Metformin during pregnancy reduces insulin, insulin resistance, insulin secretion, weight, testosterone and development of gestational diabetes: prospective longitudinal assessment of women with polycystic ovary syndrome from preconception throughout pregnancy
Metformin during pregnancy reduces insulin, insulin resistance, insulin secretion, weight, testosterone and development of gestational diabetes: prospective longitudinal assessment of women with polycystic ovary syndrome from preconception throughout pregnancy
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DOI：
10.1093/humrep/deh109
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发表时间：
2004-03-01
影响因子：
6.1
通讯作者：
Sherman, A
中科院分区：
文献类型：
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作者：
Glueck, CJ;Goldenberg, N;Sherman, A
背景资料：在一项前瞻性观察性研究中，我们对39例白人多囊卵巢综合征（PCOS）女性（年龄30 ± 4岁）的42例妊娠进行了研究，研究了二甲双胍对母体胰岛素、胰岛素抵抗（IR）、胰岛素分泌（IS）、体重增加、妊娠期糖尿病（GD）发生、睾酮和纤溶酶原激活物抑制剂活性的影响。我们评估了以下假设：饮食-二甲双胍（MET）减少了IR的生理性妊娠增加，减少了妊娠期体重增加，从而减少了GD。方法：孕前，在门诊临床研究中心，MET 1.5（8例妊娠）至2.55 g/天（34例妊娠）开始。体重指数为0.05的女性），并在孕晚期上升了10%。在最后一次孕前访视时，MET的HOMA IR降低的中位百分比为46%;在妊娠早期、中期或晚期，IR没有增加（P>0.05）。HOMA胰岛素分泌在最后一次孕前访视时下降了45%，在前三个月没有增加，在第二个三个月上升了24%，在第三个三个月上升了109%。在最后一次孕前访视时，MET的睾酮下降了30%（P=0.01），然后在妊娠1、2和3期分别上升了74%、61%和95%;妊娠晚期的睾酮中位数与治疗前水平没有差异。结论：通过降低孕前体重、胰岛素、IR、胰岛素分泌和睾酮，并通过在整个妊娠期间维持这些胰岛素增敏作用，MET饮食降低了发生GD的可能性，并防止胎儿雄激素过多。
Background: In a prospective observational study of 42 pregnancies in 39 Caucasian women (age 30+/-4 years) with polycystic ovary syndrome (PCOS), we examined effects of metformin on maternal insulin, insulin resistance (IR), insulin secretion (IS), weight gain, development of gestational diabetes (GD), testosterone and plasminogen activator inhibitor activity. We assessed the hypothesis that diet-metformin (MET) lessens the physiological gestational increase in IR and reduces gestational weight gain, thus reducing GD. Methods: Preconception, in an out-patient clinical research centre, MET 1.5 (eight pregnancies) to 2.55 g/day (34 pregnancies) was started. Women with body mass index 0.05), and rose 10% in the third trimester. The median percentage reduction in HOMA IR was 46% on MET at the last preconception visit; IR did not increase (P>0.05) in the first, second or third trimesters. HOMA insulin secretion fell 45% on MET at the last preconception visit, did not increase in the first trimester, rose 24% in the second trimester, and rose 109% in the third trimester. Testosterone fell 30% on MET at the last preconception visit (P=0.01) and then rose 74, 61 and 95% during trimesters 1, 2 and 3; median testosterone during the third trimester did not differ from pre-treatment levels. Conclusions: By reducing preconception weight, insulin, IR, insulin secretion and testosterone, and by maintaining these insulin-sensitizing effects throughout pregnancy, MET-diet reduces the likelihood of developing GD, and prevents androgen excess for the fetus.