Some diabetic drugs such as metformin and their usage in men may damage sperm development and possess a higher risk of birth defects.
- Diabetes is increasing in men of reproductive age, compromising the sperm quality
- The medications used to treat diabetes such as metformin could affect birth outcomes
- This calls for guidance from clinicians to help couples in planning pregnancy
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Sugar and Sperm Don’t Get Along
The World Health Organization projects that the number of people with diabetes will nearly double by 2025, surpassing 300 million, due partly to an increasingly obese, inactive, and aging population. Type 1 diabetes typically manifests itself in childhood or young adulthood, while Type 2 usually strikes adults over 30. Apart from the damage to the heart, kidney, nerve, and eye, diabetes also has a striking impact on the reproductive health of both men and women.Moreover, in males’ diabetes can affect the quality of sperm through DNA damage. From a clinical perspective, this is important, particularly given the overwhelming evidence that sperm DNA damage impairs male fertility and pregnancy loss.
Given the global rise in the prevalence of diabetes, it is also vital to examine the outcomes of pregnancies fathered by diabetic men.
Metformin may be a Culprit
To explore this, researchers from the University of Southern Denmark and Stanford University studied data from nationwide national registries of births, patients, and prescriptions to evaluate the risk for birth defects among babies born to men treated with insulin, metformin, or sulfonylureas before conception.Babies were considered exposed to a diabetes drug if their father had filled at least one prescription during 3 months when the fertilizing sperm were developing.
Researchers then compared birth defects in the babies across different diabetes drugs, different times of taking the drug relative to the development of fertilizing sperm, compared with unexposed siblings of the babies.
Babies whose fathers took metformin had an increased risk for birth defects compared to babies whose fathers took sulfonylureas or insulin. Taking metformin before or after sperm development did not increase the risk for birth defects. Unexposed siblings were also not at increased risk.
These findings suggest that treatment of prospective fathers with diabetes, including pharmacologic management and counseling on diet, physical exercise, and weight loss, should be explored furthermore.
The Good News
Knowing the importance of diabetic drugs, researchers also call for guidance from clinicians to help couples planning for pregnancy to weigh the risks and benefits of metformin use relative to other medications in men.Ideally, it is the best to try for a baby when the diabetes is well-controlled and there are no other health problems. This will reduce diabetes-related risks during pregnancy.
Reference:
- Wensink, M. J., Lu, Y., Tian, L., Shaw, G. M., Rizzi, S., Jensen, T. K., Mathiesen, E. R., Skakkebæk, N. E., Lindahl-Jacobsen, R., & Eisenberg, M. L. (2022). Preconception antidiabetic drugs in men and birth defects in offspring. Annals of Internal Medicine - (https://doi.org/10.7326/M21-4389)
Source-Medindia