Metformin reduces abortion in pregnant women with polycystic ovary syndrome

Sherif Khattab; Iman Abdel Mohsen; Ismail Aboul Foutouh; Ashraf Ramadan; Mohamed Moaz; Hesham Al-Inany

doi:10.1080/09513590601010508

Therapeutics · Metabolic and Endocrine Agents

Metformin reduces abortion in pregnant women with polycystic ovary syndrome

Khattab S, Mohsen IA, Foutouh IA, Ramadan A, Moaz M, Al-Inany H

Published December 13, 2006 Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology, 22(12), 680-684

DOI 10.1080/09513590601010508 PMID 17162710

RRM Academy Synopsis

Metformin in PCOS pregnancy linked to fewer early losses

A 2006 cohort study of 200 women with polycystic ovary syndrome (PCOS, now called PMOS) found early pregnancy loss in about 12 out of 100 women who continued metformin. About 36 out of 100 who stopped it lost the pregnancy early. Each woman chose whether to continue.

Key Findings

Of 200 non-diabetic women with PCOS, 120 continued metformin throughout pregnancy and 80 stopped it at conception or during pregnancy.
Early pregnancy loss, defined as loss of a conception in the first 12 weeks, occurred in 14 of 120 women (11.6%) who continued metformin.
Early pregnancy loss occurred in 29 of 80 women (36.3%) who stopped metformin.
The odds ratio for early pregnancy loss with metformin was 0.23 (95% confidence interval 0.11-0.42).
The authors report one baby girl born with tracheoesophageal fistula and no other teratogenic fetal effects.

Interpretation

The women chose whether to continue metformin. A cohort study like this shows an association and cannot show cause. Women in the comparison group stopped mainly because of side effects and fear of harm to the baby. All were women at one Cairo infertility center who conceived during fertility treatment, between April 2004 and January 2006. The result may not apply to women with PCOS who conceive without treatment. Women with diabetes were excluded. The authors suggest several ways metformin might act but did not measure them. The paper reports no live-birth rate. It states that no adequately controlled studies in pregnant women give conclusive evidence of metformin's safety.

RRM Context

PCOS is now called polyendocrine metabolic ovarian syndrome (PMOS). Insulin resistance is one of its metabolic features. The authors list it as a risk factor for early loss. Restorative reproductive medicine looks for drivers like this. All the women here took metformin before pregnancy for PCOS.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Women with polycystic ovary syndrome (PCOS) are considered to be at increased risk of miscarriage. Since metformin has beneficial effects on the risk factors contributing to first-trimester abortion in PCOS patients, we hypothesized that metformin - owing to its metabolic, endocrine, vascular and anti-inflammatory effects - may reduce the incidence of first-trimester abortion in PCOS women.

Materials and Methods

A prospective cohort study was set up to determine the beneficial effects of metformin on PCOS patients during pregnancy. Two hundred non-diabetic PCOS patients were evaluated while undergoing assisted reproduction. One hundred and twenty patients became pregnant while taking metformin, and continued taking metformin at a dose of 1000-2000 mg daily throughout pregnancy. Eighty women who discontinued metformin use at the time of conception or during pregnancy comprised the control group.

Results

Both groups were similar with respect to all background characteristics (age, body mass index, waist/hip ratio, follicle-stimulating hormone, luteinizing hormone, estradiol and dehydroepiandrosterone sulfate levels). Rates of early pregnancy loss in the metformin group were 11.6% compared with 36.3% in the control group (p < 0.0001; odds ratio = 0.23, 95% confidence interval 0.11-0.42).

Conclusions

Administration of metformin throughout pregnancy to women with PCOS was associated with a marked and significant reduction in the rate of early pregnancy loss.

Topics

Therapeutics › Metabolic and Endocrine Agents › Insulin Sensitizing Agents · Pregnancy › Early Pregnancy › Miscarriage

Sherif Khattab, Iman Abdel Mohsen, Ismail Aboul Foutouh, Ashraf Ramadan, Mohamed Moaz, Hesham Al-Inany

S Khattab, I Mohsen, I Foutouh, A Ramadan, M Moaz, H Al-Inany

PMID 17162710 17162710 DOI 10.1080/09513590601010508 10.1080/09513590601010508 Khattab et al. 2006, Khattab 2006

Keywords

Abortion, Spontaneous/etiology/prevention & Control, Adult, Female, Humans, Hypoglycemic Agents/pharmacology/therapeutic Use, Metformin/pharmacology/therapeutic Use, Polycystic Ovary Syndrome/complications/drug Therapy, Pregnancy, Pregnancy Trimester, First, Hypoglycemic Agents, Metformin

Metformin reduces abortion in pregnant women with polycystic ovary syndrome

Metformin in PCOS pregnancy linked to fewer early losses

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

A prospective controlled study of karyotyping for 430 consecutive babies conceived through intracytoplasmic sperm injection

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Keywords