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February 22, 2003

Family Planning, Pills for Diabetes

Question from Grand Rapids, Michigan, USA:

I have a very strong family history of diabetes, but I have ever been diagnosed with it, and about a year ago, my doctor put me on Glucophage about a year back to help me ovulate regularly and also help me from getting diabetes. I am now 16 weeks pregnant with my first child, I have been taking Glucophage since the day I conceived, and my sugar levels have been normal. I recently read some articles that Glucophage is not proven to be safe for the baby when taken during pregnancy. My doctor did tell me that a few years there were cases of children born with abnormalities when it was taken during pregnancy, but of late there are no such reported incidents. He also insisted that I should continue to take Glucophage because there are far more advantages than disadvantages from it, but I am still not satisfied with the answer, and I need a second opinion about using Glucophage during pregnancy. If it is not safe to use during pregnancy what other methods are there to keep my sugar level low?

Answer:

You question is timely to my practice. Based on some recent reports some of the infertility specialists here in Denver are continuing patients with Polycystic Ovary Syndrome on Glucophage [metformin] throughout their pregnancy. There are two reasons. The first is that there may be a reduced incidence of miscarriage. Less supported by the data is a possible reduced incidence of gestational diabetes.

It also appears that Glucophage is relatively safe: it has not been associated with any specific congenital anomalies and does not seem to cause neonatal hypoglycemia. However, none of the published studies have large numbers of patients so this information has to be taken with a grain of salt.

You are already past the time of embryo development as well as the high risk period of fetal loss. If you are concerned about the need and effects of Glucophage, then I would suggest stopping the medication. You should have the standard glucose screen at 24-28 weeks to look for gestational diabetes. After you deliver, I would recommend an evaluation by an endocrinologist. You have some of the criteria for PCOS, but this should be confirmed before you continue on medication.

OWJ