Pregnancy outcomes among women with polycystic ovary syndrome treated with metformin
Pregnancy outcomes among women with polycystic ovary syndrome treated with metformin
复制标题
DOI：
10.1093/humrep/17.11.2858
复制
发表时间：
2002-11-01
影响因子：
6.1
通讯作者：
Sieve-Smith, L
中科院分区：
文献类型：
--
作者：
Glueck, CJ;Wang, P;Sieve-Smith, L
背景：二甲双胍曾帮助 72 名患有多囊卵巢综合征 (PCOS) 的少闭经女性受孕，我们试图确定二甲双胍是否能安全地降低妊娠早期自然流产 (SAB) 率并增加活产数量，且不会产生致畸性。方法：72 名患有 PCOS 的少闭经女性服用二甲双胍（2.55 克/天）受孕。他们在门诊临床研究中心进行了前瞻性评估。结果指标包括妊娠早期 SAB 数、活产数、大于或等于 13 周的正常持续妊娠、妊娠糖尿病 (GD)、先天性缺陷 (CD)、出生体重和身高，以及生命前 6 个月的体重、身高、运动和社会发育。结果：迄今为止，在 84 名胎儿中，有 63 名正常活产，无 CD（75%），14 名妊娠早期 SAB（17%），7 名持续妊娠大于或等于 13 周，超声检查正常，无 CD（8%）。此前，在没有服用二甲双胍的情况下，72 名妇女中有 40 名怀孕了 100 次（100 个胎儿），其中 34 名（34%）活产，62 名（62%）早孕期 SAB。在这 40 名妇女（46 次妊娠，47 名胎儿）中，目前服用二甲双胍的妊娠中，有 33 名活产婴儿 (70%)，2 名妊娠持续时间大于或等于 13 周 (4%)，12 名 SAB (26%) (P < 0.0001)。没有产妇乳酸性酸中毒，也没有产妇或新生儿低血糖。空腹血清胰岛素是妊娠早期总 SAB（之前和当前）的一个显着解释变量，比值比 1.32（胰岛素每升高 5 μU/ml），95% CI 1.09-1.60（P = 0.005）。服用二甲双胍的妊娠中，有 4% 的妊娠出现 GD，而之前未服用二甲双胍的妊娠中，这一比例为 26%，P = 0.025。 63 例活产儿中均未发现严重 CD，7 名 ≤ 13 周的胎儿超声检查未发现 CD。在 63 名活产婴儿中，体重和身高均与正常新生儿群体没有差异。 6 个月随访时，身高较高（P = 0.008），体重与正常儿童人群没有差异；运动和社会发育正常。结论：PCOS 女性妊娠期间二甲双胍治疗与 SAB 和 GD 降低安全相关，不会导致畸胎，并且不会对出生体重或身高，或出生后 3 个月和 6 个月时的身高、体重、运动和社会性发育产生不利影响。
BACKGROUND: We sought to determine whether metformin, which had facilitated conception in 72 oligoamenorrhoeic women with polycystic ovary syndrome (PCOS), would safely reduce the rate of first trimester spontaneous abortion (SAB) and increase the number of live births without teratogenicity. METHODS: Seventy-two oligoamenorrheic women with PCOS conceived on metformin (2.55 g/day). They were prospectively assessed in an outpatient clinical research centre. Outcome measures included number of first trimester SAB, live births, normal ongoing pregnancies greater than or equal to13 weeks, gestational diabetes (GD), congenital defects (CD), birthweight and height, as well as weight, height, and motor and social development during the first 6 months of life. RESULTS: Of the 84 fetuses, to date there have been 63 normal live births without CD (75%), 14 first trimester SAB (17%), and seven ongoing pregnancies greater than or equal to13 weeks with normal sonograms without CD (8%). Previously, without metformin, 40 of the 72 women had 100 pregnancies (100 fetuses) with 34 (34%) live births and 62 (62%) first trimester SAB. In current pregnancies on metformin in these 40 women (46 pregnancies, 47 fetuses), there have been 33 live births (70%), two pregnancies ongoing greater than or equal to13 weeks (4%), and 12 SAB (26%) (P < 0.0001). There was no maternal lactic acidosis, and no maternal or neonatal hypoglycaemia. Fasting entry serum insulin was a significant explanatory variable for total (previous and current) first trimester SAB, odds ratio 1.32 (for each 5 μU/ml rise in insulin), 95% CI 1.09-1.60 (P = 0.005). On metformin, GD developed in 4% of pregnancies versus 26% of previous pregnancies without metformin, P = 0.025. There have been no major CD in the 63 live births or CD by sonography in the seven fetuses ≤13 weeks. In the 63 live births, neither weight nor height differed from the normal neonatal population. At 6 month follow-up, height was greater (P = 0.008) and weight did not differ from the normal paediatric population; motor and social development were normal. CONCLUSIONS: Metformin therapy during pregnancy in women with PCOS was safely associated with reduction in SAB and in GD, was not teratogenic, and did not adversely affect birthweight or height, or height, weight, and motor and social development at 3 and 6 months of life.