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Continuing metformin from preconception through the first trimester improves clinical pregnancy rates and may reduce miscarriage in women with PCOS.
A systematic review and meta-analysis suggests that women with polycystic ovary syndrome (PCOS) who continue metformin from preconception through the first trimester may experience better pregnancy outcomes.
Researchers analyzed 12 randomized controlled trials (RCTs) encompassing 1,708 women with PCOS. The studies compared outcomes in women who started metformin before conception and either continued it through early pregnancy or discontinued it after a positive pregnancy test, versus placebo or no treatment. The primary focus was miscarriage, with secondary outcomes including clinical pregnancy and live birth rates.
The analysis found that those who continued metformin into the first trimester experienced higher clinical pregnancy rates (odds ratio [OR] 1.57). There was also a trend toward lower miscarriage rates (OR 0.64) and higher live birth rates (OR 1.24), although these latter results were not statistically definitive. In contrast, those who stopped metformin once pregnancy was confirmed exhibited a modest increase in clinical pregnancy rates (OR 1.35) but also a possible rise in miscarriage risk (OR 1.46) when compared with controls.
Indirect comparisons consistently favored continuing metformin through the first trimester, suggesting benefits for clinical pregnancy, miscarriage prevention, and live birth outcomes. The authors concluded that ongoing metformin use during early pregnancy may offer meaningful reproductive advantages for PCOS-affected women. They emphasized, however, that further high-quality trials are needed to confirm these findings and optimize treatment strategies.
American Journal of Obstetrics and Gynecology
Preconception and first-trimester metformin on pregnancy outcomes in women with polycystic ovary syndrome: a systematic review and meta-analysis
James Cheshire et al.
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