Abstract
Objective: The purpose of this article is to review the literature assessing foetal and maternal pregnancy outcomes in women with PCOS who used metformin during pregnancy. Study Design: A literature search was conducted using MEDLINE, with analysis of 25 studies that recorded neonatal and maternal outcomes in women who used metformin during pregnancy. The outcomes assessed in this review include congenital deformities, miscarriages, preterm labour, gestational diabetes (GDM) and pregnancy induced hypertension (PIH). Results: We found that the use of metformin throughout pregnancy correlated with decreased rates of preterm labour, GDM and PIH. Conflicting evidence exists over whether metformin use during pregnancy reduced miscarriage rates. The use of metformin during pregnancy did not increase teratogenicity risks. Conclusion: The use of metformin throughout pregnancy is associated with decreased rates of preterm labour, GDM, and PIH. However, more randomised controls involving larger numbers of participants are required for more definitive results.
Highlights
Polycystic ovary syndrome (PCOS) is a condition diagnosed on the satisfaction of at least two of the following three criteria: 1) Oligoovulation or anovulation; 2) Clinical and/or biochemical evidence of hyperandrogenism; 3) Ultrasound findings of polycystic ovaries [1]
We found that the use of metformin throughout pregnancy correlated with decreased rates of preterm labour, Gestational Diabetes Mellitus (GDM) and pregnancy induced hypertension (PIH)
Our analysis revealed inconsistent evidence regarding the effects of continuing metformin throughout pregnancy on miscarriage rates
Summary
Polycystic ovary syndrome (PCOS) is a condition diagnosed on the satisfaction of at least two of the following three criteria: 1) Oligoovulation or anovulation; 2) Clinical and/or biochemical evidence of hyperandrogenism; 3) Ultrasound findings of polycystic ovaries [1]. The effects of PCOS on pregnancy remains controversial with some trials showing increased rates of early pregnancy loss (EPL) and foetal congenital abnormalities, with others showing no significance [3]. More recent studies have shown increased risks of pregnancy induced hypertension (PIH), preeclampsia, gestational diabetes (GDM), preterm labour and small for gestational age (SGA) infants in women with PCOS [4]. Insulin sensitising agents have been used to manage women with PCOS. Metformin decreases intestinal absorption of glucose, impairs hepatic gluconeogenesis and stimulates glucose uptake by muscle cells via the glucose transport (GLUT) system to improve peripheral sensitivity of insulin [5]. Metformin does not cause hypoglycaemia but common dose-dependent adverse effects include abdominal discomfort, diarrhoea, nausea, and in rare cases, lactic acidosis [6]
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