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Old 11-03-2006, 08:36 AM   #1
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Default Anyone take metformin while breastfeeding???

I know this topic has been done over and over again but I was just wondering if there is Anyone who took metformin while bfing? My Obgyn and pediatritian both seem to think its ok, but when I read these boards it seems that no one elses doctors do. I was a Wreck before the metformin and can't imagine not taking it but also can't imagine not breastfeeding. My other 2 were BF for a year and never even took bottles.(I could never pump very well)but that was before I discovered how much metformin could help me. I was doing research and found this article http://www.springerlink.com/content/l6m9hhpl2000e75k/
Thanks for any thoughts.

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Old 11-03-2006, 09:45 AM   #2
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I didn't but some articles:

J Pediatr. 2006 May;148(5):628-632. Links
Comment in:
J Pediatr. 2006 May;148(5):573-4.
Growth, motor, and social development in breast- and formula-fed infants of metformin-treated women with polycystic ovary syndrome.Glueck CJ, Salehi M, Sieve L, Wang P.
Cholesterol Center, Jewish Hospital, Cincinnati, Ohio 45229, USA. glueckch@healthall.com

OBJECTIVES: To test the hypothesis that metformin during lactation versus formula feeding would have no adverse effects on infants' growth, motor-social development, or intercurrent illness. STUDY DESIGN: Growth, motor-social development, and illness requiring a pediatrician visit were assessed in 61 nursing infants (21 male, 40 female) and 50 formula-fed infants (19 male, 31 female) born to 92 mothers with polycystic ovary syndrome (PCOS) taking a median of 2.55 g metformin per day throughout pregnancy and lactation. RESULTS: Within sex, at 3 and 6 months of age, weight, height, and motor-social development did not differ (p > or = .06) between breast- and formula-fed infants. No infants had retardation of growth, motor, or social development. Intercurrent illnesses did not differ. CONCLUSIONS: Metformin during lactation appears to be safe and effective in the first 6 months of infancy.

PMID: 16737874 [PubMed - indexed for MEDLINE]
1: Obstet Gynecol. 2005 Jun;105(6):1437-41. Links
Excretion of metformin into breast milk and the effect on nursing infants.Briggs GG, Ambrose PJ, Nageotte MP, Padilla G, Wan S.
Women's Pavilion, Miller Children's Hospital, Long Beach, CA 90806, USA. jbriggs@memorialcare.org

OBJECTIVE: To determine whether metformin is excreted into breast milk and whether this exposure adversely affects the blood glucose of nursing infants. METHODS: Seven women were started on metformin 500 mg twice daily on the first day after cesarean delivery. Breastfeeding was started at the same time. Two women were excluded. Two other women stopped breastfeeding for personal reasons unrelated to the drug therapy, but did provide serum and milk samples, because they regularly pumped their breasts to maintain lactation. Peak and trough serum and milk samples were drawn between postoperative days 4 and 17. In 3 infants, blood was drawn for glucose determination at the same time as the maternal samples. RESULTS: The trough milk concentration in 1 subject was below the assay detection limit. Excluding this subject, the mean peak and trough serum metformin concentrations were 1.06 mug/mL (range 0.68-1.90 mug/mL) and 0.42 mug/mL (range 0.26-0.51 mug/mL), respectively, whereas the mean peak and trough metformin concentrations in breast milk were 0.42 mug/mL (range 0.38-0.46 mug/mL) and 0.39 mug/mL (range 0.31-0.52 mug/mL), respectively. The mean milk:serum ratio was 0.63 (range 0.36-1.00) and the mean estimated infant dose as a percentage of the mother's weight-adjusted dose was 0.65% (range 0.43-1.08%). In 3 infants, the blood glucose concentrations 4 hours after a feeding were within the normal limit, ranging from 47-77 mg/dL. CONCLUSION: Metformin is excreted into breast milk, but the amounts seem to be clinically insignificant. No adverse effects on the blood glucose of the 3 nursing infants were measured.
1: Diabetologia. 2002 Nov;45(11):1509-14. Epub 2002 Sep 25. Links
Transfer of metformin into human milk.Hale TW, Kristensen JH, Hackett LP, Kohan R, Ilett KF.
Department of Pediatrics, Division of Clinical Pharmacology, Texas Tech University School of Medicine, Amarillo, Texas, USA. tom@ama.ttuhsc.edu

AIMS/HYPOTHESIS: The aim of this study was to characterize the milk-to-plasma ratio and infant dose for metformin in breastfeeding women, and to measure plasma concentrations and assess any effects in their infants. We hypothesized that metformin used by mothers is safe for their breastfed infants. METHODS: Seven women taking metformin (median dose 1500 mg orally daily) and their infants were studied. Metformin concentrations in plasma and milk were measured by high performance liquid chromatography. Infant exposure was estimated as the product of estimated milk production rate and the average concentration of the drug in milk and also expressed as a percentage of the weight-normalized maternal dose. RESULTS: The mean milk-to-plasma ratio for metformin was 0.35 (95%CI 0.2-0.5). The mean of its average concentrations in milk over the dose interval was 0.27 mg/l (0.15-0.39 mg/l). The absolute infant dose averaged 0.04 mg x kg(-1) x day(-1) (0.02-0.06 mg x kg(-1) x day(-1)) and the mean relative infant dose was 0.28% (0.16-0.4%). Metformin was present in very low or undetectable concentrations in the plasma of four of the infants who were studied. No health problems were found in the six infants who were evaluated. CONCLUSIONS/INTERPRETATION: The concentrations of metformin in breast milk were generally low and the mean infant exposure to the drug was only 0.28% of the weight-normalized maternal dose. As this is well below the 10% level of concern for breastfeeding, and because the infants were healthy, we conclude that metformin use by breastfeeding mothers is safe. Nevertheless, each decision to breastfeed should be made after conducting a risk:benefit analysis for each mother and her infant.

PMID: 12436333 [PubMed - indexed for MEDLINE]
Basically, it is a drug and it is excreted into your breastmilk which your infant ingests. Like any medication during pregnancy and breastfeeding, IMHO none is really safe. When they say something is "safe" they are saying in their very small sample sizes that they could not find any adverse effects at the time of testing. It's not like the infants are monitored over time. All that being said I also think there are sometimes when there are trade-offs that have to be made. In those instances, I believe only you and your doctor can make that decision.

Personally, I had debilitating migraines while PG and I had to go to work. I took the lowest dosages of tylenol to help me get through the pain. Also I had a c-section and took Tylenol 3 for the first 2-3 days to get through the pain. Again - it is a personal decison.
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Old 11-03-2006, 12:24 PM   #3
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Send a message via Yahoo to kirsten

Kelly is.
Maybe she'll post.
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Old 11-04-2006, 09:01 AM   #4
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Thanks for the Info Mara.

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Old 11-04-2006, 07:48 PM   #5
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I have read the same articles as captioned above. It seems pretty good evidence to take the metformin!

congratulations on breastfeeding your others. it is so much better for the baby(as you clearly know). My mom is a lactation consultant and she was SO frustrated when I had my first and COULD not produce more than a teaspoon a day. I believe it was in part having PCOs that made me unable.
We tried everything but I just couldn't. So, please keep on doing what you're doing...since you CAN!
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