|
| Number | Population | Intervention | Comparison | Relevant outcomes |
|
| 22 | 313 singleton pregnancies in
women aged 18–45 years with PCOS (Rotterdam criteria). | Metformin (850 mg twice daily or 1000 mg twice daily), n = 153.
Age 29.5 ± 4.4, BMI 29.8 ± 7 | 160 PCOS.
Age 29.1 ± 4.3,
BMI 28.6 ± 7.3. | Second-trimester miscarriage, preterm delivery, preeclampsia, and gestational diabetes. |
|
| 25 | 360 nondiabetic PCOS patients (Egypt) (Rotterdam criteria) included were taking metformin for 3–6 months before they became pregnant. | 200 pregnant women continued on metformin at a dose of 1000–2000 mg daily throughout pregnancy.
Age 30.8 ± 2.2,
BMI 30.1 ± 1.5. | 160 women discontinued metformin use at the time of conception.
Age 31.5 ± 2.4,
BMI 29.6 ± 1.6. | Gestational diabetes, preeclampsia, and
caesarean section rate. |
|
| 26 | 274 pregnancies were randomly assigned to either metformin or placebo treatment.
Criteria were (1) PCOS diagnosed according to the Rotterdam criteria, (2) age 18–45 yr, (3) gestational age between 5 and 12 wk, and (4) a singleton viable fetus shown on ultrasonography. | The metformin (2000 mg daily) treatment in pregnant PCOS women (n = 135).
Age 29.6 ± 4.4,
BMI 29.5 ± 7.0. | Placebo in pregnant PCOS women (n = 138).
Age 29.2 ± 4.4,
BMI 28.5 ± 7.2. | Preeclampsia, preterm delivery, GDM
weight, blood pressure, heart rate, and mode and length of delivery. |
|
| 27 | 197 infertile obese Pakistani women with PCOS (Rotterdam 2003 consensus) | 119 (cases) were taking metformin 500 mg three times a day and continued throughout pregnancy.
70 conceived while on metformin only. 49 needed additional medications.
Age 29 ± 4.1, BMI 32 ± 4.6. |
In 78 cases, metformin was stopped in first trimester or they conceived without metformin.
21 conceived without medication, 13 conceived on metformin, and 44 required induction of ovulation and metformin.
Age 26 ± 5.3,
BMI 33.2 ± 5.2. | EPL (fetal loss before 12 weeks of gestation), gestational diabetes (GDM), and pregnancy induced hypertension (PIH), live births, intrauterine growth restriction (IUGR), and fetal anomalies. |
|
| 28 | 59 nondiabetic infertile PCOS (Rotterdam criteria) patients with clomiphene citrate (CC) resistance and insulin resistance were conceived while taking metformin and different ovulation-inducing agents. | 29 continued metformin throughout pregnancy.
1500 mg daily for BMI ≤29, 2000 mg daily for BMI 30–32 and 2500 mg daily for BMI >32.
Age 28.14 ± 2.92, BMI 28.21 ± 2.37. | 30 did not continue metformin throughout pregnancy.
Age 26.13 ± 3.62,
BMI 27.97 ± 2.49. | Abortion rate, development
of GDM, live birth rate, congenital anomaly,
macrosomia, and condition of newborn at birth. |
|
| 29 | 137 infertile Pakistani women with PCOS (2003 Rotterdam Consensus criteria). | 105 conceived while taking metformin.
Group A (4–16 weeks met); group B (to 32 weeks met); group C (to delivery).
Group A Group B Group C
Age 28 ± 3.6 29 ± 3.1 27 ± 4.2
BMI 29.6 ± 5.1 30 ± 2.6 29.3 ± 3.3. | 32 conceived without metformin
Age 30 ± 2.9,
BMI 31.2 ± 4.6. | PIH/preeclampsia; GDM; IUGR; miscarriage; preterm delivery; live birth; mean birth weight. |
|
| 30 | 40 pregnant women (Norway) with PCOS (revised 2003 consensus) and without known diabetes mellitus were included in the first trimester. | 22 took metformin 850 mg twice daily.
Age 28.3 ± 1.7, BMI 29.3 ± 3.6. | 18 with placebo.
Age 28.9 ± 2.5,
BMI 32.1 ± 3.1. | Fasting glucose, insulin levels, insulin resistance (HOMA-IR) and beta-cell function (HOMA-b) evaluated using the homeostasis assessment model and 2 h glucose levels during a standard 75 g OGTT, DM. |
|
| 31 | Nondiabetic women with PCOS (2003 European Society of Human Reproduction and Embryology—American Society for Reproductive Medicine diagnostic criteria) | Given 26% protein, 44% carbohydrate diets, without calorie restriction during pregnancy, metformin 2–2.55 g of metformin per day was taken in 120 pregnancies: 1700 mg/d in 6, 1500 mg in 39, 1000 mg/d in 6, and 750 mg/d in 1.
Age 30 ± 5, BMI 33.5 ± 7.9. | 47 women had at least one previous LB pregnancy
(n = 64) without metformin. | The primary outcome measure was development of GD. |
|
| 32 | 40 pregnant women with PCOS (Rotterdam ESHRE/ASRM sponsored
PCOS workshop group, 2004). | 18 women were randomized to metformin medication.
Age 28.9 ± 4.8, BMI 32.1 ± 6.1. | 22 were placebo.
Age 28.3 ± 3.7,
BMI 39.3 ± 8.0. | Androgen levels, pregnancy complications (preterm deliveries, preeclampsia/hypertension
GD, CS, and ARDS).
Infants (head circumference, birth-weight, birth-length, Apgar (5 min), and Apgar (10 min)). |
|
| 33 | 72 women from the midwestern USA who were referred to a 1-year study of efficacy and safety of metformin therapy in PCOS. | Conceived on metformin, 1.5–2.55 g/day.
BMI 33 ± 5.8. | Self as control | Gestational diabetes, number of first trimester SAB, live births, normal ongoing pregnancies ≥13 weeks, nature of intrauterine fetal development by sonography, congenital defects, infant birth weight and height, and height, weight, and motor and social development during the first 6 months of life. |
|
| 34 | 1990 National Institutes of Health criteria | 33 (32 white women and 1 Latina) nondiabetic women with PCOS who conceived while taking metformin and had live births; of these, 28 were taking metformin through delivery. Metformin, 2.55 g/d, throughout pregnancy in women with PCOS. | 39 nondiabetic women with PCOS who had live birth pregnancies without metformin therapy. | Pretreatment height, weight, body mass index (BMI), glucose, insulin, insulin resistance and insulin secretion, and gestational diabetes. |
|
| 35 | 40 pregnant women with PCOS (revised 2003 consensus’ diagnostic criteria of PCOS) were recruited from the outpatient clinic at the University Hospital of Trondheim.
All participants used two capsules once daily
during the first week and two capsules twice daily for the rest of the pregnancy. | Treatment with metformin 425 mg (at 6–12, mean 8, gestational weeks).
Age 28.9 ± 3.7, BMI 32.1 ± 6.1. | Identical placebo capsules.
Age 28.3 ± 3.7,
BMI 29.3 ± 8.0. | Minor complications included mild preeclampsia, hypertension and/or insulin-treated GDM. Severe complications included
preterm deliveries before 32 gestational weeks, severe preeclampsia, or serious postpartum problems (e.g., endometritis and Group A streptococcal sepsis, adult acute respiratory distress syndrome (ARDS), thrombosis, or lung embolism). |
|
| 36 | 57 infertile cases with PCOS (revised 2003 consensus’ diagnostic criteria of PCOS) who became pregnant and were in the infertility unit and outpatient clinics in Zagazig university hospitals | Received metformin, starting in a dose of 1000 mg daily increased to 2500 mg daily according to BMI and response to treatment, some cases used other ovulation inducing drugs as clomiphene citrate and or gonadotrophines. When pregnancy occurred, cases continued on metformin in a dose of 1000–1500 mg daily till the end of pregnancy
Age 30.2 ± 3.87, BMI 29.22 ± 2.31 | Got pregnant spontaneously or by use of ovulation inducing agents but did not use metformin before or after pregnancy.
Age 28.12 ± 4.35, BMI 28.35 ± 1.97 | The rate of; spontaneous miscarriage, preterm delivery, fetal macrosomia, intrauterine growth restriction
(IUGR), suspected fetal asphyxia at birth (5 min Apgar
score 67) and recording of congenital malformation and neonatal mortality. |
|
