Inositol Nutritional Supplementation for the Prevention of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

This study was aimed at assessing the efficacy and safety of inositol nutritional supplementation during pregnancy for the prevention of GDM. PubMed, Embase, MEDLINE, and Cochrane library were systematically searched for randomized controlled trails (RCTs) in this field until May 2022. Primary outcomes were the incidence for GDM and plasma glucose levels by oral glucose tolerance test (OGTT). Pooled results were expressed as relative risk (RR) or mean difference (MD) with a 95% confidence interval (95% CI). Seven RCTs with 1321 participants were included in this study. Compared with the control group, 4 g myo-inositol (MI) supplementation per day significantly decreased the incidence of GDM (RR = 0.30, 95% CI (0.18, 0.49), p < 0.00001). It significantly decreased the plasma glucose levels of OGTT regarding fasting-glucose OGTT (MD = −4.20, 95% CI (−5.87, −2.54), p < 0.00001), 1-h OGTT (MD = −8.75, 95% CI (−12.42, −5.08), p < 0.00001), and 2-h OGTT (MD = −8.59, 95% CI (−11.81, −5.83), p < 0.00001). It also decreased the need of insulin treatment, and reduced the incidence of preterm delivery and neonatal hypoglycemia. However, no difference was observed between 1.1 g MI per day plus 27.6 mg D-chiro-inositol (DCI) per day and the control group regarding all evaluated results. In conclusion, 4 g MI nutritional supplementation per day during early pregnancy may reduce GDM incidence and severity, therefore may be a practical and safe approach for the prevention of GDM.

Higher early pregnancy plasma myo‐inositol associates with increased postprandial glycaemia later in pregnancy: Secondary analyses of the NiPPeR randomized controlled trial

“…reductions in fasting and 1 h and 2 h PG of 0.09, 0.07 and 0.10 mmol/L, respectively, in White women, being less than the 0.23, 0.49 and 0.48 mmol/L equivalents reported in a meta-analysis of six Italian trials. 13 Unlike White women, a higher 28-week myo-inositol was associated with slightly increased gestational glycaemia in Asian women in our in-silico modelling. This suggests that genetic or lifestyle factors may influence myo-inositol action or myo-inositol-micronutrient interactions in glycaemia regulation.…”

“…Our analyses accounting for folate, and vitamins B12 and D did not alter the 7‐week myo ‐inositol‐glycaemia association. However, we cannot exclude the possibility that other supplement components may weaken 28‐week myo ‐inositol‐glycaemia associations and underlie the relatively modest in‐silico‐estimated supplement‐induced reductions in fasting and 1 h and 2 h PG of 0.09, 0.07 and 0.10 mmol/L, respectively, in White women, being less than the 0.23, 0.49 and 0.48 mmol/L equivalents reported in a meta‐analysis of six Italian trials 13 …”

“…A meta-analysis of six Italian studies (n = 995 women), which started myo-inositol supplementation mostly at the end of the first trimester, reported glycaemia reductions at all three time points of a classic 2-h 75 g oral glucose tolerance test (OGTT) conducted at 24-28 weeks' gestation. 13 In addition, these trials reported accompanying reductions in gestational diabetes incidence and insulin resistance [homeostasis model assessment for insulin resistance (HOMA-IR)]. With these trials showing that myo-inositol supplementation at a daily dose of 4 g is safe and tolerable in pregnancy, some have advocated starting myo-inositol supplementation earlier in gestation or even preconception to improve gestational glycaemia regulation further.…”

“…family history of diabetes, 8,9 high body mass index (BMI), 10,11 polycystic ovary syndrome 12 ] have reported reduced gestational glycaemia. A meta‐analysis of six Italian studies (n = 995 women), which started myo ‐inositol supplementation mostly at the end of the first trimester, reported glycaemia reductions at all three time points of a classic 2‐h 75 g oral glucose tolerance test (OGTT) conducted at 24‐28 weeks' gestation 13 . In addition, these trials reported accompanying reductions in gestational diabetes incidence and insulin resistance [homeostasis model assessment for insulin resistance (HOMA‐IR)].…”

Comparative Genomics of Halobacterium salinarum Strains Isolated from Salted Foods Reveals Protechnological Genes for Food Applications

“…Additionally, this compound is of great interest to the food sector as a nutritional supplement besides cosmetic and pharmaceutical industry applications. Indeed, MI is a polyol that is naturally present in animal and plant cells, and different foods are rich in this compound, such as cereals, legumes, nuts, seeds, and oil [ 67 ]. In eukaryotic cells, MI participates in the transduction of several endocrine signals, including follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH), and insulin.…”