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Continuation of metformin reduces early pregnancy loss in obese Pakistani women with polycystic ovarian syndrome.
Gynecol Obstet Invest 2010; 69(3):184-9GO

Abstract

BACKGROUND

Polycystic ovarian syndrome (PCOS) is the most common cause of anovulatory infertility worldwide. In addition to a poor conception rate, pregnancy loss rates are significantly higher (30-50%) during the first trimester in women with PCOS. Insulin resistance (IR) in this syndrome is not only implicated toward early pregnancy loss (EPL) but also pathognomic for various obstetrical complications during pregnancy. We evaluated the role of Metformin in the reduction of EPL in women with PCOS who conceived spontaneously or after induction ovulation with or without Metformin.

OBJECTIVE

The primary objective was to evaluate the effectiveness of Metformin in the reduction of EPL in women with PCOS. Secondary outcomes like gestational diabetes, pregnancy-induced hypertension and intrauterine growth restriction were also analyzed at the end of the study.

MATERIAL AND METHODS

This case-control study was conducted from March 2005 to March 2008 in the infertility and antenatal clinics of the Department of Obstetrics and Gynecology of Aga Khan University Hospital, Karachi, Pakistan. A total of 197 infertile women with PCOS were included. 'Cases' were women with PCOS who conceived while taking Metformin and it whom it was continued throughout pregnancy. 'Controls' were women in whom Metformin was either stopped in first trimester after confirmation of pregnancy (by serum betaHCG or by ultrasound) or they conceived spontaneously without the use of Metformin.

RESULTS

All 197 women in this study had a confirmed diagnosis of PCOS (Rotterdam criteria). These women were followed till the final outcome of pregnancy was achieved. Both groups were compared for risk of EPL. It was found that continuation of Metformin during pregnancy reduces EPL, i.e. 8.8 vs. 29.4% in cases and controls, respectively (p < 0.001). In the subset of women with a prior history of miscarriage, the pregnancy loss rate was 12.5% in the Metformin versus 49.4% in control group (p = 0.002).

CONCLUSION

Metformin continuation during pregnancy significantly reduces EPL in women with PCOS. IR may play a significant role in EPL.

Authors+Show Affiliations

Department Obstetrics and Gynecology, Aga Khan University Hospital, Karachi, Pakistan. fauzia.nawaz@aku.eduNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

20029224

Citation

Nawaz, Fauzia Haq, and Javed Rizvi. "Continuation of Metformin Reduces Early Pregnancy Loss in Obese Pakistani Women With Polycystic Ovarian Syndrome." Gynecologic and Obstetric Investigation, vol. 69, no. 3, 2010, pp. 184-9.
Nawaz FH, Rizvi J. Continuation of metformin reduces early pregnancy loss in obese Pakistani women with polycystic ovarian syndrome. Gynecol Obstet Invest. 2010;69(3):184-9.
Nawaz, F. H., & Rizvi, J. (2010). Continuation of metformin reduces early pregnancy loss in obese Pakistani women with polycystic ovarian syndrome. Gynecologic and Obstetric Investigation, 69(3), pp. 184-9. doi:10.1159/000268051.
Nawaz FH, Rizvi J. Continuation of Metformin Reduces Early Pregnancy Loss in Obese Pakistani Women With Polycystic Ovarian Syndrome. Gynecol Obstet Invest. 2010;69(3):184-9. PubMed PMID: 20029224.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Continuation of metformin reduces early pregnancy loss in obese Pakistani women with polycystic ovarian syndrome. AU - Nawaz,Fauzia Haq, AU - Rizvi,Javed, Y1 - 2009/12/21/ PY - 2009/01/08/received PY - 2009/06/22/accepted PY - 2009/12/24/entrez PY - 2009/12/24/pubmed PY - 2010/7/10/medline SP - 184 EP - 9 JF - Gynecologic and obstetric investigation JO - Gynecol. Obstet. Invest. VL - 69 IS - 3 N2 - BACKGROUND: Polycystic ovarian syndrome (PCOS) is the most common cause of anovulatory infertility worldwide. In addition to a poor conception rate, pregnancy loss rates are significantly higher (30-50%) during the first trimester in women with PCOS. Insulin resistance (IR) in this syndrome is not only implicated toward early pregnancy loss (EPL) but also pathognomic for various obstetrical complications during pregnancy. We evaluated the role of Metformin in the reduction of EPL in women with PCOS who conceived spontaneously or after induction ovulation with or without Metformin. OBJECTIVE: The primary objective was to evaluate the effectiveness of Metformin in the reduction of EPL in women with PCOS. Secondary outcomes like gestational diabetes, pregnancy-induced hypertension and intrauterine growth restriction were also analyzed at the end of the study. MATERIAL AND METHODS: This case-control study was conducted from March 2005 to March 2008 in the infertility and antenatal clinics of the Department of Obstetrics and Gynecology of Aga Khan University Hospital, Karachi, Pakistan. A total of 197 infertile women with PCOS were included. 'Cases' were women with PCOS who conceived while taking Metformin and it whom it was continued throughout pregnancy. 'Controls' were women in whom Metformin was either stopped in first trimester after confirmation of pregnancy (by serum betaHCG or by ultrasound) or they conceived spontaneously without the use of Metformin. RESULTS: All 197 women in this study had a confirmed diagnosis of PCOS (Rotterdam criteria). These women were followed till the final outcome of pregnancy was achieved. Both groups were compared for risk of EPL. It was found that continuation of Metformin during pregnancy reduces EPL, i.e. 8.8 vs. 29.4% in cases and controls, respectively (p < 0.001). In the subset of women with a prior history of miscarriage, the pregnancy loss rate was 12.5% in the Metformin versus 49.4% in control group (p = 0.002). CONCLUSION: Metformin continuation during pregnancy significantly reduces EPL in women with PCOS. IR may play a significant role in EPL. SN - 1423-002X UR - https://www.unboundmedicine.com/medline/citation/20029224/Continuation_of_metformin_reduces_early_pregnancy_loss_in_obese_Pakistani_women_with_polycystic_ovarian_syndrome_ L2 - https://www.karger.com?DOI=10.1159/000268051 DB - PRIME DP - Unbound Medicine ER -