Transfer of metformin into human milk

Hale, Thomas W.; Kristensen, Judith H.; Hackett, L.P.; Kohan, Rolland; Ilett, Kenneth F.

doi:10.1007/s00125-002-0939-x

Cited by 121 publications

(8 citation statements)

References 23 publications

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“…The mean infant exposure to drug ranged from 0.11% to 0.65% of the weight normalized maternal dose. [ 13 14 15 ] This is below the 10% level of concern for breastfeeding. In addition, the blood glucose concentrations in infants 4 hours after a feeding were within the normal limit.…”

Section: Introductionmentioning

confidence: 93%

Use of oral anti-diabetic agents in pregnancy: A pragmatic approach

et al. 2015

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Insulin is the gold standard for treatment of hyperglycemia during pregnancy, when lifestyle measures do not maintain glycemic control during pregnancy. However, recent studies have suggested that certain oral hypoglycemic agents (metformin and glyburide) may be safe and be acceptable alternatives. There are no serious safety concerns with metformin, despite it crossing the placenta. Neonatal outcomes are also comparable, with benefit of reductions in neonatal hypoglycemia, maternal hypoglycemia and weight gain, and improved treatment satisfaction. Glibenclamide is more effective in lowering blood glucose in women with gestational diabetes, and with a lower treatment failure rate than metformin. Although generally well-tolerated, some studies have reported higher rates of pre-eclampsia, neonatal jaundice, longer stay in the neonatal care unit, macrosomia, and neonatal hypoglycaemia. There is also paucity of long-term follow-up data on children exposed to oral agents in utero. This review aims to provide an evidence-based approach, concordant with basic and clinical pharmacological knowledge, which will help medical practitioners use oral anti-diabetic agents in a rational and pragmatic manner. Pubmed search was made using Medical Subject Headings (MESH) terms “Diabetes” and “Pregnancy” and “Glyburide”; “Diabetes” and “Pregnancy” and “Metformin”. Limits were randomized controlled trials (RCTs) and meta-analysis. The expert reviews on the topic were also used for discussion. Additional information (studies/review) pertaining to discussion under sub-headings like safety during breastfeeding; placental transport; long-term safety data were searched (pubmed/cross-references/expert reviews).

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Section: Introductionmentioning

confidence: 93%

Use of oral anti-diabetic agents in pregnancy: A pragmatic approach

et al. 2015

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“…In addition, metformin turned out to be safe in pregnant women with PCOS when treated to minimize intrapartum complications [91][92][93]. Metformin showed minimal excretion into the breast milk and no adverse effects on breastfed infants have been reported [94,95].…”

Section: Hidradenitis Suppurativamentioning

confidence: 99%

A Molecular Perspective on the Potential Benefits of Metformin for the Treatment of Inflammatory Skin Disorders

Chang

Choi

2020

IJMS

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Due to its anti-hyperglycemic effect, metformin is the first-line medication for the treatment of type 2 diabetes, particularly in people who are obese. However, metformin is a drug with a very wide range of pharmacological properties and reports of its therapeutic effect on diseases including inflammation and cancer are increasing. Numerous research groups have reported that metformin has beneficial effects on a variety of inflammatory skin disorders including psoriasis, acanthosis nigricans, acne, hidradenitis suppurativa, and allergic contact dermatitis. According to these reports, in addition to the well-known action of metformin, that is, its anti-hyperglycemic effect, NF-kB inhibition and the resulting alteration to the cytokine network may be the potential targets of metformin. Its anti-hyperandrogenism effect has also been confirmed as the major action of metformin in some inflammatory skin diseases. Moreover, novel regulatory mechanisms, including autophagy and antioxidant processes, have been suggested as promising mechanisms of action for metformin in inflammatory skin disorders.

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“…[ 26 ] As for the use of metformin small studies have shown that it is excreted in small amounts in breast milk. [ 27 28 ] The women should be counseled about the potential problems with the use of oral hypoglycemic agents during lactation and should preferably be put on insulin till they breastfeed the baby.…”

Section: A Fter D Ischargementioning

confidence: 99%

Peripartum management of diabetes

Kalra

Anakal

2013

Indian J Endocr Metab

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The peripartum control of diabetes is very important for the well-being of the newborn as higher incidence of neonatal hypoglycemia is seen if maternal hyperglycemia happens during this period. Type of diabetes (type 1, type 2 or gestational diabetes) also has an effect on the glucose concentration during intrapartum period. During the latent phase of labor, the metabolic demands are stable but during active labor there is increased metabolic demand and decreased insulin requirement. After delivery once the placenta is extracted, insulin resistance rapidly comes down and in patients with pre-gestational diabetes there will be a sudden drop in insulin requirement and the insulin may not be required in women with gestational diabetes, but they just need close monitoring. During breast-feeding blood glucose levels fall because of high metabolic demand and women need to take extra calories to maintain the levels and more vigilance especially in type 1 and type 2 diabetic mothers is required. The protocols used for the management of peripartum management of diabetes mostly rely on glucose and insulin infusion to maintain maternal blood sugars between 70 and 110 mg/dl. The data is mostly from retrospective studies and few randomized control trials done mainly in type 1 diabetes patients. The review summarizes guidelines, which are used for peripartum management of blood glucose.

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Transfer of metformin into human milk

Cited by 121 publications

References 23 publications

Use of oral anti-diabetic agents in pregnancy: A pragmatic approach

Use of oral anti-diabetic agents in pregnancy: A pragmatic approach

A Molecular Perspective on the Potential Benefits of Metformin for the Treatment of Inflammatory Skin Disorders

Peripartum management of diabetes

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