Pre-pregnancy metformin use associated with lower risk of severe nausea and vomiting of pregnancy and hyperemesis gravidarum

Severe nausea and vomiting of pregnancy and hyperemesis gravidarum are associated with adverse maternal, fetal, and child outcomes. The recurrence risk is reported to be as high as 89%. Identifying an effective, safe, and affordable method to prevent hyperemesis gravidarum is critical to reducing risk of reoccurrence and improving maternal, fetal, and child health. We recently demonstrated that genetic predisposition to hyperemesis gravidarum is mediated by low pre-pregnancy levels of the emetogenic hormone Growth and Differentiation Factor 15, resulting in hypersensitivity to its rapid rise during pregnancy. Because metformin increases circulating levels of the Growth and Differentiation Factor 15, we hypothesized that use of metformin before pregnancy will desensitize patients to the hormone and lower the risk of severe nausea and vomiting in pregnancy and hyperemesis gravidarum.