Metformin treatment in pregnant women with polycystic ovary syndrome--is reduced complication rate mediated by changes in the uteroplacental circulation?
OBJECTIVE
To study a possible effect of metformin on the uteroplacental circulation.


METHODS
Forty pregnant women with polycystic ovary syndrome (PCOS) were enrolled in a randomized, double-blind, placebo-controlled trial of metformin (1700 mg/day) during pregnancy. Doppler ultrasound examinations of the uterine arteries were performed at 12, 19, 24, 32 and 36 gestational weeks and of the umbilical artery at 19, 24, 32 and 36 gestational weeks.


RESULTS
There was a greater mean bilateral uterine artery pulsatility index (PI) at 12 weeks (1.95 vs. 1.58, P = 0.02), and a greater reduction in mean PI from 12 to 19 weeks (P = 0.03) in metformin-treated women. There were no differences in mean PI values between groups at 19, 24, 32 or 36 gestational weeks. Pregnancy complications, such as preterm delivery before 32 weeks, severe pre-eclampsia or serious postpartum events, occurred only in the placebo group (7 of 22 vs. 0 of 18, P = 0.01). There were no associations between uterine artery Doppler measurements and pregnancy complications. We found no differences between groups in mean umbilical artery PI at 19, 24, 32 or 36 gestational weeks.


CONCLUSIONS
In this small randomized trial, metformin treatment in pregnancy reduced uterine artery impedance between 12 and 19 weeks of gestation, and this was associated with reduced complication rate. Published by John Wiley & Sons, Ltd.
Salvesen
K A
KA
National Center for Fetal Medicine, Department of Obstetrics and Gynecology, Trondheim University Hospital (St. Olav's Hospital), Trondheim, Norway. pepes@ntnu.no
Vanky
E
E
Carlsen
S M
SM
D000328:Adult; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008687:Metformin / Q000009:adverse effects / Q000627:therapeutic use*; D010920:Placenta / Q000098:blood supply* / Q000187:drug effects; D021041:Placental Circulation / Q000187:drug effects*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000517:prevention & control; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014599:Uterus / Q000098:blood supply* / Q000000981:diagnostic imaging
D007004:Hypoglycemic Agents; D008687:Metformin