Abstract
ContextLarge, longitudinal studies on androgen levels in pregnant women with polycystic ovary syndrome (PCOS) are lacking. While metformin has a mild androgen-lowering effect in non-pregnant women with PCOS, its effects on maternal androgen levels in pregnancy are less well understood.ObjectiveTo describe androgen patterns in pregnant women with PCOS and in healthy control women, and to explore the potential effects of metformin on maternal androgen levels in PCOS.Design and SettingA post hoc analysis from a randomized, placebo-controlled, multicenter study carried out at 11 secondary care centers and a longitudinal single-center study on healthy pregnant women in Norway.ParticipantsA total of 262 women with PCOS and 119 controls.InterventionThe participants with PCOS were randomly assigned to metformin (2 g daily) or placebo, from first trimester to delivery.Main Outcome MeasuresAndrostenedione (A4), testosterone (T), sex-hormone binding globulin (SHBG), and free testosterone index (FTI) at 4 time points in pregnancy.ResultsWomen with PCOS versus healthy controls had higher A4, T, and FTI, and lower SHBG at all measured time points in pregnancy. In the overall cohort of women with PCOS, metformin had no effect on A4, T, SHBG, and FTI. In subgroup analyses, metformin reduced A4 (P = 0.019) in nonobese women. Metformin also reduced A4 (P = 0.036), T (P = 0.023), and SHBG (P = 0.010) levels through pregnancy in mothers with a male fetus.ConclusionMetformin had no effect on maternal androgens in PCOS pregnancies. In subgroup analyses, a modest androgen-lowering effect was observed in nonobese women with PCOS. In PCOS women carrying a male fetus, metformin exhibited an androgen-lowering effect.
Highlights
Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder
Metformin had no effect on maternal androgens in polycystic ovary syndrome (PCOS) pregnancies
In both the first and second trimester of pregnancy, and compared with healthy control mothers, serum A4, T, and free testosterone index (FTI) were higher in mothers with PCOS regardless of placebo or metformin treatment
Summary
Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder. When using Rotterdam criteria, it effects up to 15% of women in reproductive age [1,2,3]. An insulin-lowering drug, for women with PCOS increased when it became evident that insulin resistance plays an important role in the pathophysiology of the disorder [9]. There are, only a few published studies on androgen levels throughout PCOS pregnancies and the effects of metformin treatment during pregnancy, and none reach randomized controlled trial rigor [11, 12]. Maternal hyperandrogenism in PCOS gestations may breach a compromised placenta and affect the developing offspring. PCOS placentae exhibit structural and molecular dysfunction [14, 15], including increased signal transducers and activators of transcription 3 phosphorylation, indicating that specific metabolic pathways are activated by maternal gestational hyperandrogenism [16]. The aims of our study were [1] to describe androgen patterns during pregnancy in women with PCOS and relate them to androgen levels during pregnancy in healthy control women, [2] to explore whether metformin alters androgen levels during pregnancy in women with PCOS, and [3] to ascertain whether PCOS maternal androgen levels differ according to body mass index (BMI) category and sex of the fetus
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: The Journal of Clinical Endocrinology & Metabolism
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
