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A new study has found that metformin if taken during pregnancy could possibly restrict foetus growth, including a slow maturing of the kidneys. Metformin is a common anti-diabetes drug. The drug is known to help manage the metabolic disorder by lowering blood sugar. The study was led by researchers from Baylor College of Medicine, US and published in the journal American Journal of Obstetrics and Gynecology.

Researchers said that the drug is now prescribed to pregnant women to reduce the risk of complications due to diabetes-related conditions, including pre-diabetes and gestational diabetes. However, concerns have been raised regarding the long-term effects of metformin on childhood development, even as the drug has been shown to be effective in managing blood sugar in pregnant women.

For this study, the researchers developed an experimental primate model. The researchers said that within 30 days of conception, 13 female rhesus monkeys were initiated on twice-daily 10 milligrams per kilogram weight metformin, which is the equivalent of doses prescribed to humans. On the 145th day of a monkey’s pregnancy, the foetus and the placenta were delivered by performing a caesarean section.

The researchers analysed metformin levels and the results showed that the drug freely crossed the placenta and accumulated in the foetal kidneys, liver, intestines, placenta, amniotic fluid (in which the embryo is suspended) and urine, levels of which were similar to those found in the mother’s urine.

The researchers said that this accumulation of metformin during pregnancy was found to be linked with a restricted growth of kidneys, liver, skeletal muscle, heart and fat deposits known to support the abdominal organs, all of which served to lower the foetus’s body weight.

The authors wrote, “Our study demonstrates fetal bioaccumulation of metformin with associated foetal growth restriction and renal dysmorphology after maternal initiation of the drug within 30 days of conception in primates.”

They added that while the anti-diabetes drug is not known to cause birth defects, the foetus also doesn’t have a way to clear the drug. Jed Friedman, associate vice provost for diabetes programs at the University of Oklahoma Health Sciences and co-author of the study said, “Many drugs undergo 'first-pass' metabolism by becoming absorbed first in the liver, which decreases the concentration before it continues through the body. However, metformin does not experience the first-pass effect; rather, it is transported across the placenta, exposing the fetus to an adult dose of the drug.”

Results showed metformin levels did not differ according to diet. However, this being a small study, the researchers called for more studies to better understand the effects of metformin on the foetus, Friedman said.

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