try manage such things through diet and exercise. If blood sugars and insulin are within normal levels now (possibly due to the paleo diet which very strictly excludes grains and most starches), then neither oral nor injected medications would be needed. That's exactly why women diagnosed with GD are first given a nutrition plan to try to control blood sugars. If that doesn't help, then they are given oral or injectible meds. But they are not given medication from the very beginning, except in maybe very severe cases.

[gingergrltea]

I am going to try my hardest to eat paleo.I will add in raw seeds & nuts as needed and ezeckil bread.I had some pizza the other night & it made me sick and VERY shaky so carbs are out of the question for me if I want to feel normal.Otherwise carbs make me feel anxious,and panicky.My body is pretty good at letting me know when I have pissed it off.

What is a good exercise for pregnancy?Just good old walking a few miles daily or after meals?

[javilu]

Walking is a good exercise, even if it's not very far.  Exercise can also help with relaxation.  =D

[A-mac]

I've been able to control GD with exercise. I was on met at the beginning of my pregnancy and it didn't prevent GD. The doctor said that if I needed medication that he would prefer glyburide so I stopped taking the met at about 18 weeks. I was eating a low gi diet, but it wasn't enough to keep my blood sugars where I wanted them so I started an aggressive exercise program. I walk 1 mile after every meal. I know that not everyone can do this, some days it seems like a full time job between planning meals, eating, exercising, and taking my sugars, but it has kept me off of glyburide and insulin so it's been worth it. I'm at 37 weeks now and I still have excellent control.

The walking has also helped with a lot of other common pregnancy complaints, so I highly reccomend it to everyone.

[msmiranda]

Originally Posted by gingergrltea 

I am going to try my hardest to eat paleo.I will add in raw seeds & nuts as needed and ezeckil bread.I had some pizza the other night & it made me sick and VERY shaky so carbs are out of the question for me if I want to feel normal.Otherwise carbs make me feel anxious,and panicky.My body is pretty good at letting me know when I have pissed it off.

What is a good exercise for pregnancy?Just good old walking a few miles daily or after meals?

Just fyi, I tried to use Ezekiel bread in place of regular whole wheat bread and, while it is definitely better for you in lots of ways, it still has 11 net carbs per slice.  I used to have 2 slices with natural peanut butter and a glass of milk for breakfast, and at about 45g carbs total, that is too much for me at breakfast now and I had to switch to eggs and one slice Ezekiel toast. :(   I can also "feel it" when I've eaten too many carbs -- my heart races when my blood sugar is too high.  Pizza is out for me, too.  (Sigh). 

MarineWife makes a good point about trying to control with diet and exercise first ... and eating a low-carb diet is the solution for many women to GD, so if you do that religiously, the "problem" may never show up in your real life, though it still would on the GTT.  And as A-Mac says, metformin will not necessarily prevent GD for everyone -- it just reduces the risk.  But, GD usually manifests later in the second trimester, as the pregnancy hormones interfere with the body's ability to produce enough insulin to absorb all the glucose.  So just because insulin and blood sugars are controlled with diet now doesn't mean that it will stay that way throughout pregnancy, as it becomes more challenging around 24 to 28 weeks and beyond.  I never was able to keep my fasting under 90 after 28 weeks last time even though my postprandials were all within range. 

[MarineWife]

Walking is very good exercise, so is swimming, I would guess. Prenatal yoga is very good, too. That's what I stick with, walking and yoga.