Results of small study: metformin betters pregnancy outcomes in PCOS.(Obstetrics)

MONTREAL -- Despite ongoing debate about the safety of metformin use during pregnancy, patients with polycystic ovarian syndrome do better with the therapy than without it, Dr. Sonia Malik said at the 18th World Congress on Fertility and Sterility.

"Metformin lowered bleeding and pregnancy loss in my PCOS patients, even if it was given for a short time," said Dr. Malik, an ob.gyn. at Holy Angels Hospital in Vasant Vihar, New Delhi.

Dr. Malik stated that concerns have been raised about metformin's safety during pregnancy because there are no randomized controlled trials to support its use.

A recent Australian review by Dr. R.J. Norman and associates suggests that "the use of metformin in early pregnancy for reducing the risk of miscarriage should be avoided outside of the context of properly designed prospective randomized trials" (Curr. Opin. Obstet. Gynecol. 16[3]:245-50, 2004). The article also states that "there is some reason for use of metformin in midpregnancy for gestational diabetes but better evidence from randomized controlled trials is urgently needed."

In the absence of randomized controlled trials, however, Dr. Malik said that metformin, an insulin sensitizer, has proven benefits. In her retrospective study, which she presented at the meeting, she found that even 3 months of metformin treatment in pregnant patients with PCOS significantly reduced bleeding and pregnancy loss.

Her study included 30 pregnant patients with PCOS who returned to her hospital after spontaneously conceiving a second child. In all cases, the first pregnancy was achieved with metformin therapy, which was continued throughout the pregnancy.

Ten of the patients took 500 mg of metformin three times a day for the first 3 months of their second pregnancy (either because they had started the therapy on their own when they discovered they were pregnant, or because they were prescribed the therapy because of a high risk of spontaneous abortion), while the remaining 20 patients did not take metformin.