Effect of metformin on miscarriage in pregnant patients with polycystic ovary syndrome / Efecto de la metmorfina sobre los abortos espontáneos de pacientes embarazadas que presentan el síndrome de ovario poliquístico

BACKGROUND: This study was performed with the aim of evaluating the effect of metformin in reducing miscarriage when continued until the end of the first trimester of pregnancy in patients with polycystic ovary syndrome (pCOS) and infertility. SUBJECTS AND METHOD: From January 2004 to December 2005, a total of 75 pregnant women with PCOS were studied in three different groups. In Group A, metformin administration (500 mg three times daily (TDS)) was stopped immediately after diagnosis of pregnancy (5-6 weeks gestation), in Group B, metformin was administered until the end of 8 weeks gestation and in Group C until the end of 12 weeks gestation. The results of this study were then assessed using chi-square McNemar's, ANOVA Kruskal Wallis and logistic regression tests. RESULTS: There was a significant statistical difference between previous and current miscarriage in the current pregnancy with a decline in Group B from 40% to 8% and in group C from 32% to 4%. In spite of the reduced rate of miscarriage seen in Group A, from 20% to 4%, this difference was not statistically significant. Fetal anomalies were absent in all three groups. CONCLUSION: According to the current findings, it seems that continuing metformin during the first trimester of pregnancy has beneficial effects in patients with PCOS.

ANTECEDENTES: Este estudio fue realizado con el propósito de evaluar el efecto de la metmorfina en la reducción de abortos espontáneos cuando se la continúa hasta el final del primer trimestre de embarazo, en pacientes con síndrome de ovario poliquístico (SOPQ) e infertilidad. SUJETOS Y MÉTODO: De enero 2004 a diciembre 2005, fueron estudiadas en tres grupos diferentes, un total de 75 mujeres embarazadas que presentaban SOPQ. En el grupo A, la administración de metmorfina (TDS) 500 mg tres veces al día se detuvo inmediatamente después del diagnóstico del embarazo (5 - 6 semanas de gestación); en el grupo B, se administró la metmorfina hasta el final de las 8 semanas de gestación, y en el grupo C hasta el final de las 12 semanas de gestación. Los resultados de esta estudio fueron entonces evaluados usando chi-cuadrado McNemar's, ANOVA Kruskal Wallis y teste de regresión logística. RESULTADOS: Hubo una diferencia estadística significativa entre los abortos espontáneos previos y los corrientes en los embarazos corrientes, con una disminución del 40% al 8% en el grupo B, y del 32% al 4% en el Grupo C. A pesar de la reducción de la tasa de abortos espontáneos observada en el grupo A, del 20% al 4%, la diferencia no fue estadísticamente significativa. Las anomalías fetales estuvieron ausentes en los tres grupos. CONCLUSIÓN: De acuerdo con los hallazgos actuales, parece que la continuación de la metmorfina durante el primer trimestre del embarazo, tiene efectos beneficiosos en los pacientes con SOPQ.

Effect of metformin on miscarriage in pregnant patients with polycystic ovary syndrome.

BACKGROUND: This study was performed with the aim of evaluating the effect of metformin in reducing miscarriage when continued until the end of the first trimester of pregnancy in patients with polycystic ovary syndrome (PCOS) and infertility. SUBJECTS AND METHOD: From January 2004 to December 2005, a total of 75 pregnant women with PCOS were studied in three different groups. In Group A, metformin administration (500 mg three times daily (TDS)) was stopped immediately after diagnosis of pregnancy (5-6 weeks gestation), in Group B, metformin was administered until the end of 8 weeks gestation and in Group C until the end of 12 weeks gestation. The results of this study were then assessed using chi-square McNemar's, ANOVA Kruskal Wallis and logistic regression tests. RESULTS: There was a significant statistical difference between previous and current miscarriage in the current pregnancy with a decline in Group B from 40% to 8% and in group C from 32% to 4%. In spite of the reduced rate of miscarriage seen in Group A, from 20% to 4%, this difference was not statistically significant. Fetal anomalies were absent in all three groups. CONCLUSION: According to the current findings, it seems that continuing metformin during the first trimester of pregnancy has beneficial effects in patients with PCOS.

Efficacy of combined metformin-letrozole in comparison with metformin-clomiphene citrate in clomiphene-resistant infertile women with polycystic ovarian disease.

BACKGROUND: Adding metformin to clomiphene citrate in clomiphene-resistant polycystic ovary syndrome (PCOS) patients increases ovulatory response. However, because of anti-estrogenic effects of clomiphene it may be associated with lower pregnancy rate, offsetting the ovulation rate benefit. Letrozole is an aromatase inhibitor which induces ovulation without anti-estrogenic effects. METHODS: Infertile women with PCOS were randomly divided into metformin-letrozole (29 patients) and metformin-clomiphene groups (30 patients). After an initial 6-8 weeks of metformin, they received either letrozole (2.5 mg) or clomiphene (100 mg) from day 3-7 of their menstrual cycle. Estradiol (E2) levels, number of follicles, pregnancy rates and endometrial thickness were measured on the day of HCG administration. RESULTS: Mean total E2 and E2 per mature follicle were significantly higher in clomiphene group without a difference in mean number of mature follicles >18 mm and ovulation rate. Endometrial thickness was significantly higher in letrozole group. The pregnancy rate in letrozole group (10 patients, 34.50%) as compared with clomiphene group (5 patients, 16.67%) did not show significant difference, whereas full-term pregnancies were higher in letrozole group [10 patients (34.50%) versus 3 patients (10%)]. CONCLUSION: In clomiphene-resistant PCOS patients, the combination of letrozole and metformin leads to higher full-term pregnancies.

Amniotic fluid lamellar body count and its sensitivity and specificity in evaluating of fetal lung maturity.

This prospective study was designed to perform lamellar body count of amniotic fluid to evaluate fetal lung maturity. Lamellar body counts of 80 amniotic fluid samples from 80 pregnant women (28-40 weeks of gestation) were evaluated. After delivery, each infant was evaluated for any evidence of respiratory distress syndrome. Standard clinical and radiographic criteria were used to diagnose respiratory distress syndrome, and the diagnosis was confirmed by reviewing newborn records. Twenty (25%) infants delivered within 24 hours of sample collection developed RDS. Lamellar body count more than 50,000/microl predicted pulmonary maturity. Seventeen out of 20 respiratory distress syndrome cases had been predicted correctly. The negative predictive value of lamellar body count>50,000/microl was 93% and positive predictive value was 48% and the sensitivity for prediction of RDS was 85% and specificity was 70%. Lamellar body count can be used as a favourable predictor of fetal lung maturity because it is quick, simple and universally available. Also it can be used as an extremely inexpensive, reliable screening test for evaluating fetal lung maturity.

A randomised placebo-controlled trial to determine the effect of vitamin E in treatment of primary dysmenorrhoea.

OBJECTIVE: To determine whether vitamin E is effective in the treatment of primary dysmenorrhoea. DESIGN: A randomised placebo-controlled trial. PARTICIPANTS: One hundred girls, aged 16-18 years old who suffered from primary dysmenorrhoea, among 1,000 students attending a public high school in Region 5 in the Greater Tehran Municipality. METHODS: Fifty girls were given 500 units of vitamin E (five tablets) per day, and 50 were given five placebo tablets per day. The treatment began two days before the beginning of menstruation and continued through the first three days of bleeding. The severity of pain before and after the treatment was studied. Treatment in both groups was carried out in two consecutive menstrual periods. RESULTS: The severity of pain in the two groups was reduced after treatment, but the reduction was greater in the group treated with vitamin E. These differences were maintained in the second month of therapy. CONCLUSION: Both placebo and vitamin E are effective in relieving symptoms due to primary dysmenorrhoea, but the effects of vitamin E are more marked.