Impact of Polycystic Ovary Syndrome on Pregnancy

Understanding Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) affects 5 to 10% of women and is a leading cause of infertility in the United States. This condition is marked by mild obesity, irregular menstrual cycles, and elevated androgen levels in the bloodstream. Women diagnosed with PCOS face increased risks of pregnancy complications, including gestational diabetes, preterm delivery, and preeclampsia.

Role of Metformin in Managing PCOS

Metformin, a first-line medication for type 2 diabetes, is commonly prescribed to assist women with PCOS in achieving pregnancy. It aids in normalizing menstrual cycles and has shown potential in preventing pregnancy complications associated with the condition.

Clinical Trial on Metformin and Pregnancy Outcomes

Study Design and Methodology

Researchers from the Department of Clinical and Molecular Medicine at the Norwegian University of Science and Technology conducted a clinical trial to investigate whether metformin could prevent late miscarriage and preterm births in women with PCOS. The findings were published in The Lancet Diabetes and Endocrinology.

The study involved 487 pregnant women diagnosed with PCOS, recruited from 14 hospitals across Norway, Sweden, and Iceland. Participants were randomly assigned to receive either metformin (500 mg twice daily for the first week, followed by 1000 mg twice daily until delivery) or a placebo. The study maintained a double-blind design, ensuring that neither the participants nor the investigators knew who received the treatment.

Primary and Secondary Outcomes

The primary outcome of the study focused on the rates of late miscarriage and preterm birth. Secondary outcomes included the incidence of gestational diabetes, preeclampsia, pregnancy-induced hypertension, and neonatal intensive care unit admissions.

Key Findings of the Study

Effectiveness of Metformin

The results indicated that metformin may significantly reduce the risk of late miscarriage and preterm birth. Among the 238 women who received metformin, 12 experienced late miscarriage or preterm birth. In contrast, 23 of the 240 women in the placebo group faced similar outcomes.

The incidence of gestational diabetes remained unchanged between both groups, suggesting that metformin may not influence the risk of developing diabetes during pregnancy. Additionally, women in the metformin group experienced less weight gain compared to those in the placebo group, while the risk of preeclampsia did not show any significant difference.

Combining Study Results

While this study revealed reductions in the risk of late miscarriage and preterm birth, combining its results with previous studies conducted by the same research team showed statistically significant differences. The study’s strengths include its randomized controlled design, a larger participant pool, and high adherence to treatment protocols. However, a limitation is the predominance of Nordic white ethnicity among participants, which may restrict the generalizability of the findings.

Conclusion and Future Research

The combined results from this and earlier studies suggest that metformin appears effective in lowering the risk of late miscarriage and preterm delivery in women with PCOS. However, it may not impact the occurrence of gestational diabetes. Further research is necessary to confirm the efficacy of metformin for managing PCOS and its associated pregnancy complications.

References

Pinkerton JV. Merck Manual Professional Version. Polycystic Ovary Syndrome (PCOS). 2017.
Løvvik TS, Carlsen SM, Salvesen Ø, et al. Use of metformin to treat pregnant women with polycystic ovary syndrome (PregMet2): a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2019.
Written by Jessica Caporuscio, PharmD.