Background: Pre-eclampsia causes high maternal and newborn mortality. Hypertensive diseases during pregnancy kill Egyptian mothers and 10% of pregnant women worldwide. Preterm pre-eclampsia, a severe variant, increases mother and infant risks. Delivery is the only therapy, which might cause difficulties in premature situations. Metformin, a blood glucose medicine, may cure pre-eclampsia, according to preclinical research. However, safe and effective preterm pre-eclampsia medications are required.
Aim of the Work: The study aims to investigate whether or not metformin with extended release can lengthen pregnancy in women who have been diagnosed with premature pre-eclampsia.
Patients and Methods: A double-blind, placebo-controlled clinical trial was done involving cases diagnosed with preterm pre-eclampsia between 26+0 and 31+6 weeks of gestation. The cases were given either extended release metformin or a placebo according to a random assignment. Maternal and fetal surveillance was conducted, and various outcome measures were assessed, including gestation prolongation, fetal, composite maternal, and levels of anti-angiogenic biomarkers related to pre-eclampsia, and neonatal outcomes.
 Results: The study found that there was no significant variance in the characteristics of women among the two groups. Gestation was significantly prolonged in the metformin group contrasted with the placebo group. The incidence of HELLP syndrome was significantly greater in the placebo group. Other outcomes did not show significant differences among the groups, except for a higher number of cases reaching 34 weeks' gestation in the metformin group.
Conclusion: The findings suggest that preterm preeclamptic women may benefit from using extended-release metformin to prolong gestation. However, more study is required to fully evaluate its safety and effectiveness as a treatment option.