Metformin May Prolong Gestation in Preterm Pre-Eclampsia

A new study suggests that administering extended release metformin can prolong gestation time in women with preterm pre-eclampsia.

Researchers at Monash University (Melbourne, Australia), Tygerberg Hospital (Cape Town, South Africa), and other institutions led a randomized, placebo controlled trial of 180 women with preterm pre-eclampsia under expectant management in order to evaluate if administering metformin (3 grams of oral extended release metformin, in divided doses, until delivery) could help prolong gestation. Ninety of the women were randomized to extended release metformin, and 90 to placebo. The main outcome was prolongation of gestation.

The results showed average time from randomization to delivery was 17.7 days in the metformin arm and 10.1 days in the placebo arm, an average difference of 7.6 days. Two more analyses were carried out, which showed that women who took metformin at any dose had an average 9.6 day longer gestation, while in women who took the full dose of metformin showed an average 11.5 day longer gestation. There were no differences in serious adverse events, birth complications, or death among both mothers and babies. The study was published on September 23, 2021, in The BMJ.

“Based on the findings of this study, we are cautiously optimistic that extended release metformin prolongs gestation in women with preterm pre-eclampsia,” concluded lead author Catherine Cluver, MD, and colleagues. “Further trials should be considered to confirm whether the drug can prolong gestation and to evaluate the benefits to neonates. Trials might also evaluate whether metformin can prevent worsening maternal organ dysfunction while birth is being planned among women with a diagnosis of late preterm pre-eclampsia, and even among those with pre-eclampsia at term.”

Preeclampsia is a complication of pregnancy characterized by hypertension and kidney dysfunction that can cause severe complications for both the mother (including seizures, stroke, renal failure, and liver dysfunction) and the infant (such as low birth weight, preterm delivery, and stillbirth). The condition also increases a woman's risk for cardiovascular disease (CVD) later in life. Currently, there is no cure for preeclampsia, and only childbirth can alleviate the symptoms. An estimated 10 million pregnant women develop preeclampsia annually, causing approximately 500,000 fetal and neonatal and 76,000 maternal deaths.

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Monash University
Tygerberg Hospital