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Metformin use fails to affect cervical length in women with PCOS
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Pregnant women with polycystic ovary syndrome randomly assigned metformin had no difference in cervix length during the second or third trimester when compared with pregnant women assigned a placebo, according to research in The Journal of Clinical Endocrinology & Metabolism.
In a subanalysis of the Metformin in Pregnant PCOS Women (PregMet) study, researchers also found that women with higher androgen levels at 32 weeks gestation were more likely to have shorter cervix measurements, a sign of preterm labor.
Tone Shetelig Lovvik, MD, lecturer in the department of obstetrics and gynecology at St. Olav’s Hospital, Trondheim University Hospital, Norway, and colleagues analyzed cervical length and androgen levels during 261 pregnancies in 245 women with PCOS (mean age, 30 years; mean BMI, 28.9 kg/m²). Women were assigned 2,000 mg metformin daily (n = 131) or placebo (n = 130) from first trimester until delivery. Researchers measured the length of cervix by ultrasound (mean of three measurements) at 19 and 32 weeks gestation. Participants provided blood samples to measure testosterone, androstenedione, sex hormone-binding globulin and dehydroepiandrosterone.
Researchers found no difference in cervix length between the metformin and placebo groups at 19 or 32 weeks gestation; androgen and insulin levels at both times also were similar between groups. DHEA tended to be higher in the metformin group.
Researchers found no correlation between cervical length, androgen or insulin levels at 19 weeks gestation; however, at 32 weeks gestation, cervical length was negatively correlated with androstenedione (–0.2 nmol/L; 95% CI, –0.3 to –0.03) and DHEA (–0.83 µmol/L; 95% CI, –1.5 to –0.1).
High androstenedione levels correlated with a shortening of cervical length from week 19 to week 32 after adjustment for cervical conization, previous vaginal deliveries, BMI, age and interval between exams (0.2 nmol/L; 95% CI, 0.05-0.35). A similar trend was observed for DHEA (P = .02), testosterone (P = .03) and free testosterone index (P = .03).
“Most of the preterm deliveries in the PregMet study were ‘late preterm,’ ie, after gestational week 34, which may explain why we did not find any difference in absolute cervical length at gestational week 32,” the researchers wrote. “If metformin has a protective effect on preterm deliveries, it might be exerted through pathways other than androgen synthesis or shortening of the cervix.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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