title: Enoxaparin-metformin and enoxaparin alone may safely reduce pregnancy loss.
abstract: Polycystic ovary syndrome (PCOS), thrombophilia, and hypofibrinolysis are associated with recurrent pregnancy loss (RPL) and spontaneous abortion (SAB). In 28 Caucasian women, 21 women with PCOS (4 with previous thrombosis, 18 with 1 SAB or more, and 20 with 1 coagulation disorder or more), and 7 women with coagulation disorders-thrombi, we speculated that prospective treatment with enoxaparin-metformin or enoxaparin alone would successfully and safely promote healthy live births compared with previous untreated pregnancies. In 21 women with PCOS, metformin (1.5-2.55 g/day) was given before and during pregnancy with concurrent enoxaparin (60 mg/day). Of 21 PCOS women, 19 women had 40 previous untreated pregnancies, 7 had live births (18%), 3 had elective abortions (ABs) (8%), and 30 had SABs (75%). On enoxaparin-metformin, these 19 women had 24 pregnancies, 20 live births (83%), and 4 SABs (17%); the SAB rate was 4.4-fold lower than previous untreated pregnancies (McNemar's s = 20.8, P < 0. 0001). Two women with PCOS without previous pregnancies, but with previous thrombosis, had 2 pregnancies on enoxaparin-metformin and 2 live births. Of the 7 women with coagulation disorders-thrombi, 4 had 15 previous pregnancies without enoxaparin, with 6 live births (40%), 8 SABs (53%), and 1 elective AB (7%). On enoxaparin, these 4 women had 4 pregnancies, with 4 (100%) live births (McNemar's s = 8.0, P = 0.005). The other 3 women with coagulation disorders-thrombi had 4 pregnancies on enoxaparin with 4 live births. No adverse maternal-fetal side effects were reported on enoxaparin alone or enoxaparin-metformin. Enoxaparin-metformin reduces pregnancy loss in women with PCOS-coagulation disorders and in women with coagulation disorders-thrombi.
authors.affiliation: Cholesterol Center, Jewish Hospital, Cincinnati, OH 45229, USA.
authors.forename: Ganga
authors.initials: G
authors.lastname: Ramidi
authors.forename: Naseer
authors.initials: N
authors.lastname: Khan
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Glueck
authors.forename: Ping
authors.initials: P
authors.lastname: Wang
authors.forename: Naila
authors.initials: N
authors.lastname: Goldenberg
mesh_terms: D000026:Abortion, Habitual / Q000209:etiology / Q000517:prevention & control; D000022:Abortion, Spontaneous / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000188:drug therapy* / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D020964:Embryo Loss / Q000209:etiology / Q000517:prevention & control; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D050498:Live Birth; D008687:Metformin / Q000627:therapeutic use*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D007004:Hypoglycemic Agents; D008687:Metformin