Rosiglitazone Crosses Placenta in First Trimester

Women who take rosiglitazone during pregnancy can expect some of the drug to reach the fetus during the first trimester, new research shows. Placental transfer of rosiglitazone is most likely to occur at or after 10 weeks’ gestation.

"Diabetic women receiving rosiglitazone therapy should be informed about the risk of placental transfer in the first trimester and the unknown effect of rosiglitazone on human fetuses," lead author Dr. Louis Yik-Si Chan and colleagues, from The Chinese University of Hong Kong in Shatin, advise.

In women with polycystic ovary syndrome (PCOS), use of the hypoglycemic agent has been shown to result in resumption of ovulation, and may help prevent first trimester miscarriages, the authors note.

The findings, are based on a study of 31 women without diabetes who were undergoing elective termination of their pregnancy between 8 and 12 weeks’ gestation. Prior to the procedure, each woman received two doses of rosiglitazone.

The average maternal serum level of rosiglitazone was 110.3 ng/mL. The drug was detected in 19 fetal samples (61.3%) at a mean tissue concentration of 52.7 ng/g.

Fetuses terminated at or after 10 weeks were at least 32 times more likely to have detectable rosiglitazone than those terminated earlier in pregnancy.

Of the 22 coelomic fluid samples obtained, rosiglitazone was detected in 13 (59.1%) at a mean concentration of 22.8 ng/mL. By contrast, the drug was only detected in 2 of 31 amniotic fluid samples obtained at a mean concentration of 10.3 ng/mL.

The fact that rosiglitazone was often found in fetal tissue but seldom in amniotic fluid samples suggests that fetuses may be able to metabolize the drug, the investigators point out.

The findings also have implications for using rosiglitazone to induce ovulation and prevent miscarriages in women with polycystic ovary syndrome. "It may be safe to use rosiglitazone to induce ovulation then stop the therapy once pregnancy is confirmed, but the use of this drug beyond 10 weeks of gestation for preventing first trimester miscarriages should be approached with great caution," the authors emphasize.
Fertil Steril 2005;83:955-958

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FACT:
Stress causes blood glucose to rise: Stress makes our body react and prepare to fight or flee from danger. When this happens, adrenalin (epinephrine), the emergency hormone, is produced by the adrenal grands and this causes a cascade of metabolic reactions, including the release of cortisol and glucagon, also called counterregulatory hormones, because they increase blood glucose levels from the breakdown of glycogen, a form of glucose stored in muscles and liver.

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