title: Maternal and fetal insulin levels at birth in women with polycystic ovary syndrome: data from a randomized controlled study on metformin.
abstract: BACKGROUND
  Metformin is suggested to reduce pregnancy complications in women with polycystic ovary syndrome (PCOS). Metformin crosses the placenta and therapeutic concentrations are measured in the fetal circulation. Whether metformin treatment in pregnant PCOS women affects maternal and fetal insulin concentrations at birth is not clarified.
  
  
  OBJECTIVE
  To investigate the possible effect of metformin on insulin concentrations in umbilical cord blood and the possible association between maternal and fetal insulin concentrations.
  
  
  METHODS
  Post-hoc analysis of a subgroup of PCOS women participating in a double-blind randomized controlled trial.
  
  
  METHODS
  University hospital setting.
  
  
  METHODS
  Women with PCOS (n=118), aged 19-39 years.
  
  
  METHODS
  Maternal and umbilical cord insulin concentrations immediately after birth.
  
  
  RESULTS
  At delivery women randomized to metformin had lower insulin concentrations than those randomized to placebo (259±209 vs 361±261 pmol/l; P=0.020). No difference was found in insulin concentrations in umbilical venous (P=0.95) and arterial (P=0.39) blood between the metformin and placebo groups. The arteriovenous difference was also equal between the groups (P=0.38). Insulin concentrations were higher in the umbilical vein than in the umbilical artery independent of randomization (70±51 vs 45±48 pmol/l; P<0.0005).
  
  
  CONCLUSIONS
  In PCOS, metformin treatment during pregnancy resulted in lower maternal insulin concentrations at delivery. Metformin treatment did not affect fetal insulin concentrations. Higher insulin concentrations in the umbilical vein indicate that the placenta somehow secretes insulin to the fetus. The possibility of placental insulin secretion to the fetus deserves further investigations.
authors.affiliation: Department of Internal Medicine, Drammen Hospital, Vestre Viken, Dronninggata 28, 3004 Drammen, Norway.
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Helseth
authors.forename: Eszter
authors.initials: E
authors.lastname: Vanky
authors.forename: Solhild
authors.initials: S
authors.lastname: Stridsklev
authors.forename: Christina
authors.initials: C
authors.lastname: Vogt
authors.forename: Sven M
authors.initials: SM
authors.lastname: Carlsen
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D005260:Female; D005312:Fetal Blood; D006801:Humans; D006946:Hyperinsulinism / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood* / Q000378:metabolism; D000078790:Insulin Secretion; D050498:Live Birth; D008431:Maternal-Fetal Exchange / Q000187:drug effects; D008687:Metformin / Q000009:adverse effects / Q000627:therapeutic use*; D010865:Pilot Projects; D010920:Placenta / Q000187:drug effects / Q000378:metabolism; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D015203:Reproducibility of Results; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin