1: Transl Res. 2009 Jan;153(1):33-43. Epub 2008 Dec 4.

Enoxaparin-metformin and enoxaparin alone may safely reduce pregnancy loss.

Ramidi G, Khan N, Glueck CJ, Wang P, Goldenberg N.
Cholesterol Center, Jewish Hospital, Cincinnati, OH 45229, USA.

OVERALL SUMMARY: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women, occurring in about 6% of Caucasians, 8% of African-Americans, and 10% of Hispanics. If untreated, it is associated with frequent miscarriage, often as high as 40-50% of pregnancies. On Glucophage, miscarriage rates are reduced to about 15%, the national average for women. Miscarriage also often occurs due to inherited coagulation disorders. When recognized, these can be treated safely with low molecular weight heparin during pregnancy. In women with recurrent miscarriages, and both PCOS and inherited coagulation disorders, the concurrent use of Enoxaparin (Lovenox) and Glucophage is safe and effective in optimizing healthy normal births and pregnancies.

Polycystic ovary syndrome (PCOS), thrombophilia, and hypofibrinolysis are associated with recurrent pregnancy loss (RPL) and spontaneous abortion (SAB). In 28 Caucasian women, 21 women with PCOS (4 with previous thrombosis, 18 with 1 SAB or more, and 20 with 1 coagulation disorder or more), and 7 women with coagulation disorders-thrombi, we speculated that prospective treatment with enoxaparin-metformin or enoxaparin alone would successfully and safely promote healthy live births compared with previous untreated pregnancies. In 21 women with PCOS, metformin (1.5-2.55 g/day) was given before and during pregnancy with concurrent enoxaparin (60 mg/day). Of 21 PCOS women, 19 women had 40 previous untreated pregnancies, 7 had live births (18%), 3 had elective abortions (ABs)(8%), and 30 had SABs (75%). On enoxaparin-metformin, these 19 women had 24 pregnancies, 20 live births (83%), and 4 SABs (17%); the SAB rate was 4.4-fold lower than previous untreated pregnancies (McNemar's s = 20.8, P < 0. 0001). Two women with PCOS without previous pregnancies, but with previous thrombosis, had 2
pregnancies on enoxaparin-metformin and 2 live births. Of the 7 women with coagulation disorders-thrombi, 4 had 15 previous pregnancies without enoxaparin, with 6 live births (40%), 8 SABs (53%), and 1 elective AB (7%). On enoxaparin, these 4 women had 4 pregnancies, with 4 (100%) live births (McNemar's s = 8.0, P = 0.005). The other 3 women with coagulation disorders-thrombi had 4 pregnancies on enoxaparin with 4 live births. No adverse maternal-fetal side effects were reported on enoxaparin alone or enoxaparin-metformin. Enoxaparin-metformin reduces pregnancy loss in women with PCOS-coagulation disorders and in women with coagulation disorders-thrombi.