Hi, my name is Medora and I am a junior nursing student at the University of North Dakota. I am in my second semester of childbearing classes and am working in the OB setting for clinicals. I have been following the discussions on Lactnet for a few weeks and I was interested by a post on Polycystic Ovary Syndrome (PCOS) and difficulty breastfeeding. An article by Marasco, Marmet, and Shell wrote an article on the relationship between PCOS and its possible connection to inadequate milk supply. This study focused on two of the diagnostic criteria of PCOS: hyperandrogenemia and chronic anovulation. The presence of elevated levels of androgens may present problems to the process of lactation; they may down regulate the effect of estrogen and prolactin receptors. Obesity in women with PCOS may also contribute to the elevated levels of estrogen. PCOS onset occurs most often during puberty thus creating potential for disruption of mammary development of the ductile system, in which estrogen plays a large role, and lobuloalveolar development, which progesterone regulates. Prolactin is important for mammary development during pregnancy and the endocrine phase of lactation can be limited if prolactin receptors are down regulated (2000, p.143-4, 6-7). Another key hormone in breastfeeding is insulin. Insulin plays a role in stimulating stem cells of the mammary glands to grow and divide during the beginning of milk synthesis. Insulin resistance is a common problem in women with PCOS and therefore a potential deterrent to effective lactogenesis (Marasco et al., p. 147). A common treatment for insulin resistance in women with PCOS is metformin. This drug has been shown in many studies to be very effective for women with PCOS who have infertility problems by facilitating a more regular ovulation and conception. Metformin also can decrease miscarriage, gestational diabetes, macrosomia, and is not teratogenic (Glueck et al., p. 628). However, less studied is the effect of metformin on breastfeeding and infants. I found several recent studies examining the presence of metformin in human breast milk and its effects on the health, growth and development on the breastfeeding infant. Metformin, a biguanide, improves glucose tolerance by reducing hepatic glucose production rather than stimulating insulin release, which can then increase insulin-stimulated glucose intake by the cells. This drug was also found not to increase plasma glucose concentrations or cause hypoglycemia in healthy adults, and the same was also found to be true in infants (Hale et al., p. 1512 & Briggs et al., p.1440). Hale et al. and Briggs et al. both concluded that the amount of drug found in the mother’s breast milk stayed fairly constant over a 12 hour period and that the concentration of drug in the milk was below 10% of the mother’s weight-adjusted dose (mg/kg/d), a level that is considered to be not clinically concerning (Hale et al., p. 1512-3 & Briggs et al., p.1440). Both Hale et al. and Briggs et al. concluded that women taking metformin postpartum should still be encouraged to breastfeed as no adverse affects were attributable to the infants (Hale et al., p. 1513 & Briggs et al., p.1440). A study performed by Glueck et al. showed that formula-fed infants who were born to women taking metformin during pregnancy were just as healthy as breastfed infants born to women taking metformin during pregnancy. At three and six month check-ups, children of both groups were at the same level of weight, height and motor-social development for their age. Glueck et al. also conclude that metformin appears to be safe and effective for lactating mothers and their infants (p.628, 631). This is what I had found in the literature, but I was wondering if anyone had seen metformin used successfully to help mothers with PCOS to lactate more successfully? References: Briggs, G. G., Ambrose, P. J., Nageotte, M. P., Padilla, G., & Wan, S. (2005). Excretion of Metformin Into Breast Milk and the Effect on Nursing Infants. American College of Obstetricians and Gynecologists. 105(6): 1437-41 Gluec, C. J., Salehi, M., Sieve, L., & Wang, P. (2006). Growth, Motor, and Social Development in Breast- and Formula- Fed Infants of Metformin-Treated Women with Polycystic Ovary Syndrome. Journal of Pediatrics. 148: 628-32. Hale, T. W., Kristensen, J. H., Hackett, J. P., Kohan, R., & Ilett, K. F. (2002). Transfer of Metformin Into Human Milk. Diabetologia. 45: 1509-14. Marasco, L., Marmet, C., & Shell, E. (2000). Polycystic Ovary Syndrome: A Connection to Insufficient Milk Supply? Journal of Human Lactation. 16(2): 143- 8. *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html Mail all commands to [log in to unmask] To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or [log in to unmask]) To unsubscribe: unsubscribe lactnet or ([log in to unmask]) To reach list owners: [log in to unmask]