Noninvasive Airway Management of Comatose Patients With Acute Poisoning

Abstract

To the Editor The MOMPOD study 1 revealed that for pregnant individuals with preexisting type 2 or early gestational diabetes, metformin, 1000 mg twice daily, starting before 23 weeks' gestation and taken until delivery, did not reduce a composite adverse neonatal outcome but resulted in reduced numbers of large-for-gestational-age infants. However, we believe that safety issues regarding the long-term effects of metformin on male infant fertility should also be considered.Metformin is classified as US Food and Drug Administration pregnancy category B. However, prenatal exposure of human fetal testicular cells to metformin may significantly decrease testosterone secretion. 2 Metformin concentration in umbilical cord blood has been shown to be equal to the concentration in maternal venous blood. 3 The level of sex hormone-binding globulin was increased in newborns following metformin exposure in the first trimester of pregnancy, which could result in lower free androgen indexes. 3 The production of fetal androgen is critical for masculinization of the fetal reproductive system and maintaining gonocyte integrity. 3 Therefore, metformin exposure during fetal and neonatal periods could result in a reduction in testicular size, Sertoli cell numbers, and sperm count, and may result in hypospadias and subinfertility. 4 Based on available data, use of metformin during pregnancy is still controversial, 5 and further data are required to identify the long-term effects of metformin on fetal testicular cells and determine infertility rates among male infants who were exposed to metformin during pregnancy. Therefore, in the MOMPOD study, long-term monitoring of fertility in male infants is highly recommended for the possible effects of fetal exposure to metformin.