Guest Author - Krissi Danielsson

At Washington University School of Medicine in St. Louis, Missouri, a study is underway looking at Metformin -- an insulin sensitizing drug -- as a potential recurrent pregnancy loss treatment.

According to study leader Dr. Kelle Moley, associate professor of obstetrics and gynecology at the university, evidence suggests insulin resistance could play a role in repeat miscarriages. In 2002, a University of Tennessee researcher found that patients with "a higher rate of pregnancy loss have a higher rate of insulin resistance" that is statistically significant, she says. Two to five percent of patients have two or more misciarrages, but 27 percent of women with miscarriages had insulin resistance compared to 9.5 percent of the general population.

"That suggested that perhaps insulin resistance was the etiology in a subset of women," Dr. Moley points out.

After the University of Tennessee study, a subsequent paper found a correlation between obesity and pregnancy loss. Obesity is known to correlate with insulin resistance. Polycystic ovarian syndrome (PCOS) is another disorder associated with insulin resistance and pregnancy loss. Patients have been successfully treated with Metformin to reduce insulin resistance, which cut pregnancy loss rates.

Dr. Moley's study will examine whether undiagnosed insulin resistance could be a potential cause of recurrent miscarriage by treating participants with the drug and tracking their progress through the first trimester of pregnancy. It will use participants between 20 and 34 years old with two or more unexplained first trimester miscarriages. The participants will be screened for possible immunological factors that could explain their losses, such as anticardiolipin antibodies or the lupus anticoagulant, before participating in the study.

The study will compare patients' data in a control group with that of patients treated with Metformin. The experimental group will take Metformin while trying to conceive, and those who get pregnant will have weekly screenings and continue the drug for the first twelve weeks.

If it turns out that Metformin cuts the pregnancy loss rates in the experimental group, Dr. Moley predicts there's a strong chance the drug could be more widely used to treat patients with recurrent pregnancy loss. While there may be some doctors already using Metformin in patients without a firm diagnosis of PCOS or another insulin resistance condition, Dr. Moley believes it's important to gather reliable evidence of the drug's efficacy.

"A lot of treatments don't necessarily have any scientific basis in our literature," she explains. "It's important to do a double-blinded, prospective randomized controlled trial."

Metformin may cause side effects of nausea or diarrhea in ten to fifteen percent of patients, but it carries no risk for the developing baby and may reduce the mother's risk of gestational diabetes or related complications, she says.

Dr. Moley's study is already underway at Washington University School of Medicine, but more participants are still needed. Readers who meet the study's criteria and live in the St. Louis area should contact the university at (314) 286-2419 for more information.