Metformin treatment seems to prolong pregnancy in preterm preeclampsia

Preeclampsia ⁽¹⁾ is one of the most common causes of preterm birth, since delivery of the placenta cures the disorder. Bergman’s research involves using the pharmaceutical drug metformin (or a placebo) to treat women with early-onset preeclampsia, with the aim of prolonging pregnancy and reducing the preterm birth rate.

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“Early onset of the condition, between the 22nd and 34th week of pregnancy, often means that the birth needs to be induced preterm. Today, there’s no treatment to slow down the progression of the disorder, so if we could find a drug that can do that it would enable the pregnancy to be prolonged for a few more weeks, and that would be of great benefit for the preterm babies,” Bergman says.⁽²⁾

Bergman collaborates with a research group in Melbourne, Australia. Several years ago, they started investigating, for new indications, drugs already approved in pregnancy. The advantage of this approach is that the potential risk to the fetus is already known.

“This research group found that metformin, already used in pregnancy for pre-gestational and gestational diabetes, had protective effects against preeclampsia in lab models and animal subjects. They highlighted this treatment as potentially efficacious for women with preeclampsia as well. The research group leader is now also part of my research group, and we’re going to investigate this in a Swedish population.”

Studies originating in Cape Town now underway in a Swedish population
Since 2016, Bergman has lived partly in Cape Town, South Africa, where she is an affiliated senior researcher at Stellenbosch University, working part-time. Her research group conducted the first study of metformin for women with preeclampsia.

“In a pilot study, colleagues in my research group in South Africa have shown that metformin can prolong pregnancy for women with preeclampsia by roughly one week. That study was published in 2021. If this is true in our Swedish population as well, it could make a huge difference for the children. The researcher responsible for that study is my good friend and collaborator Cathy Cluver, who also belongs to the steering group for this study in Sweden.” ⁽³⁾

The most challenging part of the research is reaching the inclusion target of almost 300 women with early-onset preeclampsia in the study, since the early form of the condition is less common than the late one.

“However, I have good hopes, since we’re a strong national research group running the study in five counties: Dalarna, Uppsala, Stockholm, Gothenburg, and Skåne are taking part.”

Recognition for research in obstetric care
Doing research is very much a matter of securing funding. Receiving a major, multi-year grant that permits the recipient to plan ahead and get the study over the finish line is of outmost importance. The large-scale funding she has now received is enough to cover the whole study.

She stresses how meaningful it is that obstetric care is now getting this recognition from the Swedish Research Council.⁽⁴⁾

“Carrying out interventional studies in this research field is challenging and has led to pregnant women often being excluded from clinical trials, so we usually have to rely on old, tried-and-tested drugs during pregnancy. It feels hugely important to change this approach and see pregnant women as a priority target group, and we have a big responsibility to develop new therapies to improve outcomes for the mother and child. Our obstetrics unit at Sahlgrenska University Hospital and the Institute of Clinical Sciences are highly active in research, and in many areas nation-leading. For me as a clinician and researcher, it’s really inspiring to get the chance to work in that environment.”

Text: Susanne Lj Westergren