Pregnancy outcomes and the effect of metformin treatment in women with polycystic ovary syndrome: an overview

Abstract

This article is a review of the literature assessing pregnancy outcomes and the effect of metformin treatment among women with polycystic ovary syndrome (PCOS). A review of research published in English was undertaken using PubMed and MEDLINE databases. The weight of the available evidence suggests that pregnant women with PCOS are at an increased risk of developing gestational diabetes, hypertensive disorders of pregnancy, preterm birth and early pregnancy loss. Obesity is a contributory factor for the increased risk of gestational diabetes in this group of women and is estimated to affect 5-40% of pregnant women with PCOS. The prevalence of other obstetric complications is estimated at 10-30% for gestational hypertension, 8-15% for pre-eclampsia and 6-15% for preterm birth. The association between PCOS and early pregnancy loss may not be direct, wherein the presence of PCOS-associated hyperinsulinemia, leading to hyperandrogenemia, has been implicated in the pathophysiology of early pregnancy loss. Apart from the role of metformin in improving the metabolic consequences accompanying PCOS, it has been shown to improve pregnancy rates in women with PCOS who are resistant to clomiphene citrate. In conclusion, pregnancy in women with PCOS is associated with adverse obstetric outcomes (multiple adverse obstetric risk). Whether metformin should be administered throughout pregnancy still remains controversial. Further prospective studies that foster a larger number of participants and adjust for all potentially confounding factors are needed.

Gestational diabetes mellitus among Norwegian women with polycystic ovary syndrome: prevalence and risk factors according to the WHO and the modified IADPSG criteria

“…According to the Rotterdam criteria, PCOS diagnosis requires the presence of at least two of the three criteria (12). Women with PCOS are at an increased risk of developing GDM (13,14,15,16,17). Women with both PCOS and GDM have a higher risk of developing pregnancyinduced hypertension and preeclampsia and of delivering preterm than those with GDM only (18).…”

PCOS and Pregnancy: Impact of Endocrine and Metabolic Factors

“…However, PCOS by itself is not an independent risk factor because these patients have more assisted reproductive technologies, more chance of multiple pregnancies, and pregnancy-induced hypertension contributing to more preterm deliveries [ 17 ]. A high frequency of cervical insuffi ciency was found in PCOS, with a prevalence in the range of 3 % and incidence rate of 18 per 1,000 births, particularly in South Asian and Black women [ 14 ].…”

Menstrual preconditioning for the prevention of major obstetrical syndromes in polycystic ovary syndrome

“…A metaanalysis of pregnancy outcomes in women with PCOS demonstrated a significantly higher risk of developing gestational diabetes, pregnancy-induced hypertension, pre-eclampsia and preterm birth ( Table 1) [8]. An exhaustive review of the literature assessing pregnancy outcomes and the effect of metformin treatment among women with PCOS by Ghazeeri et al [9] concluded that the weight of available evidence suggests that pregnant women with PCOS are at increased risk of developing preterm birth and hypertensive disorders of pregnancy with a prevalence of respectively 6-15% for preterm birth, 10-30% for gestational hypertension, 8-15% for pre-eclampsia. The authors concluded that metformin has proven to be effective in improving ovulation and pregnancy rates among patients receiving fertility-enhancing agents, supporting its use among anovulatory women with PCOS.…”