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Diagonosed with PCOD. Taking metben tablets. Got positive pregnancy test. Should I continue the medicine?

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Dear Doctor, Greetings.

we have been married for 1 year. About 10 months into our marriage, we decided to consult an infertility specialist. Scans revealed that my wife had poly cystic ovaries. However her periods were regular. progesterone tests on CD 21 showed that my wife ovulated regularly. The specialist prescribed metben tablets (metformin Hydrochloride & Benfotiamine). My wife did not take it though.

This year in the beginning of february, we decied to consult an infertility specialist in chennai. Once again scans showed polycystic ovaries and CD 21 progesterone showed normal ovulation. The scan was taken on Feb 8th. As a precaution my wife started taking the metben tablet this time from feb 8th only. Before that she has not taken it at all.

By Gods grace, we did a pregnancy test on Feb 21 and it turned out positive. This was also confirmed by ultrasound on Feb 27th.

I want to know whether my wife should continue taking the metben tablets? Will it cause any harm to the baby? The metben consists of both metformin and benfotiamine. If she should continue taking metformin, are there any tablets without benfotiamine? i.e only metformin.

I dont think she has insulin problems as revealed by blood tests taken a few weeks earlier. If she has no insulin problems, is there any necessity to continue with metformin?

I have attached her blood test reports. Please go through them doctor and suggest whether she should continue with metben.

last menstrual period - 25/01/2013
Blood Test report - taken on 26/01/2013 - on day 2

Estradiol - 33.91 pg/ml ; insulin - fasting - 14.67 mU/L; Progesterone - 0.62 ng/ml
FSH - 5.68 mIU/ml ; LH - 3.02 mIU/ml; Prolactin - 19.13 ng/ml
Free T3 - 2.36 pg/ml; Free T4 - 0.74 ng/dl ; TSH - 5.57 mIU/ml

Progesterone - CD 21 (Feb 14th) - 28 ng/ml

Pregnancy test - (Feb 21st - Morning) - positive; - (Feb 23rd - late night) - positive; Feb 26th late night - positive; Feb 27th - Ultra sound - positive - Gestational and yolk sac seen.



Posted Sun, 31 Mar 2013 in Pregnancy
 
 
Answered by Dr. Rakhi Tayal 1 hour later
Hello,
Thanks for posting your query.
Congratulations.
I have seen all the reports. The blood insulin levels are within normal limits. Since she has conceived, there is no need to continue with metformin or Benfotiamin. Benfotiamin is given to prevent nerve degeneration associated with high blood glucose levels. Metformin without benfotiamin is also available but both of these are not needed for now.
Your wife can start with folic acid (5mg) supplements daily to avoid any neural tube defects in the baby and get her fasting blood glucose levels tested to rule out any gestational diabetes.
Hope this answers your query. I will be glad to answer the follow up queries that you have.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Regards.
Dr. Rakhi Tayal.
Above answer was peer-reviewed by
 
Follow-up: Diagonosed with PCOD. Taking metben tablets. Got positive pregnancy test. Should I continue the medicine? 6 hours later
Dear Doctor,

Thanks for your prompt response. We have decided to get the following tests done to rule out using metformin. Can you please tell me if the following tests are sufficient?

(1) Blood Glucose - Fasting
(2) Blood Glucose - PP
(3) insulin - fasting

Are any more tests required? Instead of tests 1 & 2 will random blood glucose be okay?

Doctor, from what I have read on the web, metformin effectively deals with insulin resistance and helps to reduce risk of miscarriage. So just to be on the safe side, can my wife take metformin at the lower dose of 500 mg? I also want to confirm with you whether metformin is contraindicated for pregnancy?
 
 
Answered by Dr. Rakhi Tayal 10 hours later
Hello.
Thanks for writing again.
All the three tests thta you have mentioned should be done. Random blood glucose is not recommended. Fasting and PP levels will be more diagnostic.
Metformin reduces insulin resistance and decreases chances of early miscarriage.
Metformin is classified as Class B in pregnancy, with no evidence of animal or fetal toxicity or teratogenicity. It can be safely taken in first trimester of pregnancy- upto 12 weeks or later in a dose of 500mg daily.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards
Above answer was peer-reviewed by
 
Follow-up: Diagonosed with PCOD. Taking metben tablets. Got positive pregnancy test. Should I continue the medicine? 10 days later
Dear Doctor,

Greetings. We have taken the Blood glucose and Insulin tests. Results as follows

Glucose - Fasting - FBS 81.8 mg/dl - Normal range is 70 - 115

Glucose (PP 2 hours) 97.3 mg/dl - Normal range is 70 - 140

Insulin - fasting 18.86 mU/L - Normal range is 3.0 - 25.0

Insulin - Post prandial 42.42 mIU/mL - normal range is 2.6 - 37.6


Please advice doctor. Insulin PP is high. Even Glucose PP is on the high side. Please suggest what we should do next. Should my wife start taking metformin tablets?
 
 
Answered by Dr. Rakhi Tayal 14 minutes later
The glucose PP levels are in normal range. There is only a mild - borderline rise of post prandial insulin levels. This only indicates her future likelihood of developing insulin resistance at a later stage.
An active treatment with metformin is not indicated right now.
You need to closely monitor for any change in these levels by doing a repeat test after three weeks. In case there is a persistent rise in PP insulin levels then metformin can be started after consulting your gynecologist.
Regards.
Above answer was peer-reviewed by
 
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