Evaluation of Preeclampsia Results after Use of Metformin in Gestation: Systematic Review and Meta-analysis

Abstract

Objective Does the use of metformin have an influence on the outcomes of preeclampsia (PE)?

Sources of Data The descriptors pregnancy, metformin, treatment, and preeclampsia associated with the Boolean operators AND and OR were found in the MEDLINE, LILACS, Embase and Cochrane databases. A flowchart with exclusion criteria and inclusion strategy using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, and eligibility criteria was used. Data were extracted regarding the type of study, the applied dosage, treatment time, segment, bias risks, and the Patient, Intervention, Comparison and Outcome (PICO) strategy to identify the quality of the study.

Selection of Studies Total number of journals in the initial search (n = 824); exclusions from repeated articles on different search engines (n = 253); exclusions after reading the titles, when the title had no correlations with the proposed theme (n = 164); exclusions due to incompatibility with the criteria established in the methodological analysis (n = 185), exclusion of articles with lower correlation with the objective of the present study (n = 187); and final bibliographic selection (n = 35).

Data Collection At first, a systematic review of the literature was performed. Subsequently, from the main selection, randomized and non-randomized trials with metformin that presented their results in absolute and relative numbers of PE outcomes were selected. The variables were treated statistically in the meta-analysis with the Review Manager software (RevMan), version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration. Denmark in the Hovedistaden region.

Synthesis of Data The study showed that metmorfin presented greater preventive effects for pregnancy-induced hypertension and was less effective for PE.

Conclusion Metformin may gain place in preventive treatments for PE, once the dosages, the gestational age, and treatment time are particularly evaluated. A methodological strategy with an improved perspective of innovative and/or carefully progressive dosages during pregnancy to avoid side effects and the possibility of maternal-fetal risks is suggested.

Resumo

Objetivo O uso de metformina tem influência nos resultados da pré-eclâmpsia (PE)?

Fontes de Dados Os descritores gravidez, metformina, tratamento e pré-eclâmpsia associados aos operadores booleanos AND e OR foram encontrados nas bases de dados MEDLINE, LILACS, Embase e Cochrane. Foi utilizado um fluxograma com critérios de exclusão e estratégia de inclusão, utilizando o protocolo Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA e critérios de elegibilidade. Os dados foram extraídos quanto ao tipo de estudo, dosagem aplicada, duração do tratamento, segmento, riscos de viés e estratégia Patient, Intervention, Comparison and Outcome (PICO) para identificar a qualidade do estudo.

Seleção de Estudos Número total de periódicos na busca inicialmente realizada (n = 824); exclusões de artigos repetidos nos diferentes sites de busca (n = 253); exclusões após a leitura dos títulos, quando o titulo não apresentava correlações com o tema proposto (n = 164); exclusões por incompatibilidade com os critérios estabelecidos na análise metodológica (n = 185), exclusão de artigos com menor correlação com o objetivo do presente estudo (n = 187); e seleção bibliográfica final (n = 35).

Coleta de Dados Inicialmente, foi realizada uma revisão sistemática da literatura. Posteriormente, a partir da seleção principal, foram selecionados estudos randomizados e não randomizados com metformina, os quais apresentaram em seus resultados números absolutos e relativos de desfechos de PE. As variáveis foram tratadas estatisticamente na metanálise por meio do Review Manager software (RevMan), version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration. Denmark in the Hovedistaden region.

Síntese dos Dados O estudo demonstrou que a metmorfina apresenta maiores efeitos preventivos para a hipertensão induzida pela gravidez e é menos eficaz para a PE.

Conclusão A metformina pode conquistar seu espaço nos tratamentos preventivos da PE, uma vez que as dosagens, a idade gestacional e o tempo de tratamento são particularmente avaliados. Sugere-se uma estratégia metodológica com uma perspectiva aprimorada de doses inovadoras e/ou cuidadosamente progressivas durante a gravidez, a fim de evitar efeitos colaterais e a possibilidade de riscos materno-fetais.

Keywords

pregnancy - metformin - treatment - preeclampsia

Palavras-chave

gravidez - metformina - tratamento - pré-eclâmpsia

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