Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome
| Autor: | Charles J. Glueck, Luann Sieve-Smith, Ping Wang, Harvey Phillips, Suichi Kobayashi |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Adult
Blood Glucose Male medicine.medical_specialty endocrine system diseases medicine.medical_treatment Statistics Nonparametric Cohort Studies Diabetes Complications Islets of Langerhans Insulin resistance Pregnancy Diabetes mellitus Insulin Secretion medicine Diabetes Mellitus Humans Hypoglycemic Agents Insulin Prospective Studies Retrospective Studies Gynecology Obstetrics business.industry digestive oral and skin physiology Body Weight nutritional and metabolic diseases Obstetrics and Gynecology General Medicine medicine.disease Polycystic ovary Metformin Gestational diabetes Diabetes Gestational Reproductive Medicine Gestation Female Insulin Resistance Live birth business medicine.drug Polycystic Ovary Syndrome |
| Zdroj: | Fertility and sterility. 77(3) |
| ISSN: | 0015-0282 |
| Popis: | Women with polycystic ovary syndrome (PCOS) characteristically are obese and have insulin resistance and hyperinsulinemia-all risk factors for gestational diabetes. Conversely women who develop gestational diabetes are likely to have polycystic ovaries. The investigators evaluated treatment with metformin, a safe and effective insulin-sensitizing drug, in forestalling the development of gestational diabetes in 72 women with established PCOS. All were nondiabetic before their pregnancies and had had at least one live birth. Thirty-three women conceived while taking metformin in a dose of 2.55 gm daily, and were studied prospectively. All but five of these women took the drug throughout pregnancy, and there were 34 live births. The remaining 39 women with PCOS were studied retrospectively. They had a total of 64 live births, for 60 of which information on gestational diabetes was available. Women in the prospective group were placed on a high-protein, low-carbohydrate diet with 30% calories as fat. Women were screened for gestational diabetes with a 100-gm glucose challenge at 26 to 28 weeks' gestation. Both groups of women were insulin-resistant with high fasting insulin levels and had elevated insulin secretion. Only one woman in the prospective series (3% of pregnancies) developed gestational diabetes, contrasting with 67% of their previous pregnancies in the absence of metformin therapy. Gestational diabetes developed in 23% of pregnancies in the retrospective group. The overall incidence in all live births without metformin therapy was 31%. The odds ratio of gestational diabetes in pregnancies of metformin-treated women compared to those not receiving metformin was 0.115 (95% CI, 0.014-0.938). Women taking metformin throughout their pregnancies had decreases in body weight and body mass index. At the same time, insulin levels and insulin resistance both declined and did not change significantly during the rest of pregnancy. No woman taking metformin developed lactic acidosis. Intermittent diarrhea or gastritis was common in the first 3 weeks of treatment, but subsequently resolved spontaneously. None of 34 live-born infants were hypoglycemic or had major malformations. A substantial reduction in risk of gestational diabetes is observed when women with PCOS take metformin throughout pregnancy. The drop in insulin resistance and insulin secretion decreases the secretory demands placed on the pancreatic beta cells. |
| Databáze: | OpenAIRE |
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