• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Mechanisms Underlying Gestational Weight Gain with PCOS and Effects of Metformin

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Women with polycystic ovary syndrome (PCOS) experience higher gestational weight gain compared to matched controls
  • Metformin can induce weight loss through mechanisms that suppress appetite and improve leptin sensitivity
  • Molin et al. (BJOG, 2021) examined gestational weight gain in women with PCOS and the impact of metformin

METHODS:

  • Secondary analysis of patients in RCTs (2005 to 2017)
    • 2 randomized, double-blind, placebo-controlled multi-centered trials studying the effect of metformin on pregnancy complications in PCOS (PregMet and PregMet2)
  • Population
    • Pregnant individuals with PCOS who were randomized to metformin or placebo
    • A prospective cohort of healthy pregnant individuals
    • BMI <30 | Nulliparous | Singleton
  • Study design
    • PCOS diagnosis based on Rotterdam Criteria
    • Metformin Dose: 2000 mg daily from inclusion at 5 to 13 weeks until delivery
    • Serum levels of the following appetite regulating hormones in the first and third trimesters were measured
      • Leptin
      • Ghrelin
      • Allopregnanlone
      • Soluble leptin receptor (sOB-R)
  • Primary outcome
    • Excessive gestational weight gain relative to BMI (according to 2009 Institute of Medicine guidelines)
    • Leptin sensitivity as measured by
      • Serum leptin/sOB-R ratio
      • Free-leptin-index (FLI)

RESULTS:

  • PCOS-Metformin: 36 individuals | PCOS-Placebo: 37 | Healthy controls: 15
  • BMI median (min-max range)
    • PCOS-Metformin: 23.4 (19.3 to 29.8)
    • PCOS-Placebo: 24.2 (19.6 to 29.7)
  • Overall prevalence of excessive gestational weight gain: 44%
  • Compared to health controls, women with excessive gestational weight gain had
    • Higher first and third trimester FLI: P<0.001
    • Lower third trimester allogrananolone: P=0.003
  • The prevalence of excessive gestational weight gain was lower in women with PCOS receiving metformin vs those receiving placebo
    • PCOS-Metformin: 28%
    • PCOS-Placebo: 62%
    • Odds ratio (OR) 0.4 (95% CI, 0.2 to 0.8); P=0.005
  • Women on metformin were more likely to gain weight below recommendations
    • PCOS-Metformin: 33%
    • PCOS-Placebo: 8%
    • OR 4.1 (95% CI, 1.5 to 15.5); P = 0.01
  • FLI decreased during pregnancy in women with PCOS taking metformin, but stayed the same in women with PCOS receiving placebo and healthy controls (P=0.01)
  • Throughout pregnancy, all groups had comparable levels of ghrelin and allopregnanolone

CONCLUSION:

  • For women with PCOS, taking metformin in pregnancy reduced the rates of excessive gestational weight gain and improved leptin sensitivity
  • The authors state

Metformin appears effectively to counteract leptin resistance and prevent eGWG in PCOS

However, nearly one-third over-responded in our study and gained below recommendations, all of whom had BMI <25

Awareness of this possible side-effect is warranted, as inadequate GWG may have negative implications for pregnancy outcome

Learn More – Primary Sources:

Gestational weight gain, appetite regulating hormones, and metformin treatment in polycystic ovary syndrome: a longitudinal, placebo-controlled study

Want to stay on top of key guidelines and research papers?

ObGFirst® – Try It Free! »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

RCT Results: Does Weight Loss Prior to Pregnancy Affect Gestational Weight Gain?
Practical obstetrics info for your women's healthcare practice
Recommended Weight Gain and Obesity Management in Pregnancy
Can a Smartphone ‘Diet and Activity’ App Impact Gestational Weight Gain?
Is There an Association Between High or Low Weight Gain and Maternal and Infant Outcomes?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site