Babies given anti-obesity drugs in the womb

Ez - posted on 05/15/2011 ( 6 moms have responded )

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Ok, so the title of this article is slightly misleading. There is a new UK trial involving Metformin and obese mothers. Metformin is NOT an anti-obesity drug or diet pill, but rather helps regulate glucose levels (it's commonly used in Diabetics). But the theory is that by administering the drug during pregnancy, the baby will not become LGA/macrosomic and therefore reduce the risk of c-section (which is far from ideal in an obese mother).



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One hundred obese mums-to-be will be given Metformin as part of a three-year study to tackle obesity rates and reduce the number of difficult births.



Patients at Liverpool Women's Hospital will be given the drug to reduce the food supply to their unborn babies, although it will not help the mums themselves to lose weight.



Leading the trial, senior lecturer in obstetrics, Dr Andrew Weeks, said: "It is about trying to improve outcomes in pregnancy for women who are overweight.



"The problem is babies tend to be larger and many of the downsides of being overweight during pregnancy relate to the birth."



Metformin reduces blood sugar levels which are passed onto babies in the womb, and is already regularly used to treat diabetic mums-to-be, as well as diabetics in general.



During the study, half of the patients will take Metformin pills up to three times a day from 12 weeks gestation, while the other half will be given placebo drugs.



Doctors hope it will prevent the birth of oversized babies, thereby reducing the need for caesarean sections.



Instances of pre-eclampsia, the potentially fatal complication in pregnancy common to overweight mothers, are also hoped to be reduced.



The trial will run as a joint study between hospitals in Liverpool, Coventry and Edinburgh and will monitor over 400 women in total.



Dr Weeks added: "The difficulty comes when you have been living in a particular way for years that is not healthy.



"To suddenly change to a different lifestyle is not easy to do.



"Lifestyle change takes time and we would always encourage this as well but the use of Metformin gives us another option when the other is not realistic."



However, a leading expert behind the UK's fastest growing weight loss organisation has voiced concerns over giving pregnant women drugs to prevent them having obese babies.



CEO of All About Weight, Alison Wetton, said: "Women rightfully feel uneasy - no mother-to-be likes to take medication.



"The fact that the widely-used diabetes pill, Metformin, is being trialled to prevent obese babies being born to overweight mothers is disturbing to me, and I am sure most other women as well."



Will Williams, scientific advisor for All About Weight, added that, although there were "reasonable grounds" for the trial, it was "a shame that it is needed at all".



He said: "We know Metformin is safe in pregnancy and has no negative effects on the child up to 2 years, but there is a lack of studies on older children.



"Women wanting to conceive could instead lose weight by following a healthy weight loss plan, including diet and exercise.



"This would achieve all the things that the Metformin trial is hoping to do, without the risks or costs of adding a drug with uncertain long term effects.



"This would be far preferable to popping a pill that may help pregnancy outcomes.



"It is unlikely to break the cycle of an unhealthy lifestyle leading to overweight children and the continuing rise of obesity and diabetes in the general population."



However, Jane Norman, Professor of Maternal and Foetal Health at Edinburgh Royal Infirmary and the University of Edinburgh, believes the benefits of the trial will outweigh the risks.



Prof Norman, a representative of leading pregnancy charity Tommy's, said: "Research has shown that babies born to obese mothers are at increased risk of complications in later life.



"Obese pregnant women have high levels of glucose and Metformin is proven to reduce glucose.



"We have to be careful with the use of drugs in pregnancy but we already know that it is safe to give expectant mothers.



"It is likely that Metformin will prevent babies from getting too big and, putting all these factors together, I am confident that the benefits will outweigh the risks."



http://www.telegraph.co.uk/health/health...



I had a few questions pop into my head when I read this. If the trial proves beneficial with obese mothers, will they then try it on average-sized women who are prone to growing big babies (like me)? What about first time mothers with a strong family history of macrosomia (yep, that was me too)?



If the aim is only to help obese women during pregnancy, I think it could be a really good thing. I just have visions of this drug being misused/overused. Will it become the new go-to when a mother starts measuring slightly larger than dates? If so, they would have dosed me to the eyeballs when my fundal height went to 36 at 28wks. Will women be able to request it because they're scared of having a 9 pounder?



Thoughts?

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Mary - posted on 05/16/2011

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A BMI of 25?? That seems pretty low to me to classify someone as "obese". I think our cutoff was 30 to put them into the high risk category. It's not that they weren't overweight if under 30, but they weren't considered morbidly obese (and therefore high risk) until they hit that mark.

While there were certainly guidelines in place with specific numbers like a BMI, we also just looked at the overall person. BMi's are not a good indicator (by themselves) of general risk in pregnancy. As far as caring for them in the hospital setting....sometimes, you just had to eyeball them AND look at their "numbers" to make a determination. After all, a BMI of 32 on a woman who is 6ft vs one who is 5ft is really a radical difference. Throw in age, and overall activity/fitness level and health history....weight (or BMI) alone is not a good predictor of risk.

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Kathleen - posted on 05/16/2011

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I'm just not for giving anything to a pregnant mom. Even with trials, I'd worry if the baby will not respond well, and cause other problems later.

Mary - posted on 05/16/2011

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Jodi, I completely understand what you are saying. I do know that most of the practices where I worked do try starting the "bigger girls" on a restricted diet from the very beginning. The problem is compliance. Two things are working against them on this: 1) a woman who, thus far, has not led a lifestyle of healthy eating, nor been "good" about restricting either choices or portions, 2) The mentality of "I'm not really a diabetic (yet) so it's not so bad if I slip, and 3) The still prevalent belief amongst a large percentage of society that pregnancy is time to eat whatever the hell you want ("I'm eating for two!").



Another factor is that the ranges for "acceptable" blood sugars is much tighter in pregnancy than in non-pregnant diabetics. I see where starting metformin at the end of the first trimester could possibly be beneficial. If they can prevent an already at-risk group from having huge spikes in their sugars, it could prevent them from having a larger baby.



***ETA***

Yes, metformin has been approved for use in pregnancy, and is currently used in women who develop gestational diabetics. It's not the use of metformin in pregnancy that is new, but rather the introduction of it BEFORE the routine 1 hour gtt at 28 weeks.

Jodi - posted on 05/16/2011

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My husband is on Metformin. He is a Type 2 diabetic. I know it comes in different strengths. He takes 2 x 500mg tablets a day. IF he has had a lot more exercise that usual and he still takes his tablet after his meal, he finds he can find himself a little low.

So I guess, I am questioning giving these to people with normal blood sugar. I can understand those who may be pre-diabetic, but I would think they should really give these women a GTT earlier than usual as a check before handing these pills over. I don't know how someone who is not diabetic reacts to these pills, so I am only speculating based on my husband's blood sugar reaction.

Personally, I think they would be MUCH better getting high risk patients onto a diabetic diet and starting with that early in the pregnancy, rather than pumping them full of pills. THEN if the diet fails, it could be a possibility.

The other interesting thing to me is the question of whether Metformin has ever been tested on pregnant women before?

Anyway, I don't think it should be used just because a woman is obese. I think that it should only be used based on blood sugar levels, which should be monitored closely in high risk patients.

Ez - posted on 05/16/2011

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Ahh Mary I was waiting for you to see this! I'm hoping the 'obese' tag is just for the sake of the article and press, and not what would be used in a clinical setting when discussing this treatment with a pregnant mumma. Because I agree, that may not go down so well.

I read in a different article that they plan on using a BMI of 25 as an indication for this treatment. I see that being problematic too.

Overall, if a treatment like this can stop an overweight mother developing GD, then that can only be a good thing. But I worry about the practicalities. How are overweight pregnant women going to respond to being treated differently? Or are they already?

Mary, does being overweight automatically make you high risk in a hospital setting? And do they use the BMI to judge that?

Mary - posted on 05/16/2011

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Interesting questions, Erin!

I do have to say, it really bugs me that this article refers to LGA babies as "obese". I know it's just a question of semantics, but I fear the way a lot of woman will respond to calling their infant "obese" as opposed to LGA.

I don't think, that even if became standard practice (after this and other trials), it would be abused for women such as yourself who started measuring larger later in pregnancy. In the above mentioned study, they are beginning the metformin at 12 weeks, in an effort to maintain consistent blood sugars throughout pregnancy. I'm sure some of the theory behind this is that a larger number of these women will become gestational diabetics anyway; starting meds at 12 weeks instead of waiting for the GTT at 28 weeks gives them a head start on maintaining consistent blood sugars, instead of correcting a problem after it is already occurred.

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