Homocysteine and some related micronutrients status in polycystic ovary patients treated with metformin

ABSTRACT

Polycystic ovary syndrome [PCOS] is characterized by anovulation, infertility and hyper and rogenism. The condition affects about 5-10% of women in the reproductive age group. Metformin, a well known drug used in the treatment in type 2 diabetes, has been proved to be effective in the management of anovulation and hirsutism and is now a widely accepted therapy for PCOS. Metformin is known to reduce vitamin B12 absorption, decrease serum folic acid inducing elevation in serum homocysteine. Homocysteine is a major risk factor for cardiovascular complications and, thrombosis. Pre-eclampcia is associated with hyperhomocysteinemia and disturbed blood levels of zinc and copper. Neural tube defect has been closely related to maternal folic acid deficiency. In addition, maternal zinc deficiency is recorded to affect fetus brain development. Other maternal and fetal complications may develop as a result to the induced hyper-homocysteinemia, low folic acid and vitamin B12 and other related micronutrients disturbance. The aim of this study is to evaluate the serum level of homocysteine, vitamin B12, folic acid and some related micronutrients in polycystic ovary syndrome [PCOS] patients receiving metformin for a year. This is a retrospective comparative study. 60 patients were included in this study divided into 2 main groups Group [1] included 40 patients with confirmed diagnoses of PCOS receiving metformin tablets 850 mg three times daily for a year. Group [2] included 20 patients confirmed to have PCOS not receiving metformin. Patients were selected from the outpatient gynecology clinic of Ain Shams University Hospital. Serum homocysteine was significantly increased in patients receiving metformin compared to those not receiving metformin, [p=0.001]. Folic acid and calcium showed relative decrease in patients receiving metformin [p> 0.05]. Vitamin B12, zinc, calcium and magnesium serum levels showed significant decreases, [p=0.001, 0.045, 0.001 and 0.001 respectively]. Phosphorus showed raise in serum level among the group receiving metformin [p=0.003]. Metformin although proved to have positive effect in reducing body hair and help to regulate the menstrual cycle increasing the possibility for pregnancy. Our study recorded increase in serum homocysteine, decrease in vitamin B12, folic acid, zinc, magnesium, calcium and copper. Multiple health hazards are facing those patients and their expected babies. Supplementation and enhancing diet rich in Vitamin B12, folic acid, calcium, zinc and magnesium is highly recommended. A diet restricted in caloric intake to help weight loss and rich in vegetables, fruits, milk and meat is recommended. Close medical assessment and follow up is m and atory to guard against possible risk hazard both for mother and fetus