Response to diet and metformin in women with idiopathic intracranial hypertension with and without concurrent polycystic ovary syndrome or hyperinsulinemia
Abstract
In the current issue of Medscape General Medicine, Bagga and colleagues[1] review therapies for idiopathic intracranial hypertension (IIH) during pregnancy and suggest that “…most therapies used during non-pregnant state can also be used during pregnancy.” One novel therapy that we have used successfully during pregnancy in 4 women with both IIH and polycystic ovary syndrome (PCOS) is glucophage, which is safe for both mother and fetus during pregnancy, is not teratogenic, and leads to a median average weight gain during pregnancy of zero pounds. Glucophage safely promoted weight loss in a predominantly morbidly obese cohort during pregnancy,[2–11] and thus was beneficial for IIH, particularly during pregnancy.
Our 2 previous studies revealed that 15 of 38 (39%)[12,13] and 37 of 65 (57%)[12] women referred solely for IIH had PCOS – a prevalence 5 to 8 times higher than the 7% prevalence seen in the general unselected population.[14] Obesity is a clinical characteristic of both PCOS [15–20] and IIH.[21–25] The increased prevalence of PCOS in women with IIH speculatively reflects PCOS-driven morbid obesity, [15–18] which, in turn, facilitates development of IIH.[26]There are also links between obesity, PCOS, hypofibrinolysis, and thrombophilia.[15–18,27] Obesity, often with concurrent hyperinsulinemia and PCOS, is associated with hypofibrinolysis through elevation of plasminogen activator inhibitor activity (PAI-Fx).[15–18,28] Reduction of obesity by metformin in…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 15 participants or records.
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