Prevention of Gestational Diabetes

Dr Charles J. Glueck, Dr Joel Pranikoff, and associates at the Jewish Hospital Cholesterol Center have completed a series of seminal studies (1-11) over the past 5 years in the prevention of gestational diabetes in women with Polycystic Ovary Syndrome (PCOS), the most common endocrine problem of women. These studies have shown the following:

1. Compared to previous pregnancies without Glucophage, where approximately 40% of the women developed gestational diabetes, on Glucophage in subsequent pregnancies, only about 4% developed gestational diabetes, which approximates the national average of 4%.
2. Compared to previous pregnancies without Glucophage, where the miscarriage rate approximated 50%, on Glucophage in subsequent pregnancies, the miscarriage rate was about 15%, which is the national average for all pregnancies.
3. Compared to previous pregnancies where fetal macrosomia was present (neonate weight >4000 grams, on Glucophage fetal macrosomia was no more common than the general US population of newborn reported by the CDC, or in the suburban ob-gyn practice of Dr Pranikoff.
4. Related to the reduction in fetal macrosomia, risk of shoulder distocia during delivery in neonates from women receiving Glucophage was comparable to the national average.
5. The Glucophage therapy reduced the risk of developing hypertension of pregnancy, pre-eclampsia, and eclampsia.
6. Glucophage was safe for mother and fetus during pregnancy, without any increase in birth defects, and was safe during lactation.
7. Growth, development, and development of motor, intellectual skills was entirely normal in the offspring of PCOS mothers taking Glucophage during pregnancy, who remained normal through 5 years of follow-up.
8. In habitually oligo-amenorrheic women with PCOS, Glucophage and diet promoted development of normal regular menstrual periods in 94% within 6 months, facilitating conception and reversal of the endocrinopathy of PCOS.

These studies have begun to revolutionize the therapy of PCOS before, during, and after pregnancy and lactation. Since PCOS affects about 6% of Caucasians, 8% of African –Americans, and up to 10% of Hispanics, these studies have major public health import.

1. Glueck CJ, Bornovali S, Pranikoff J, Goldenberg N, Dharashivkar S, Wang P. Metformin, pre-eclampsia, and pregnancy outcomes in women with polycystic ovary syndrome. Diabet Med 2004;21(8):829-36.
2. Glueck CJ, Goldenberg N, Pranikoff J, Loftspring M, Sieve L, Wang P. Height, weight, and motor-social development during the first 18 months of life in 126 infants born to 109 mothers with polycystic ovary syndrome who conceived on and continued metformin through pregnancy. Hum Reprod 2004;19(6):1323-30.
3. Glueck CJ, Goldenberg N, Sieve L, Wang P. An observational study of reduction of insulin resistance and prevention of development of type 2 diabetes mellitus in women with polycystic ovary syndrome treated with metformin and diet. Metabolism 2008;57(7):954-60.
4. Glueck CJ, Goldenberg N, Wang P, Loftspring M, Sherman A. Metformin during pregnancy reduces insulin, insulin resistance, insulin secretion, weight, testosterone and development of gestational diabetes: prospective longitudinal assessment of women with polycystic ovary syndrome from preconception throughout pregnancy. Hum Reprod 2004;19(3):510-21.
5. Glueck CJ, Phillips H, Cameron D, Sieve-Smith L, Wang P. Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion: a pilot study. Fertil Steril 2001;75(1):46-52.
6. Glueck CJ, Pranikoff J, Aregawi D, Wang P. Prevention of gestational diabetes by metformin plus diet in patients with polycystic ovary syndrome. Fertil Steril 2008;89(3):625-34.
7. Glueck CJ, Wang P, Fontaine R, Tracy T, Sieve-Smith L. Metformin-induced resumption of normal menses in 39 of 43 (91%) previously amenorrheic women with the polycystic ovary syndrome. Metabolism 1999;48(4):511-9.
8. Glueck CJ, Wang P, Fontaine R, Tracy T, Sieve-Smith L. Metformin to restore normal menses in oligo-amenorrheic teenage girls with polycystic ovary syndrome (PCOS). J Adolesc Health 2001;29(3):160-9.
9. Glueck CJ, Wang P, Fontaine RN, Sieve-Smith L, Tracy T, Moore SK. Plasminogen activator inhibitor activity: an independent risk factor for the high miscarriage rate during pregnancy in women with polycystic ovary syndrome. Metabolism 1999;48(12):1589-95.
10. Glueck CJ, Wang P, Goldenberg N, Sieve-Smith L. Pregnancy outcomes among women with polycystic ovary syndrome treated with metformin. Hum Reprod 2002;17(11):2858-64.
11. Glueck CJ, Wang P, Kobayashi S, Phillips H, Sieve-Smith L. Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome. Fertil Steril 2002;77(3):520-5.