The influence of different inositol stereoisomers supplementation in pregnancy on  maternal gestational diabetes mellitus and fetal outcomes in high-risk patients:  a randomized controlled trial

Claudio Celentano; Barbara Matarrelli; Giulia Pavone; Ester Vitacolonna; Peter A Mattei; Vincenzo Berghella; Marco Liberati

doi:10.1080/14767058.2018.1500545

Therapeutics Metabolic and Endocrine Agents

The influence of different inositol stereoisomers supplementation in pregnancy on maternal gestational diabetes mellitus and fetal outcomes in high-risk patients: a randomized controlled trial

Celentano C, Matarrelli B, Pavone G, Vitacolonna E, Mattei PA, Berghella V, Liberati M

Published March 2020 The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 33(5), 743-751

DOI 10.1080/14767058.2018.1500545 PMID 30558466

RRM Academy Synopsis

Myo-inositol lowered abnormal glucose tests in high-risk pregnancy

A randomized trial in Chieti, Italy, tested myo-inositol in pregnancy. Fewer than 1 out of 10 women taking myo-inositol had an abnormal glucose test, against about 6 out of 10 controls. The 180 women were nonobese, had high fasting glucose early in pregnancy, and were split into four groups.

Key Findings

Abnormal glucose tolerance test: 5.1% (2/39) with myo-inositol, 34.4% (11/32) with D-chiro-inositol, 38.2% (13/34) with the combination, 61.5% (32/52) in controls (p < .001).
Insulin therapy was needed by 9 of 52 controls, 1 of 39 on myo-inositol, 5 of 32 on D-chiro-inositol and 3 of 34 on the combination (p = .134).
Neonatal hypoglycemia occurred in 11 of 52 control newborns and in none of 39 in the myo-inositol group (p = .023).
Gestational age at delivery was significantly higher in the myo-inositol group (p = .025 by ANOVA).
No participant reported an adverse reaction to the supplements.

Interpretation

This randomized controlled trial followed 180 nonobese women. Early in pregnancy, each had high fasting glucose. Doctors split the women into four groups: myo-inositol, D-chiro-inositol, a combination of both, or a control group. Myo-inositol lowered the rate of abnormal glucose tests, cut neonatal hypoglycemia, and led to a later gestational age at delivery. The authors note that larger studies are needed to check rarer outcomes like macrosomia and perinatal death. The findings support larger trials of myo-inositol in high-risk pregnancy.

RRM Context

Insulin resistance is a root cause restorative reproductive medicine looks for. Earlier studies found myo-inositol lowered insulin resistance in women with polycystic ovaries. Some women in this trial had that history. The condition has a new name now: PMOS, short for Polyendocrine Metabolic Ovarian Syndrome, formerly PCOS.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To identify the effects of different dietary inositol stereoisomers on insulin resistance and the development of gestational diabetes mellitus (GDM) in women at high risk for this disorder.

Design

A preliminary, prospective, randomized, placebo controlled clinical trial.

Participants

Nonobese singleton pregnant women with an elevated fasting glucose in the first or early second trimester were studied throughout pregnancy.

Intervention

Supplementation with myo-inositol, d-chiro-inositol, combined myo- and d-chiro-inositol or placebo.

Main Outcome Measures

Development of GDM on a 75 grams oral glucose tolerance test at 24-28 weeks' gestation. Secondary outcome measures were increase in BMI, need for maternal insulin therapy, macrosomia, polyhydramnios, neonatal birthweight and hypoglycemia.

Results

The group of women allocated to receive myo-inositol alone had a lower incidence of abnormal oral glucose tolerance test (OGTT). Nine women in the control group (C), one of the myo-inositol (MI), five in d-chiro-inositol (DCI), three in the myo-inositol/D-chiro-inositol group (MI/DCI) required insulin (p = .134). Basal, 1-hour, and 2 hours glycemic controls were significantly lower in exposed groups (p < .001, .011, and .037, respectively). The relative risk reduction related to primary outcome was 0.083, 0.559, and 0.621 for MI, DCI, and MI/DCI groups.

Conclusions

This study compared the different inositol stereoisomers in pregnancy to prevent GDM. Noninferiority analysis demonstrated the largest benefit in the myo-inositol group. The relevance of our findings is mainly related to the possibility of an effective approach in GDM. Our study confirmed the efficacy of inositol supplementation in pregnant women at risk for GDM.

Topics

Therapeutics › Metabolic and Endocrine Agents › Insulin Sensitizing Agents · Lifestyle and Environment › Nutrition and Metabolic Health › Blood Sugar and Insulin · Pregnancy › Pregnancy Complications › Gestational Diabetes

Claudio Celentano, Barbara Matarrelli, Giulia Pavone, Ester Vitacolonna, Peter A Mattei, Vincenzo Berghella, Marco Liberati

C Celentano, Barb Matarrelli, B Matarrelli, G Pavone, E Vitacolonna, Pete Mattei, P Mattei, V Berghella, M Liberati

PMID 30558466 30558466 DOI 10.1080/14767058.2018.1500545 10.1080/14767058.2018.1500545 Celentano et al. 2020, Celentano 2020

Keywords

Vitamin B Complex, Inositol