Discussion and reply

D.B. is a 27-year-old Hispanic female who is in the OB clinic for an acute sick visit, and she is an established patient. Her chief complaint is “I feel like I can’t drink enough water.” Her past and current medical and surgical history include Primigravida 25-week gestation, Obesity, Appendectomy. Her current medications are Prenatal vitamin 2 capsules daily PO. Her family history is: Mother: Type 2 Diabetes, COPD and Father: Hypertension

Recent Labs:
3 hour glucose tolerance test:
Fasting: 97 mg/dL
1Hour: 185 mg/dL
2Hour: 160 mg/dL
3Hour: 155 mg/dL
She currently is being diagnosed today with Gestational Diabetes Mellitus in pregnancy. The OB recommends for Metformin to be started.
In this discussion forum:
1. Review the case, do you agree with the recommendation of Metformin?
2. At what dose would you consider starting?
3. What is the mechanism of action of Metformin?
4. Discuss the safety profile of Metformin in pregnant women.
5. What considerations should be made if the mother continues to require Metformin in the postpartum period and wishes to breastfeed her infant?