>>Question about PCOS/Metformin. I have a C/S mom who delivered yesterday,
dx'd with PCOS. 40 years old, P1, IVF pregnancy.  She has very small
breasts, widely spaced. She states she has seen colostrum. Baby has stooled
3x and voided 2x since birth yesterday at 16:39.  I literally just
discussed Metformin with her OB. He wants to know exact dosage and when to
start. We are seeing more and more moms with this, are others finding this
as well? Is there any study I can share with her OB?<<

Has this mother never been on metformin before?  There is no exact dosage--
the dose is whatever it takes to be therapeutic. This can be anywhere from
500mg to 2500mg per day. Of the moms I've talked to who have improved
lactation with metformin, they seem to be in the range of 1500-2500mg daily.
Because met can cause gastric distress, it is often started low and worked
up gradually.  Do remember that metformin does not guarantee success; if the
breasts did not develop normally, it can't fix the problem of not enough
equipment. Rather, when it works, it is fixing existing equipment that is
not running smoothly. 

I no longer consider the demonstrable presence or absence of colostrum as a
predictor of success or failure. Many low milk supply mothers see colostrum.
Milk *volume* requires different things (like lots of lactose) than does the
production of colostrum. 

Please do give us an update on this mother. The first day's output looks
good; let's hope it continues to increase.

~Lisa Marasco

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