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LettersSeptember 2022Preconception Antidiabetic Drugs in Men and Birth Defects in OffspringPeter Rossing, MD, DMSc and Michael Gwilt, PhDPeter Rossing, MD, DMScSteno Diabetes Center, Copenhagen, DenmarkSearch for more papers by this author and Michael Gwilt, PhDGT Communications, Shrewsbury, United KingdomSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L22-0232 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: Wensink and colleagues' article (1) describes an excess of birth defects in neonates fathered by men who received metformin during the 3-month period of spermatogenesis before conception (known as sperm development). This is an important contribution. Nevertheless, we would place its findings into a broader clinical context.Hyperglycemia, older age, and obesity are known risk factors for fetal malformations or other outcomes (2–4). The fathers with type 1 diabetes—who made up 84% of the insulin (control) cohort—had probably been receiving insulin for years. We do not know how many members of the metformin and sulfonylurea cohorts (presumably ...References1. Wensink MJ, Lu Y, Tian L, et al. Preconception antidiabetic drugs in men and birth defects in offspring. A nationwide cohort study. Ann Intern Med. 2022;175:665-73. [PMID: 35344380] doi:10.7326/M21-4389 LinkGoogle Scholar2. Zhu JL, Madsen KM, Vestergaard M, et al. Paternal age and congenital malformations. Hum Reprod. 2005;20:3173-7. [PMID: 16006461] CrossrefMedlineGoogle Scholar3. Hieronimus B, Ensenauer R. Influence of maternal and paternal pre-conception overweight/obesity on offspring outcomes and strategies for prevention. Eur J Clin Nutr. 2021;75:1735-44. [PMID: 34131301] doi:10.1038/s41430-021-00920-7 CrossrefMedlineGoogle Scholar4. Eberle C, Kirchner MF, Herden R, et al. Paternal metabolic and cardiovascular programming of their offspring: a systematic scoping review. PLoS One. 2020;15:e0244826. [PMID: 33382823] doi:10.1371/journal.pone.0244826 CrossrefMedlineGoogle Scholar5. Broe A, Damkier P, Pottegård A, et al. Congenital malformations in Denmark: considerations for the use of Danish health care registries. Clin Epidemiol. 2020;12:1371-80. [PMID: 33364846] doi:10.2147/CLEP.S278596 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Peter Rossing, MD, DMSc; Michael Gwilt, PhDAffiliations: Steno Diabetes Center, Copenhagen, DenmarkGT Communications, Shrewsbury, United KingdomDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L22-0232. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPreconception Antidiabetic Drugs in Men and Birth Defects in Offspring Maarten J. Wensink , Ying Lu , Lu Tian , Gary M. Shaw , Silvia Rizzi , Tina Kold Jensen , Elisabeth R. Mathiesen , Niels E. Skakkebæk , Rune Lindahl-Jacobsen , and Michael L. Eisenberg Preconception Antidiabetic Drugs in Men and Birth Defects in Offspring Maarten J. Wensink , Elisabeth R. Mathiesen , Rune Lindahl-Jacobsen , Michael L. Eisenberg Metrics Cited byHypothesis: Metformin is a potential reproductive toxicant September 2022Volume 175, Issue 9Page: W106KeywordsCongenital disordersDiabetes mellitusDrugsInsulinSperm ePublished: 20 September 2022 Issue Published: September 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...