Zusammenfassung
Das polyzystische Ovarsyndrom (PCOS) ist die häufigste hormonelle Störung fertiler Frauen (15 %). Die Diagnose wird gestellt bei Erfüllung der Rotterdam-Kriterien: Hyperandrogenismus, chronische Anovulation und polyzystische Ovarmorphologie. Die Fertilität ist reduziert und die Abortrate erhöht, inwieweit dies primär durch das PCOS oder die häufig assoziierte Adipositas bedingt ist, ist unklar. Gewichtsabnahme hat einen vergleichbar positiven Effekt auf die Fertilität wie die Gabe von Metformin, das als First-line-Therapie gilt. Die Evidenz zur Fortführung von Metformin im ersten Trimenon zur Reduzierung der Abortrate ist schwach, kann aber erwogen werden. Metformin hat keinen teratogenen Effekt. In der Schwangerschaft ist die Prävalenz von Präeklampsie und Gestationsdiabetes (GDM) deutlich erhöht, die Datenlage rechtfertigt nicht die Fortführung der Metformingabe zur Reduzierung der Schwangerschaftskomplikationen. In GDM-Studien profitierten Metformin-exponierte Kinder zwar mit einer Risikoreduktion für Makrosomie und die Mütter mit einer geringeren Gewichtszunahme, jedoch sind diese positiven Effekte möglicherweise mit einem metabolischen Langzeitrisiko des Kindes verbunden, wie die Follow-up-Studien zeigten. Der Beitrag geht ausführlich auf die Metformintherapie bei PCOS in der Schwangerschaft ein. Das individuelle Risikoprofil der Schwangeren mit PCOS (mit oder ohne Adipositas oder Diabetes) bestimmt den zu erwartenden Nutzen einer Metformintherapie in der Schwangerschaft. Darüber hinaus sind mögliche Chancen und Risiken für das Kind zu berücksichtigen.
Abstract
Polycystic ovary syndrome (PCOS) is the most frequent hormonal disorder of fertile women (15%). The diagnosis is made by fulfilling the Rotterdam criteria: hyperandrogenism, chronic anovulation and polycystic ovarian morphology. The fertility is reduced and the abortion rate is increased but it is unclear to what extent this is primarily caused by PCOS or the frequently associated obesity. Weight loss has a comparably positive effect on fertility as the administration of metformin, which is considered the first line treatment. The evidence for continuation of metformin in the first trimester to reduce the abortion rate is weak but can be considered. Metformin has no teratogenic effects. During pregnancy the prevalence of pre-eclampsia and gestational diabetes (GDM) is clearly increased but the data situation does not justify the continuation of metformin administration to reduce the complications of pregnancy. In GDM studies, children exposed to metformin benefited from a reduction of macrosomia and the mother from a lower weight increase. However, these positive effects are possibly associated with a long-term metabolic risk for the child, as shown by follow-up studies. This article covers with metformin treatment for PCOS during pregnancy in detail. The individual risk profile of pregnant women with PCOS (with or without obesity or diabetes) determines the benefits to be expected from metformin treatment during pregnancy. Furthermore, possible chances and risks for the child must be considered.
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U. Schäfer-Graf und S. Reger-Tan geben an, dass kein Interessenkonflikt besteht.
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Klaus Vetter, Berlin
Nicole Ochsenbein-Kölble, Zürich
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Schäfer-Graf, U., Reger-Tan, S. PCOS und Schwangerschaft. Gynäkologe 55, 85–89 (2022). https://doi.org/10.1007/s00129-021-04894-2
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DOI: https://doi.org/10.1007/s00129-021-04894-2