Women with Poly Cystic Ovarian Syndrome (PCOS) who become pregnant have a high risk of metabolic and endocrine disorders that predispose them to complications such as gestational diabetes, miscarriage, small for gestational age infants, and neonates with an increased risk of admission to a neonatal intensive care unit, among others. Metformin, the first line treatment for type 2 diabetes, provides an attractive therapeutic option for managing such patients due to its benefits on various metabolic aspects. Using metformin to treat women with PCOS during pregnancy has yielded favorable pregnancy outcomes. However, some recent reports associate prenatal exposure to metformin with obesity in children. Additionally, several animals’ studies associate metformin use in pregnancy to sexual and fertility problems in the offspring, which highlights the need to conduct clinical studies specially designed to assess these types of undesirable outcomes in humans. In conclusion, there is a need to weigh the risks against the benefits of prescribing metformin for different patient groups. Moreover, it should be recommended to give parent counseling regarding the potential development of overweight in their children.
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