Hello Lactnetters

For the person who was asking recently for info to give a doctor about the 
safety of metformin during lactation, I ran across this recent article on 
PubMed today.

Ann Pharmacother. 2007 May 29; [Epub ahead of print]

Oral Antidiabetic Agents in Pregnancy and Lactation: A Paradigm Shift?
(July/August).

Feig DS, Briggs GG, Koren G.

Departments of Medicine, Obstetrics and Gynecology, and Health, Policy,
Management and Evaluation, University of Toronto; Division of Endocrinology 
and
Metabolism, Mount Sinai Hospital, Toronto, Ontario, Canada.

OBJECTIVE: To provide information on the use of oral antidiabetic agents in
pregnancy and breast-feeding. DATA SOURCES: Primary articles were identified 
by
a MEDLINE search (1966-March 2007) using the MeSH headings: pregnancy in
diabetics, pregnancy, polycystic ovary syndrome, hypoglycemic agents, 
glipizide,
glyburide, metformin, rosiglitazone, pioglitazone, clinical trial, 
controlled
clinical trial, multicenter study, randomized controlled trial, case-control
studies, and cohort studies. STUDY SELECTION AND DATA EXTRACTION: All 
studies
using oral antidiabetic agents in pregnancy were evaluated and relevant data
were included in the discussion. DATA SYNTHESIS: Studies of glyburide and
glipizide have found little or no transfer of these drugs across the 
placenta,
whereas metformin and rosiglitazone cross readily. Animal studies have found 
no
evidence to suggest that glyburide, glipizide, metformin, or rosiglitazone 
are
teratogenic. In gestational diabetes, glyburide was safe and efficacious;
however, 16-19% of women failed to achieve optimal glucose control. No
developmental toxicity in infants was observed when metformin was used 
before
and throughout pregnancy in women with polycystic ovarian syndrome (PCOS). 
Some
of the studies involving patients with type 2 diabetes had methodological
problems. A randomized controlled trial using metformin for gestational 
diabetes
in the third trimester is underway. The human information is inadequate to
evaluate the risk of glipizide or the thiazolidinediones in pregnancy. In 
breast
milk, 3 studies measured nonsignificant amounts of metformin and one study 
was
unable to detect either glyburide or glipizide. CONCLUSIONS: Neither 
glyburide
nor metformin has caused developmental toxicity in humans. Glyburide has 
been
used for the treatment of gestational diabetes, and metformin has been used 
in
women with PCOS who eventually became pregnant. Additional trials are needed 
to
better define the benefits and risks of oral antidiabetic agents in 
pregnancy.
Metformin, glyburide, and glipizide appear to be compatible with 
breast-feeding.

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