Vol.13, No 3, 2006 pp. 172 - 176
UC 618.3:618.11-006
PREGNANCY OUTCOMES AMONG INFERTILE PATIENTS
WITH POLYCYSTIC OVARY SYNDROME TREATED WITH
METFORMIN
Mileva Milosavljević, Milan Stefanović, Ranko Kutlešić, Predrag
Vukomanović, Aleksandra Andrić
Faculty of Medicine, Department of Obstetrics and Gynecology, Clinical
Center Niš, Serbia
Summary. The Polycystic Ovary Syndrome (PSOS) is the commonest cause
of anovulatory infertility. Matformin is effective in the treatment of
PCOS- related anovulation. Metformin is an oral biguanide, well established
for the treatment of hyperglycemia. Preliminary evidence indicates that
metformin may also be effective in decreasing the risk of early spontaneous
abortion in women with PCOS. The aim of the study was to determine whether
metformin would safely reduce the rate of first trimester spontaneous abortion
in this women and increase the number of live birth without teratogenicity.
We assessed 3 oligo-amenorrheic non-diabetic women with PCOS and previously
early spontaneous abortion who conceived while taking metformin and continued
it throughout pregnancy. They were prospectively assessed. Outcome measures
included first trimester spontaneous abortion, normal ongoing pregnancies
?13 weeks, live birth, birthweight and height. Results: 3 women had 3 healthy
neonatuses. Conclusion: While safety during pregnancy has not been established,
three women who conceived on and continued metformin through pregnancy
have delivered normal babies. This study found that the abortion was reduced
when metformin was used for ovulation induction before pregnancy (1 woman)
and continued throughout the pregnancy (2 women): 3 month (1 woman) and
during entire pregnancy (1 woman). Our data showed a decreases risk of
first trimester spontaneous abortion compared with previous pregnancies
in the same women not on metformin. Pregnancy outcomes did not differ in
women who stopped metformin after conception and at the end of the first
or third trimester pregnancy. Newborn outcomes were good in all three women,
with normal growth and Apgar Score. The study found no evidence of any
adverse clinical effects on the mother or the newborn when metformin is
continued through first trimester and entire pregnancy. Our cases highlights
the importance of PCOS diagnosis in the management women with previously
first trimester spontaneous abortion.
Key words: PCOS, early spontneous
abortion, metformin, pregnancy outcome
ISHOD TRUDNOĆE KOD INFERTILNIH PACIJENTKINJA
SA SINDROMOM POLICISTIČNIH OVARIJUMA LEČENIH METFORMINOM
Kratak sadržaj: Sindrom policisticnih ovarijuma je čest uzrok anovulatornog
infertiliteta. Metformin je efikasan u tretmanu anovulacije povezane sa
sindromom policističnih ovarijuma. Metformin je oralni bigvanid, dobro
afirmisan u tretmanu hiperglikemije. Preliminarni podaci indiciraju da
metformin može biti takodje efikasan i u sniženju rizika od ranih spontanih
pobačaja kod žena sa sindromom policističnih ovarijuma. Cilj studije bio
je da proceni da li metformin može sigurno da redukuje stopu
pobačaja u prvom tromesečju trudnoće u ovih žena i da poveća broj
živo rođenih bez anomalija. Tri oligo-amenoroične nedijabetične žene sa
sindromom policističnih ovarijuma i prethodnim ranim spontanim pobačajima
začele su na metforminu i nastavile su da ga koriste tokom trudnoće. Praćene
su prospektivno. Procena ishoda uključivala je spontane abortuse u prvom
tromesečju, normalne trudnoće u toku starije od 13 nedelja, živo rodjene,
težinu i dužinu na rođenju. Tri žene rodile su tri zdrava neonatusa.
Iako sigurnost metformina za vreme trudnoće još nije dobro ispitana, tri
žene koje su začele na metforminu i nastavile da ga koriste tokom trudnoće
rodile su zdrave bebe. Ova studija je našla da do redukcije stope
pobačaja dolazi kada se metformin koristi za indukciju ovulacije pre trudnoće
i nastavlja tokom trudnoće (3 meseca, ili tokom cele trudnoće). Naši podaci
ukazuju na sniženje rizika od spontanih pobačaja u prvom tromesecju trudnoće,
u komparaciji sa prethodnim trudnoćama u istih žena, kada nisu bile na
terapiji metforminom. Ishod trudnoće nije se razlikovao kod žene koja je
stopirala metformin nakon ovulacije, na kraju prvog, ili trećeg tromesečja
trudnoće. Studija nije našla dokaze za nepovoljne kliničke efekte
na majku ili fetus kada je metformin nastavljen tokom prvog tromesečja
ili čitave trudnoće. Naši slučajevi ukazuju na značaj
PCOS dijagnoze u vodjenju žena sa prethodnim spontanim pobačajima u prvom
tromesečju trudnoće.
Ključne reči: sindrom policističnih
ovarijuma, rani spontani pobačaji, metformin, ishod trudnoće
