Akademik Veri Yönetim Sistemi
OBSTETRICAL & GYNECOLOGICAL SURVEY, sa.5, ss.263-265, 2019 (SCI-Expanded)
Preeclampsia is a leading cause of maternal mortality and morbidity that imposes a substantial burden on the health care system. Metformin has been reported to reduce the risk of preeclampsia. It is also known to influence soluble fms-like tyrosine kinase 1 level, which correlates with the gestational age at onset and severity of preeclampsia. It has also been suggested that metformin may prevent preeclampsia by improving cardiovascular function and limiting gestational weight gain. Regardless of the underlying mechanism, the clinical implications are very important if metformin is proven effective in preventing late-onset preeclampsia. The researchers performed a systematic review and meta-analysis. MEDLINE (1947 to September 2017), Scopus (1970 to September 2017), and the Cochrane Library (inception to September 2017) were searched for relevant citations in the English language. Only randomized controlled trials on metformin use, reporting the incidence of preeclampsia or pregnancy-induced hypertension, were included. Studies on populations with a high probability of metformin use prior to randomization (those with type 2 diabetes or polycystic ovary syndrome) were excluded. Random-effects models with theMantel-Haenszel method were used for subgroup analyses. Bayesian random-effects metaregression was used to summarize the evidence. In total, 3337 citations matched the search criteria. After evaluating 2536 abstracts and performing full-text review of 52 studies, 15 were included in the review. In women with gestational diabetes, metformin use was associated with a reduced risk of pregnancy-induced hypertension when compared with insulin (relative risk [RR], 0.56; 95% confidence interval [CI], 0.37-0.85; I-2 = 0%; 1260 women) and a nonsignificantly reduced risk of preeclampsia (RR, 0.83; 95% CI, 0.60-1.14; I-2 = 0%; 1724 women). In obese women, when compared with placebo, metformin use was associated with a nonsignificant reduction in risk of preeclampsia (RR, 0.74; 95% CI, 0.09-6.28; I-2 = 86%; 840 women). In women with gestational diabetes, metformin use was also associated with a nonsignificant reduction in risk of any hypertensive disorders of pregnancy (HDP) (RR, 0.71; 95% CI, 0.41-1.25; I-2 = 0%; 556 women) when compared with glyburide. When studies were combined using Bayesian random-effects metaregression, with treatment type as a covariate, the posterior probabilities of metformin having a beneficial effect on the prevention of preeclampsia, pregnancy-induced hypertension, and any HDP were 92.7%, 92.8%, and 99.2%, respectively, when compared with any other treatment or placebo. The researchers concluded that there is a high probability that metformin use is associated with reduced HDP incidence when compared with other treatments or placebo. The small number of studies included in the analysis, the low quality of evidence, and the clinical heterogeneity preclude generalization of these results to broader populations. Given the clinical importance of this topic and the magnitude of effect observed in this meta-analysis, the researchers recommend further prospective trials.