Continuing Metformin in Early Pregnancy Linked to Lower Miscarriage Risk in PCOS: Meta-Analysis
UK: A recent systematic review and meta-analysis published in the American Journal of Obstetrics & Gynecology has suggested that women with polycystic ovary syndrome (PCOS) may benefit from continuing metformin therapy during the early stages of pregnancy. The study, led by Dr. James Cheshire from Birmingham Women's and Children's NHS Foundation Trust in the UK, found that maintaining metformin use through the first trimester may improve pregnancy outcomes, particularly by reducing miscarriage risk.
The research team analyzed data from 12 randomized controlled trials involving a total of 1,708 women with PCOS. All included trials assessed the use of metformin initiated before conception and continued until at least a confirmed pregnancy, comparing outcomes against either placebo or no treatment.
The analysis revealed the following findings:
- Women who continued metformin through the first trimester had higher clinical pregnancy rates (OR 1.57).
- In this group, there was a trend toward fewer miscarriages (OR 0.64).
- A possible increase in live birth rates was also noted (OR 1.24), though not statistically conclusive.
- Women who stopped metformin after a confirmed pregnancy also showed higher clinical pregnancy rates (OR 1.35).
- However, this group had a potential increase in miscarriage risk (OR 1.46).
- Indirect comparisons favored continued metformin use over stopping it at pregnancy confirmation.
- Trends indicated a lower risk of miscarriage (OR 0.44) and better pregnancy outcomes when metformin was continued through the first trimester.
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