Metformin & Pregnancy

[janey.1971]

Hi everyone. I hope you will be able to help me. Last week, I got diagnosed with Gestational Diabetes. This is my fourth pregnancy. I got GD in my second pregnancy but not in the other 2. The first time round, I controlled it by diet alone with no problems. My baby was 7lbs 12ozs which was absolutely fine.

This time, after my GTT, my levels were quite high. The Diabetic Midwife put me on a strict diet straight away and after a few days contacted me to say they were still too high and that I needed to go on Metformin. I am not that happy about this as every website I have been on has said that these tablets shouldn't be taken in pregnancy. I'm at a loss with what to do now. I'm almost 40 and this is my last child and I'm concerned taking these tablets will cause problems for the baby.

I spoke to a Pharmacist about these tablets and he couldn't help either. I would be grateful if anyone could advise me on these tablets and what the possible side effects for the baby are and whether or not they are indeed safe.

Thank you

Jane

 

[cugila]

From my own reading into this subject, Metformin has been shown to improve Insulin sensitivity and may also help with weight loss. Apparently it does cross the placenta but but trials have shown no (serious) adverse effects.

In one study in 2007 (MiG 2007) it was suggested that Metformin was safe to use and that there was no evidence of any increase in complications and/or birth defects. It was approved by NICE for use in pregnant Diabetic Women.

If you are concerned then this is something you should discuss more fully with your Diabetic Midwife. You are obviously under enough stress without adding more. There have been some posts here about this before, in one instance I remember that the member persuaded her Consultant that she could manage using diet alone. She had a fine healthy baby !

Best of luck to you and your baby whatever you decide to do. If you do go down the diet route, then the advice that Sue and I usually hand out to newly diagnosed Diabetic's may be of some benefit to you in taking better control of those Bg numbers. We could post it for you if you so wish ?

Ken

 

[janey.1971]

Thank you very much for your reply. I'm just so confused about what to do. I am awaiting a callback from the Diabetic Midwife as I need reassurance before I attempt to take these tablets.

I would be very grateful if you could send any information that you have as it is all quite confusing about what I can and can't eat. Do you have a list of foods which are ok to take for Diabetics. I thought vegetables were fine but I have been told to limit them plus fruit too.

Thank you

Jane

 

[cugila]

Jane.
Here is the information we post........please discuss it with the Midwife. Don't be surprised if she thinks that some things might not suit, you will have to decide what to do and as you are an expectant mother, there are other considerations. The Bg targets may well be different.
It is just a basic guide which according to those who have followed the advice works very well.

Here is the advice we usually give to newly diagnosed diabetics. We hope that these few ideas gained through experience help you to gain control and give you some understanding of Diabetes. This forum doesn't always follow the recommended dietary advice, you have to work out what works for you as we are all different.

It's not just 'sugars' you need to avoid, diabetes is an inability to process glucose properly. Carbohydrate converts, in the body, to glucose. So it makes sense to reduce the amount of carbohydrate that you eat which includes sugars.

The main carbs to avoid OR reduce are the complex or starchy carbohydrates such as bread, potatoes, pasta, rice, starchy root veg and also any flour based products. The starchy carbs all convert 100% to glucose in the body and raise the blood sugar levels significantly.

If you are on Insulin you may find that reducing the carb intake also means that you can reduce your dose of insulin. This can help you to keep weight gain down as Insulin tends to make you put on weight and eventually cause insulin resistance. This should be done slowly so as not to cause hypos.

The way to find out how different foods affect you is to do regular daily testing and keep a food diary for a couple of weeks. If you test just before eating, then two hours after eating, you will see the effect of certain foods on your blood glucose levels. Some foods, which are slow acting carbohydrates, are absorbed more slowly so you may need to test three or even four hours later to see the effect that these have on your blood glucose levels.

Buy yourself a carb counter book (you can get these on-line) and you will be able to work out how much carbs you are eating, when you test, the reading two hours after should be roughly the same as the before eating reading, if it is then that meal was fine, if it isn’t then you need to check what you have eaten and think about reducing the portion size of carbs.

When you are buying products check the total carbohydrate content, this includes the sugar content. Do not just go by the amount of sugar on the packaging as this is misleading to a diabetic.

As for a tester, try asking the nurse/doctor and explain that you want to be proactive in managing your own diabetes and therefore need to test so that you can see just how foods affect your blood sugar levels. Hopefully this will work! Sometimes they are not keen to give Type 2’s the strips on prescription, (in the UK) but you can but try !! If you are an Insulin user in theory you should have no problem getting test strips.

The latest 2010 NICE guidelines for Bg levels are as follows:
Fasting (waking).......between 4 - 7 mmol/l........(Type 1 & 2)
2 hrs after meals......no more than 8.5 mmol/l.....( Type 2)

2hrs after meals....... no more than 9 mmol/l ......(Type 1)

If you are able to keep the post meal numbers lower, so much the better.

It also helps if you can do 30 minutes moderate exercise a day. It doesn't have to be strenuous.

The above is just general advice and it is recommended that you discuss with your HCP before making any changes. You can also ask questions on the forum on anything that is not clear.

Ken / Sue.

 

[jopar]

Hi Jane

I know back in 2001 Metformin wasn't licnece for use during pregnacy...

As I fell unexpectantly pregnant at this time with my youngest daughter, when I went to my GP with the I'm sure I'm preganat bit, his face dropped, with ashen face and 3 medical books in front of him, all saying a big No No, he advised me to medically terminate the pregnacy, my consultant also advised me to terminate the pregnacy due to having taken Metfromin...

This was a very eventful pregnancy indeed, I probably spent more time in hospital than out for verios reasons, but at the end of it I did have an healthy baby who's grown into a intelligent (pain in the backside) teenager..

You need to remember that this was 20 years ago, so a lot more research has been done, also I suspect that there have been many mum's such as myself, who made the same decision as myself, and like me had a perfactly healthy baby..

If you are very concerned about taking Metformin, ask if they will prescibe insulin as they used to swap T2's trying for babies or as in my case found themselves pregnant straight onto insulin...

Worse bit about it all, I was never a T2 diabetic, I actually had slow on set T1 diabetes, which is another long story indeed...

 

[cugila]

You are so right Jopar, things have moved on since then including more trials as mentioned here and elsewhere, so the thinking back in your day didn't have all the relevant information to hand. The medic's have changed the advisory notices now.

From the BNF 2010.

Copied and pasted.......hope that's alright ? :roll:

Pregnancy and breast-feeding.
During pregnancy, women with pre-existing diabetes can be treated with metformin [unlicensed use], either alone or in combination with insulin (section 6.1.1). Metformin can be continued, or glibenclamide resumed, during breast-feeding for those with pre-existing diabetes. Women with gestational diabetes may be treated, with or without concomitant insulin (section 6.1.1), with glibenclamide from 11 weeks gestation (after organogenesis) [unlicensed use] or with metformin [unlicensed use]. Women with gestational diabetes should discontinue hypoglycaemic treatment after giving birth.

Ken

 

[Dipsy]

Someone here gave me a link to a doctor who suggested 30g carb per main meal and 15g for snacks during pregnancy. Armed with my Collins Gem carb counter book, this did the trick for me. Loads of salads and omlettes and cauliflour/broc instead of spuds later, blood sugars normal and baby fine.

 

[the_anticarb]

Hi Janey, just to let you know I don't think you have to worry, I am pregnant and on metformin, my doctor was not sure whether to keep me on it but he did so and if they weren't allowed to keep you on metformin, they wouldn't do that. For me the risks of high spikes after meals is worse than any risk metformin may pose, just hope my little one is ok but I am pretty sure I would have been taken off the metformin straight away if it was a risk.