Metformin for prevention of hypertensive disorders of pregnancy in women with gestational diabetes or obesity: systematic review and meta‐analysis of randomized trials

Abstract

There is a high probability that metformin use is associated with reduced HDP incidence when compared with other treatments or placebo. The small number of studies included in the analysis, the low quality of evidence and the clinical heterogeneity preclude generalization of these results to broader populations. Given the clinical importance of this topic and the magnitude of effect observed in this meta-analysis, further prospective trials are urgently needed. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Pre-eclampsia: pathogenesis, novel diagnostics and therapies

“…Placental hypoxia is central to the pathogenesis of pre-eclampsia, and ouabain, a digoxinlike molecule that inhibits HIF1 and HIF2, was shown to block sFLT1 production and reduce hypertension in rats with placental ischaemia 197 . Use of metformin (an insulin sensitizer that is approved for use in type 2 diabetes mellitus) during pregnancy is associated with a reduced incidence of pre-eclampsia 198 . Metformin has been shown to reduce the production of antiangiogenic factors in vitro 199 ; however, prospective clinical trial data for metformin use in preventing pre-eclampsia are lacking.…”

The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre‐eclampsia: A pragmatic guide for first‐trimester screening and prevention

“…These include frequent clinic blood pressure and/or home blood pressure monitoring to ensure early diagnosis of PE. The purported benefit of other treatments, such as heparin, vitamins C and E, magnesium, folate, metformin, and statin for prophylaxis of preterm PE is not yet based on credible evidence and their use solely for the purpose of preventing preterm PE in pregnancy is neither justified nor recommended …”

Metformin in Health Issues and Reproductive System

“…From another aspect, metformin decreases the frequency of preeclampsia, by reduction in the production of anti-angiogenic factors (soluble vascular endothelial growth factor receptor-1 and soluble endoglin) and the modification in endothelial dysfunction [34].…”