Kumar, P., & Khan, K. (2012). Effects of metformin use in pregnant patients with polycystic ovary syndrome. Journal of Human Reproductive Sciences, 5(2), 166-169. https://doi.org/10.4103/0974-1208.101012
Kumar P, Khan K. Effects of metformin use in pregnant patients with polycystic ovary syndrome. J Hum Reprod Sci. 2012;5(2):166-169. doi:10.4103/0974-1208.101012
Kumar, Pratap, and Kashif Khan. "Effects of metformin use in pregnant patients with polycystic ovary syndrome." Journal of Human Reproductive Sciences, vol. 5, no. 2, 2012, pp. 166-169.
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Metformin through PCOS pregnancy linked to fewer early losses
Women with PCOS who kept taking metformin through pregnancy had fewer early pregnancy losses in several studies. A 2012 review collects these reports. Several were case-controlled or cohort studies. One placebo-controlled trial of 257 women saw no drop in complications.
Key Findings
In a 3-year case-controlled study of 197 pregnant women with PCOS, women who continued metformin throughout pregnancy had significantly fewer early pregnancy losses than women who stopped after the first trimester.
In a prospective cohort of 360 non-diabetic women with PCOS, 200 continued metformin throughout pregnancy and 160 stopped. The continuing group had significantly less gestational diabetes.
In a case-controlled study of 137 women with PCOS split into 3 groups, the group that continued metformin throughout pregnancy had less fetal growth restriction, less preterm labor and more live births.
A randomized, placebo-controlled, double blind study of 257 pregnant women with PCOS, given metformin or placebo from first trimester to delivery, found no reduction in gestational diabetes, pre-eclampsia or preterm delivery.
Pooling 17 randomized controlled trials, a meta-analysis found no reduction in miscarriage risk in women with PCOS who took metformin before conception.
Interpretation
This 2012 review gathers studies on metformin use during pregnancy in women with PCOS, also called PMOS (Polyendocrine Metabolic Ovarian Syndrome). In several case-controlled and cohort studies, women who kept taking metformin through pregnancy had fewer early losses, less gestational diabetes, less growth restriction, less preterm labor, and more live births. A placebo-controlled trial of 257 women found no drop in gestational diabetes, pre-eclampsia, or preterm birth. A pooled look at 17 randomized trials found no drop in miscarriage risk with metformin use before conception. The authors note that no clear guidelines yet recommend metformin in PCOS pregnancy. The findings support larger, randomized studies of this drug in PCOS pregnancy.
RRM Context
The review says high insulin may play a central role in PCOS. Insulin raises the ovaries' output of androgens. Restorative reproductive medicine looks for causes like this and treats them before conception.
Our editorial summary of this paper, not the article's abstract.
Abstract
Use of metformin throughout pregnancy in women with polycystic ovary syndrome (PCOS) has shown to reduce the rates of early pregnancy loss, preterm labor, and prevention of fetal growth restriction. Metformin has been shown to have encouraging effects on several metabolic aspects of polycystic ovarian syndrome, such as insulin sensitivity, plasma glucose concentration and lipid profile and since women with PCOS are more likely than healthy women to suffer from pregnancy-related problems like early pregnancy loss, gestational diabetes mellitus and hypertensive states in pregnancy, the use of metformin therapy in these patients throughout pregnancy may have beneficial effects on early pregnancy loss and development of gestational diabetes.
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