Metformin concerns

[bunny85]

Hi all,

So, I've been officially diagnosed with GD at 16 weeks (18+1 now) and prescribed metformin and insulin. The reason they know it's a GD opposed to undisgnosed type 2 from before is because they did a Hba1c blood test which shows my average blood glucose for the past 3 months and it came back normal, so it's definitely something that developed during pregnancy, although very early.

Now, I have started insulin at night as told. I know it doesn't cross the placenta and it's safe, and it seems to work well. They are however insisting I need metformin as well as apparently the GD is (or going to be) progressing week by week. I don't mind following the doctors instructions, but there is a huge mismatch in what they say compared to what I found on Internet. They say it doesn't cross the placenta, or if it does, then it's minimal amounts. Now, everywhere I read (BMJ or other medical journals) clearly say it freely crosses the placenta and is found in umbilical cord in concentrations as high as, or higher (!) than in mother's blood. It says there's not enough evidence, not enough research. I don't know if there were any studies of a long term effects (decades after birth). It appears safe, but IS it safe? I'm very confused and scared. They obviously explained that untreated GD can cause way more harm, and today I did take my first metformin tablet. But I just want to understand.

Has any of you taken metformin in pregnancy, especially from such an early stage? I'm particularly interested in long term effects, if there's any of you who took it many years ago and if it did in any way affect the children?

I'm sorry for the long post. I do think I suffer with anxiety in this pregnancy (it's my first one) as I drive myself sick with worry. But I feel this one is serious. Please can you share your thoughts on this... Many many thanks in advance.

I had diabetes for 7 years before becoming pregnant. I took metformin during this time and throughout my pregnancy.

I also know if any get of people who've taken metformin to reduce the chance of miscarriage.

I've not experienced any ill effects, nor has my nearly-five year old or anyone else who I know has take it.

I know that metformin is considered safe to take in pregnancy (unlike a lot of other oral diabetes medications), so please don't worry too much about taking it.

I'm 15+2 and have been taking metformin since the beginning of my pregnancy and before because of PCOS. The doctors have said for me to keep taking it throughout my pregnancy, so far no ill effects or anything! X

I've been taking it for years pre-pg and throughout this pg as my endocrinologist said it was fine. Not wanting to rely solely on what he said, I did a lot of research and found that it's being given to thousands of women in a multi-centre study (Google the EMPOWAR study) for those suffering with obesity in the hopes that it'll prevent GD and the knock-on effects on the child in later life. My OB was totally unimpressed with the idea of taking it, as I didn't have GD, even though he was sure I'd get it by the end...??

From what I've read, it's safe (safer than many other meds out there) and will not cause teratogenic effects, however the whole point of those studies is to assess the changes at the epigenetic level and see what future outcomes it may have on the offspring. Don't forget, however, that metformin has been used for decades now.

IMHO the risks of uncontrolled GD are far worse than metformin usage, but I'm no scientist... ?

Thanks to you all for your replies. This sounds reassuring. I've started taking them, as seems I've got no choice, as you say uncontrolled diabetes is far more dangerous, but still feeling very very uneasy...

Probably not what you want to hear but my consultant said I was to come off it as soon as I had a positive test. Was on it for PCIS and will go back on it once baby is here.

LAM, are you serious? Are you in the UK?

Did he explain why? Is it because you didn't need it during pregnancy or because it is unsafe? Actually I want to hear everything, good and bad...

I just don't know what to do anymore...

Does anyone else have any words of wisdom?

I was on metformin for several years before becoming pregnant due to PCOS. I continued to take it through my pregnancy as advised and DS was absolutely fine.

I took it throughout my pregnancy having been diagnosed with GD around 20 weeks. Like you my Hba1c showed I had only just developed it. Diabetes runs in my family and after I gave birth I've continued to be an insulin controlled diabetic.

I read a lot about Metformin and the risks in pregnancy, and spoke to my consultant at length about it. He reassured me he has been prescribing it for many years to pregnant women and it has never been an issue.

He also said that there hasn't been official clinical trials as very few drug manufacturers do trials on pregnant women which is the only reason there is information about not taking it in circulation. This is what I was told anyway.

I do know of people who have been told to take it to reduce the risk of miscarriage.

My DD is fine, her blood sugar at birth was fine and I breastfed for a year, while taking Metformin, it was all fine.

Thanks girls... I'm just experiencing a really bad anxiety over this and even wake up at night thinking over and over. It's my first pregnancy and I'm petrified to do something to harm the baby.

Salty, I'm so sorry to hear your diabetes didn't go away after the birth. Did they explain why you have to keep taking insulin instead of just controlling it with metformin? Is it because it got quite severe after birth?

LAM, that was incorrect advice.

bunny, Metformin can be safely taken in pregnancy. High blood glucose would put your baby at more risk than taking Metformin (which is why it crossing the placenta is not a bad thing).
It is positively encouraged in PCOS.
And yes, studies/evidence is not there because there is no way to set them up in an ethical manner so it's all empirical/experience rather than hard evidence.

Thank you Pacific. I've started taking it after my last urine test showed glucose and ketones present. All the previous ones were clear, and this one has scared the sh..t out of me.

But honestly, after I put a pill in my mouth every single time, I get into panic and crying and bad state. Then I calm down and then it starts again after the evening pill.

Thank you for your support.

Bunny no real explanation other than for most people GD is gestational, for others it just doesn't go away. I had a GTT test 6 weeks afterwards and then again about three months afterwards and I was still diabetic.

It runs in my family so I guess I was genetically predisposed to get it. I'm currently about a stone overweight but not obese (I'm a size 12/14) and fairly fit and active (I've run a half marathon in the last three months). It's just one of those things I guess. I do take metformin still but also take insulin for tighter control - in part as we've been trying for number two for the last two years so I need to keep my Hb1ac low (the last test I was 32 which I think is pretty good). I'm technically type 2 as my body does produce some insulin, but I wouldn't be able to satisfactorily manage it on metformin / diet alone.

Towards the end of my pregnancy I was having to inject fairly high levels of the two types of insulin I was put on. I don't take anything like that much now. It's not a problem and just part of everyday life now. I do remember being terrified when I was first diagnosed while pregnant. We had been trying for a while, had fertility treatment and I'd had a miscarriage a few months prior. It felt like everything was against me but I can't fault the medical care I received and the extra scans and consultant appointments were very reassuring.

If metformin concerns you, consider inositol. It does many of the same things with a significantly reduced side effect profile. For more info on it, search scholar.google.com for inositol and gestational diabetes. You'll be surprised. A LOT of women need to know about this...metformin is the devil with side effects for many people, and inositol is safer and cheaper.

Salty it's nice to hear you are managing so well. Yes hba1c of 32 is great! I also have a strong family history of diabetes, that's why I was wondering. However it's probably best to leave this worry out for now.. Good luck with number 2!

Womb, I'll definitely look into it. Never heard of this one before. Thanks for the info!

Do you know if it crosses the placenta by the way? Couldn't find any info about it on the net.

I actually work for one of the world's leading diabetes experts. I also had GD. It's fine to take the metformin, really. I know that it's a horrible time, but as you say, uncontrolled GD is way worse.

Bear, do you really? So does he/she think it's safe to take it then, even though it crosses the placenta? I really could do with the opinion of the world's leading expert, maybe this will calm me down.

Yes - I'm not a clinician so I spoke to him about it before agreeing to the treatment and he advised that it was the best treatment for me. I also checked with a senior lecturer at one of the UK's leading medical schools (trying jot to out myself here!) who specialises in GD and she agreed.

My sister had GD twice before I was diagnosed, and took metformin each time. There is a genetic risk profile to GD, so I thought that it was likely that I would get it too, but I was still shocked, so I totally understand how you feel.

Thanks Bear. Hearing positive stories like this really does help. Tonight I took my tablet without much of a drama afterwards, trying to come back mentally to your words and the other lovely ladies on here.

But just out of interest now - why do you think they are telling me it doesn't cross the placenta when it does? Is it because they don't know themselves or are they lying? Two consultants in the hospital and all the midwifes are telling me this every time. Isn't that weird?

Glad I could help put your mind at rest. There have been studies done which demonstrate no fetal abnormalities as a result of taking metformin and all other studies indicate that it's safe, so try not to worry.

I think that the misinformation often results because of a couple of reasons; firstly, there's so much research to keep on top of and consultants go with NHS guidelines. Secondly, a little knowledge can be dangerous for patients and can actually make patient's anxiety worse.

I was spoken to like a bit of a dafty until I snapped and told my consultant that I'm not clueless and who I work for. Their attitude changed instantly and I was then able to make my requests re my treatment and birth plan requests heard. I must have been their most annoying patient!

I have a perfectly healthy ds, (as well as a niece and nephew) and it's the same for so many other women who take metformin. You and your baby will be fine.

I was on metformin three times a day in my first pregnancy from 28 wèeka and have a healthy thriving 3yo who is dinky on the 9th centile.
On second pregnancy was again on metformin from week 28 but only twice a day, and again have a thriving healthy 3 month old

I took it pre- pregnancy and during my pregnancy for PCOS and later GD. My sons are 8 and 6 respectively now and as healthy as can be. Pregnancy makes me anxious and worried too, it's perfectly normal to worry and good practice for when baby arrives. Congratulations, and try to relax a bit.

I have taken metformin through pregnancy until I stopped recently for a GTT. There is good evidence it reduces miscarriage, gestational diabetes and breastfeeding issues in women with PCOS so I was keen to continue. The research on metformin in pregnancy for women with PCOS showed no harm to the fetus. I have seen lots of women use it for GD with no issues and healthy babies.

As it turns out my baby does have some serious and major problems (trisomy 18) but nothing to do with metformin.