Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion: a pilot study.
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).


METHODS
Prospective pilot study.


METHODS
Outpatient.


METHODS
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.


METHODS
Metformin, 1.5-2.55 g/day, throughout pregnancy.


METHODS
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.
Glueck
C J
CJ
The Cholesterol Center, Jewish Hospital, Cincinnati, Ohio 45229, USA. glueckch@healthall.com
Phillips
H
H
Cameron
D
D
Sieve-Smith
L
L
Wang
P
P
D000014:Abnormalities, Drug-Induced / Q000453:epidemiology; D000022:Abortion, Spontaneous / Q000517:prevention & control*; D000328:Adult; D001724:Birth Weight; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood; D008687:Metformin / Q000009:adverse effects / Q000627:therapeutic use*; D009839:Oligomenorrhea / Q000150:complications; D010865:Pilot Projects; D017395:Plasminogen Activator Inhibitor 1 / Q000235:genetics; D015849:Plasminogen Inactivators / Q000097:blood / Q000235:genetics; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D015842:Serine Proteinase Inhibitors / Q000097:blood / Q000235:genetics
D007004:Hypoglycemic Agents; D007328:Insulin; D017395:Plasminogen Activator Inhibitor 1; D015849:Plasminogen Inactivators; D015842:Serine Proteinase Inhibitors; D008687:Metformin