Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion: a pilot study
Glueck CJ,Phillips H,Cameron D,Sieve-Smith L,Wang P
Published January 2001Fertility and Sterility, 75(1), 46-52
Glueck, C. J., Phillips, H., Cameron, D., Sieve-Smith, L., & Wang, P. (2001). Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion: a pilot study. Fertility and Sterility, 75(1), 46-52. https://doi.org/10.1016/s0015-0282(00)01666-6
Glueck CJ, Phillips H, Cameron D, Sieve-Smith L, Wang P. Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion: a pilot study. Fertil Steril. 2001;75(1):46-52. doi:10.1016/s0015-0282(00)01666-6
Glueck, C. J., et al. "Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion: a pilot study." Fertility and Sterility, vol. 75, no. 1, 2001, pp. 46-52.
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Metformin in pregnancy was linked to fewer early miscarriages in PCOS
In a 2001 pilot case series of women with PCOS, early miscarriage ended 1 out of 10 pregnancies on metformin, against about 7 out of 10 before. The comparison covers 10 women. So far, none of the 19 women who stayed on it has reported a baby with a birth defect.
Key Findings
Ultrasound of the 6 ongoing pregnancies found no congenital defects; median gestation was 23 weeks.
Of 19 women who continued metformin, 11 had normal live births without birth defects (58%), 2 miscarried in the first trimester (10.5%), and 6 were still pregnant (32%).
Ten women had 22 earlier pregnancies without metformin: 16 first-trimester miscarriages (73%) and 6 normal live births (27%).
The same 10 women on metformin: 6 normal live births (60%), 1 miscarriage (10%), 3 normal ongoing pregnancies (30%). P<.002 (Fisher exact test).
This pilot case series followed women with PCOS through pregnancy on metformin, comparing each woman's outcome with her own earlier pregnancies. The 73% counts earlier pregnancies; the 10% counts current pregnancies in the same 10 women. The authors note the small sample may exaggerate the contrast. The findings support larger studies of continuing metformin throughout pregnancy in PCOS.
RRM Context
PCOS is now also called polyendocrine metabolic ovarian syndrome (PMOS). It often brings insulin resistance and irregular ovulation. RRM looks for what drives those problems and treats it. The authors speculate that the drug's effects on insulin and clotting explain the change.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To determine whether metformin would safely reduce the rate of first-trimester spontaneous abortion without teratogenicity in 19 women with the polycystic ovary syndrome (PCOS).
Design
Prospective pilot study.
Setting
Outpatient.
Patients
Twenty-two previously oligoamenorrheic, nondiabetic women with PCOS; 125 women with PCOS who were not currently pregnant and who had > or = 1 previous pregnancy while they were not receiving metformin.
Interventions
Metformin, 1.5-2.55 g/day, throughout pregnancy.
Main Outcome Measures
Rates of first-trimester spontaneous abortion and teratogenicity.
Results
Before metformin, 10 women had 22 previous pregnancies with 16 first-trimester spontaneous abortions (73%). While receiving metformin, these 10 women had 6 normal live births (60%), 1 spontaneous abortion (10%), and 3 normal ongoing pregnancies (30%) (all > or = 13 weeks; median gestation, 23 weeks). Among women receiving metformin, including those with live births and normal pregnancy for at least the first trimester, 1 of 10 (10%) had first-trimester spontaneous abortion compared with 73% in 22 previous pregnancies without metformin (P<.002). To date, the 19 women receiving metformin have had no adverse maternal side effects, and no birth defects have occurred; 9 (47%) had normal term live births, 2 (11%) had normal and appropriate for gestational age births (one at 33 and one at 35 weeks), 6 (32%) have ongoing normal pregnancies lasting longer than the first trimester, and 2 (10.5%) had first-trimester spontaneous abortions. Sonography showed normal fetal development without congenital defects in the 6 ongoing pregnancies (median gestation, 23 weeks). Among women who received metformin before conception, reductions in insulin and plasminogen activator inhibitor activity were correlated (r=0.65, P=.04).
Conclusions
Metformin therapy throughout pregnancy in women with PCOS reduces the otherwise high rate of first-trimester spontaneous abortion seen among women not receiving metformin and does not appear to be teratogenic.
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