A 32-year-old woman with PCOS is started on metformin 500 mg twice daily. She becomes pregnant while on metformin. She asks whether to continue metformin during pregnancy. According to current evidence and guidelines, what is the most appropriate advice?

• A Metformin must be stopped immediately as it is FDA Category D and teratogenic
• B Metformin should be stopped only after the first trimester organogenesis is complete
• C Metformin should be switched to insulin as soon as pregnancy is confirmed
• D Metformin may be continued in women with PCOS during pregnancy; it is FDA Category B and may reduce early pregnancy miscarriage risk ✓

Explanation

Metformin is FDA Pregnancy Category D. Evidence from the MiG trial and subsequent studies shows metformin is safe in pregnancy for women with PCOS and may reduce early miscarriage rates and gestational diabetes. It need not be stopped upon pregnancy confirmation. Option A is wrong as it is not Category B. Insulin is reserved for gestational diabetes not controlled otherwise, not routinely required.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.