Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. PCOS produces symptoms in approximately 5 to 10% of women of reproductive age (12โ45 years old) and is thought to be one of the leading causes of the female subfertility. PCOS is a medical condition, in which there is an imbalance of the female sex hormones i.e. elevated levels of testosterone, DHEA-S, androstenedione, prolactin, and LH along with a normal, high or low estrogen levels. According to the Rotterdam criteria, a diagnosis of PCOS can be made in a woman if she has 2 of the following 3 manifestations: Irregular or absent ovulation, elevated levels of androgenic hormones, and/or enlarged ovaries containing at least 12 follicles each. Other conditions with similar presenting signs, such as androgen-secreting tumors or Cushing’s syndrome, must be ruled out before a diagnosis of PCOS is established. Controversies in continuation of metformin therapy throughout pregnancy, in women who have conceived after treatment of PCOS, has remained a controversial topic till date. This literature gives an insight into the problem.
Hyperinsulinaemia, insulin resistance and impaired glucose tolerance are very common in women with PCOS, particularly in those with a body mass index (BMI) > 30, but insulin resistance may occur in lean women with PCOS. An insulin action in the ovary is mediated via the insulin receptor rather than the type 1 insulin-like growth factor (IGF) receptor, which binds IGF-I with high affinity and insulin with low affinity. Hyperinsulinaemia has shown to increase androgen production by the ovaries and hence it may play a central role in the pathogenesis of PCOS.
Use of metformin throughout pregnancy in women with polycystic ovary syndrome (PCOS) has shown to reduce the rates of early pregnancy loss, preterm labor, and prevention of fetal growth restriction. Metformin has been shown to have encouraging effects on several metabolic aspects of polycystic ovarian syndrome, such as insulin sensitivity, plasma glucose concentration and lipid profile and since women with PCOS are more likely than healthy women to suffer from pregnancy-related problems like early pregnancy loss, gestational diabetes mellitus and hypertensive states in pregnancy, the use of metformin therapy in these patients throughout pregnancy may have beneficial effects on early pregnancy loss and development of gestational diabetes.
54 responses to “Effects of metformin use in pregnant patients with polycystic ovary syndrome”
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