USE OF METFORMIN IN PREGNANCY

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(Date of issue: September 2017, Version: 2)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

A corresponding patient information leaflet on metformin use in pregnancy is available at www.medicinesinpregnancy.org.

Summary

Metformin is an antihyperglycaemic biguanide used in the management of type 2 diabetes. It acts by lowering basal and postprandial plasma glucose without stimulating insulin secretion, thereby reducing the risk of hypoglycaemia associated with insulin therapy. Metformin is also used off-label for the treatment of infertility secondary to polycystic ovarian syndrome (PCOS).

The available data do not show an increased risk of congenital malformation, spontaneous abortion, preterm delivery, small or large for gestational age infants, perinatal mortality or neonatal complications. However, there are insufficient data relating to metformin exposure in early pregnancy to exclude an increased risk of congenital malformations or spontaneous abortion. NICE guidance states that women with diabetes may be advised to use metformin as an adjunct or alternative to insulin in the preconception period and during pregnancy, when the likely benefits from improved blood glucose control outweigh the potential for harm.

Exposure to metformin at any stage of pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring over and above that recommended for women with diabetes in pregnancy. However, other risk factors may be present in individual cases which independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.
                     
This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.