metformin + aspirin

Metformin is a biguanide small molecule traditionally used as an oral hypoglycemic agent for type 2 diabetes. In a clinical trial led by the Chinese University of Hong Kong (the AVERT trial, NCT05580523), it is being repurposed for the prevention of preterm preeclampsia in high-risk pregnant women. The intervention involves a combination of metformin (titrated up to 1.5 g/day) and low-dose aspirin (75 mg/day). The biological mechanism for preeclampsia prevention involves the activation of Adenosine monophosphate-activated protein kinase (AMPK) signaling pathways, which in turn inhibits oxidative stress and inflammatory responses. Specifically, it regulates the NF-κB/sFlt-1 and Nrf2/HO-1 pathways, potentially reducing the production of anti-angiogenic factors like soluble fms-like tyrosine kinase-1 (sFlt-1) that are central to the pathogenesis of preeclampsia.

Other names

Aspirin vs Metformin for Preterm Preeclampsia PreventionAVERT trial interventionMetformin for preeclampsia prevention