metformin, preganancy ,pcos

[rajbs]

hi,
i am 28 and i have pcos... i was on metformin since one year
ttc for more 3 year.. i found i was preganent on 5th on nov 2010
went to gp she consulted fertility clinic about my preganacy and they told me to stop metformin..
i am 5 weeks 1 day preganent today...
she also told some people take metformin up to 12 weeks
i read in some internet site chance of first trimester miscarrriage is high with pcos..
now i am confused shud i stop taking metformin suddenly...
stopping metformin suddenly wont effect embryo?
if i continue is bad for baby after birth or in future
i am too scared and confused
please suggest

[Jenny5]

My doctor kept me on metformin and said to take it the whole first trimester. Also other women in this forum who got pregnant were on metformin until 12 weeks. I think the decision to stay on it or no it depends from doctor to doctor, i have had 3 m/c so my doctor kept me on it to minimize the chances of m/c but it hasn't worked cause iwth metformin or without i seem to m/c within the 8 weeks. Have another opinion from another doctor. Good luck on your pregnancy

[Lynniepooh]

The role of metformin in ovulation induction is well established, and several studies have demonstrated that women with PCOS are more likely to ovulate with metformin than with placebo alone.[2, 4] Therefore, women with PCOS often conceive while on metformin, and exposure during organogenesis is common. At present, metformin is classified as Class B in pregnancy, with no evidence of animal or fetal toxicity or teratogenicity. 5] Reproduction studies in rats and rabbits show no teratogenicity with dosages up to 600 mg/kg per day, approximately twice the recommended human dosage.[6] Additionally, there are numerous reports using metformin for the treatment of gestational diabetes mellitus (GDM), without evidence of fetal harm.[7-9] Although metformin does cross the placenta, a partial placental barrier likely exists, as maternal and fetal concentrations are different.[5,6,10]

Several studies have reported an increased risk of spontaneous abortion in women with PCOS, perhaps 20% to 40% higher than in the general obstetric population.[3] This increased risk may be due to hyperinsulinemia, which adversely affects endometrial function and environment.[3,4] The use of metformin to decrease this risk in women with PCOS was reported in 2 small, observational studies, with a reduction in miscarriage from 58% to 11%.[3,4] However, it must be emphasized that there is a paucity of evidence to support the use of metformin for this indication, and further study using prospective, randomized trials is warranted.[5]

Women with PCOS who are insulin resistant are at high risk for the development of diabetes in pregnancy, and a possible role for metformin therapy may be the prevention of GDM. In a cohort of 33 women with PCOS taking metformin until delivery, GDM occurred in 3% compared with 23% in 39 women taking no medication.[4,6] However, given the lack of data from well-designed, prospective clinical trials, metformin is currently not indicated for the prevention of GDM. Therefore, in a patient who has conceived on metformin, the current recommendation would be to discontinue the medication once pregnancy is confirmed.

Good Luck, I hope that helped!