Metformin in pregnancy

[nellsbells]

Hi ladies, thought I would seek your advice. I've just found out I am pg, my FS started me on prednisolone 5mg twice a day 3DPO (prophalactically-haven't been tested for Nk cells or anything).
I have been on metformin for approx 5months (for impaired glucose tolerance-not ovulation induction) and on clomid for ovulation induction. My question is should I stay on the metformin for glycaemic control given that I'm UTD? Though I'm sure my sugars would be much improved now that i've lost 13kgs!!) I know I will probably need to move onto insulin later on given the high risk of GD. Can metformin reduce or increase the chance of M/C?
Anyone else UTD and on metformin in first trimester?
Thanks ladies, your support is amazing.

[butterfly_warrior]

There are two schools of thought on this one...

Basically, metformin is a category B (B1 I think) drug in pregnancy, which means that there aren't enough studies to show that it is safe, but it hasn't yet been known to cause birth defects.

The vast majority of obstetricians (and fertility specialists and GPs) will have you stop metformin as soon as you are pregnant, but more recent studies show that continuing to take it through first trimester can help reduce the risk of miscarriage.

I was on metformin during my first pregnancy. When some bad morning sickness set in my GP had me reduce my dosage (I didn't even stop it completely!) and sadly, within a few days my baby had died. At the same time I was on prednisone for arthritis... every time I reduced my dosage of prednisone below 10mg I would get spotting. Some thing happened when I reduced the dosage of metformin.

Fast forward through some hellish IVF experiences to my current pregnancy... I stayed on 1500mg of metformin up until 17 weeks (when my OB got me to do my first glucose tolerance test) and all was well. No episodes of spotting at all through first trimester. I'm still on the 10mg of prednisone, but would reduce my dosage if my arthritis were under better control.

It's a decision that you need to make in conjuction with your specialist. In the end, I had one fertility specialist, my GP and my OB all saying stop. Of those, my OB was the most relaxed about me continuing to take it through first trimester only. I had another fertility specialist and a different OB both tell me that I should continue to take it, and through my own research, experience and gut feelings... I decided that staying on it was the right thing to do for me.

BW

[nellsbells]

Thanks butterfly warrior, the nurse at my FS clinic is asking my gyn what he thinks, my gut tells me to stay on it, so will wait and see what they come up with. My pg was only confirmed yesterday. With no answers to my 2 previous M/C, makes me want to try anything that may help! Is 5mg bd an adequate dose of prednisolone? Thought I read somewhere that someone was on 20mg bd. Obviously you pred was for a different reason. Goodluck with your pg,
jm

[Snoopea]

Please continue to take it through the first trimester, I was told after I stopped taking the metoformin as advised by my local GP, that it increases the chance of miscarriage if stopped in the first trimester and sadly we lost the baby shortly after I stopped it was only during a check up with the hospital that I was told that I should have stayed on the drug until the 12 week mark!
Snoopea

[briggsy's girl]

i've been on metformin since July 2006 - and have been told to stay on it now until advised differently. my clinic were adamant that i not stop met as yet, and i'm guessing, like snoopea, i'll be on it until at least the end of the first tri.

[mollycat]

When I fell pg last year my GP told me to stop taking metformin. That was at 6w. I m/c at 8w2d (my baby was the size of a 6w). When I spoke to my gyno later, he said that he would have told me to stay on it. He has patients that are on metformin right through their pg.

[butterfly_warrior]

I want some of your doctors!

Nellsbells, after my first miscarriage I was tested for NK cells. Nobody has been able to say exactly what my arthritis is, so it was looked into. I got an inconclusive result. I'd been unable to come off the prednisone for the test, so it would have had some impact on the result.

The level came back at a point that the doctor would have been perfectly happy with a healthy person... but it was higher than he would have liked considering that I was already taking prednisone. At that point in time I was on 10mg (I take all of mine in the morning though, otherwise I don't sleep), and my dosage was increased to 20mg for subsequent frozen embryo transfers. We got through two, and sadly both ended in very early miscarriages.

My gut feeling is that 20mg was too high for me. Prednisone increases insulin resistance and therefore makes the PCOS side of things worse. With this current pregnancy, I stayed on 10mg the whole way through (thinking that it was at least getting my NK cells down to a happy level if I did have an excess of them), and stayed on 10mg... Now I'm at 25 and a half weeks having my insides turned to mash by an ultra-active baby.

The thing with the prednisone is that nobody will be able to tell you if 10mg is enough without having had NK tests done. My PCOS comes with really quite severe insulin resistance and I felt that the increased prednisone may have been taking good care of any NK cells, but it was making another miscarriage cause MUCH worse.

I'm sorry I can't give definite answers. I hate the fact that I can't! All I can do is tell you about my experiences and encourage you to listen to your gut feelings and trust your doctors (hopefully they match, in my case they often didn't). Do you have a family history of auto-immune problems? If not, I'd be inclined to think that the 10mg would be enough for now, but if things don't work out this time, I'd strongly encourage you to get yourself tested for NK cells.

BW

[Liz]

I stayed on metformin for the first trimester.

[nellsbells]

Thanks ladies, you have been a great help. My nurse rang today to say to stay on the metformin until my 7wk scan and then we'll discuss it with my FS. But now I'll be adamant to stay on it, at least for the firs trimester. Thanks again ladies!
Butterfly warrior- no i don't have a family history of auto-immune disorders so fingers crossed it's an adequate dose. thanks for your advice-much appreciated.

[gypsy79]

I was also on metformin and Clomid for PCOS. In contrast the the previous posts, however, I miscarried my first pregnancy during which I had continued to take the metformin. When I got preg again, I stopped taking it within a couple of days and am now 25 weeks and counting.

The only thing I think this proves is that they really don't know enough about it at this stage. Good luck.