Diabetes drug may help to prolong preterm pregnancies
Metformin may help prolong pregnancy (gestation) in women diagnosed with preterm pre-eclampsia, according to a study published today in The BMJ.
The data indicate that pregnancy was prolonged by one week in the treatment group compared to the control group, although the difference was not statistically significant, indicating the need for additional research.
If further research confirms this, it could have significant benefits for both mother and infant. Pre-eclampsia is a dangerous disorder that is thought to be caused by an abnormal placenta. Preterm pre-eclampsia (between 26 and 32 weeks' gestation) frequently results in premature delivery, putting infants at risk of major impairment and death, especially in low- and middle-income countries.
Metformin is typically prescribed to people with diabetes to aid in blood sugar control, but preliminary research indicates that it may also be used to treat pre-eclampsia.
As a result, researchers in Australia and South Africa sought to determine whether prolonged release metformin could be used to prolong gestation in women diagnosed with preterm preeclampsia.
The experiment was conducted at a big hospital in Cape Town, South Africa, and featured 180 pregnant women who were being closely monitored for preterm pre-eclampsia.
Women were recruited between February 2018 and March 2020 at an average gestational age of 29 weeks. None of them had diabetes or were using metformin or any other medication that could interact with it.
Women were randomly assigned to one of two groups (arms): 90 got extended release metformin daily till delivery and 90 received a placebo daily.
Between randomisation and delivery, the average period was 17.7 days in the metformin arm and 10.1 days in the placebo arm, a difference of 7.6 days. This difference, however, was not statistically significant.
Two more analyses were conducted. The first study (in women who continued to take metformin at any dose) demonstrated an average 9.6-day increase in gestation, whereas the second study (in women who took the highest dose of metformin) demonstrated an average 11.5-day increase in gestation. These two findings were statistically significant.
There were no significant differences between the two arms in terms of serious delivery problems or maternal or infant death. And there were no significant side effects, but diarrhoea was more prevalent in the metformin arm.
Although this is a well-designed and rigorous trial, the researchers admit several limitations. For example, because this was a single-center study involving women with a high prevalence of HIV, obesity, and chronic hypertension, the findings may not be generalizable.
Additional trials of metformin should be undertaken to see whether the medicine can statistically significantly prolong gestation and to assess the drug's advantages to neonates, the authors write. However, based on the findings of this trial, "we are cautiously optimistic that prolonged release metformin prolongs gestation in preterm preeclampsia patients."