Myo-Inositol for Gestational Diabetes

Gestational Diabetes Mellitus (GDM) poses challenges during pregnancy, but emerging research suggests that Myo-Inositol (MI) supplementation may offer a promising solution. In this blog, we'll explore the latest findings on GDM, the potential benefits of MI, and its role in minimising pregnancy complications.

What is GDM?

GDM is one of the most frequent complications in pregnancy, impacting over 10% of pregnancies. It is triggered by hormonal shifts during pregnancy which slow down food digestion, facilitating greater nutrient transfer to the fetus but simultaneously increasing insulin resistance. GDM is generally diagnosed through the OGTT test (this is another topic to unpack).

Complications of GDM include; pre-term birth (before 37 weeks gestation), macrosomia (birth weight ≥4 kg) and gestational hypertension. 

Who is at risk?

Various factors increase the risk of developing GDM including:

• Being overweight or obese
• Consuming a diet high in processed foods
• Sedentary lifestyle
• Ethnicity
• Polycystic ovary syndrome (PCOS)
• Personal or family history of diabetes
• Previous instances of GDM in earlier pregnancies.

It's essential to identify and manage GDM effectively, as it can affect both the mother and baby's health, during pregnancy and potentially lead to long-term health issues.

Conventional Treatment:

Conventional treatment for GDM primarily focuses on diet modification and, if necessary, insulin therapy. Dietary management is the cornerstone of treatment, involving a balanced diet that controls glucose levels while meeting the nutritional needs of both the mother and the developing fetus. Regular physical activity is also recommended to improve glucose control. If diet and exercise alone are insufficient to control blood glucose levels, insulin therapy may be indicated. Insulin is preferred over oral hypoglycaemic agents as it does not cross the placenta and thus is safer for the fetus. The goal of treatment is to maintain blood glucose levels within a target range, thereby reducing the risk of complications for both the mother and the baby.

The Promise of Myo-Inositol (MI):

As one of the intracellular mediators of insulin signalling, MI demonstrates a correlation with insulin sensitivity in type 2 diabetes. This promising effect positions MI as a valuable supplement for minimising the risk of GDM, offering a potential avenue for managing insulin resistance during pregnancy.

Administered from the first trimester until delivery to women at risk for GDM, MI showcased a remarkable decrease in GDM occurrence by more than 60% compared to the placebo group. Recent secondary analyses from three randomised controlled trials further underscore MI's potential in significantly reducing GDM complications, such as pre-term birth and macrosomia, positively impacting the well-being of both mother and fetus.

While additional studies are needed to further validate these findings, MI has a high safety profile during pregnancy and breastfeeding. With minimal to no negative side effects. Incorporating MI into one's routine, alongside other recommended lifestyle changes, emerges as a proactive measure for managing and preventing GDM.

Research Findings:

Reducing GDM Incidence:

• Studies have shown that MI supplementation may significantly decrease the occurrence of gestational diabetes by more than 60%, compared to a placebo group. This reduction in incidence is particularly noteworthy for overweight women (1)
• The studies are altogether positive and show MI as an effective (50%) treatment in preventing GDM in overweight women (2)
• A meta-analysis showed that MI may reduce the incidence of gestational diabetes by improving insulin sensitivity (3)(5)
• MI supplementation could lead to remarkably reduced incidence of gestational diabetes, reduced 2-h glucose OGTT, increased gestational age at birth and decreased incidence of preterm delivery (4)

Preventing Complications & Improving Maternal Outcomes:

• Myo-Inositol has demonstrated efficacy in reducing complications associated with gestational diabetes, such as preterm birth and macrosomia. These positive outcomes contribute to the overall well-being of both the mother and the fetus (1)
• Evidence from seven studies shows that antenatal dietary supplementation with myo-inositol during pregnancy may reduce the incidence of gestational diabetes, hypertensive disorders of pregnancy and preterm birth (6)
• Based on the results, MI has shown to be a new and safe preventive strategy in reducing the incidence of GDM and in regulating FG and 1-h and 2-h OGTT levels, and also in reducing the incidence of GDM complications such as preterm delivery and gestational hypertension in pregnant women with overweight and obesity (7)
• Women with GDM treated with MI showed an improved glycaemic control in the 3^rd trimester of pregnancy and a lower insulin requirement, when insulin was added to the treatment, compared to controls. In addition, they showed lower preterm birth weight and neonatal hypoglycaemia, compared to women not supplemented with MI. (8)
• MI supplementation is effective to reduce the incidence of gestational diabetes, 2-h glucose OGTT, HOMA-IR and preterm delivery, which suggested that MI supplementation should be recommended to prevent gestational diabetes (9)
• MI decrease the incidence of GDM in pregnancies high-risk for GDM. Moreover, MI supplementation reduces the risk of insulin need, preeclampsia or gestational hypertension, preterm birth, and neonatal hypoglycaemia. Based on the present study 2-4 g MI can be suggested from the first trimester to prevent GDM and related outcomes (10)

Safe & Effective Supplementation: 

• Inositol administration during pregnancy appears to be safe and may represent a novel strategy for GDM prevention. In particular, the double administration of MYO 2 g per day may improve the glycemic homeostasis and may reduce GDM rate and preterm delivery rate (11)

Recommendations & Future Research:
Considering the positive outcomes observed in the studies, the incorporation of MI into prenatal care for women at risk of GDM is a proactive and safe approach. Ongoing and future research should explore MI supplementation in diverse populations, including women of different ethnicities and varying risk factors. Comparative studies with placebos, diet and exercise interventions, and other pharmacological approaches will provide a more comprehensive understanding of MI efficacy.

Conclusion:
MI supplementation, emerges as a promising strategy for preventing GDM and associated complications. The research findings suggest that a daily dose of 4g of MI during early pregnancy may significantly reduce the incidence and severity of GDM. This not only highlights the potential of MI as a preventive measure but also underscores its role in enhancing maternal and fetal well-being. As we continue to unravel the complexities of GDM, embracing safe and effective preventive strategies like MI supplementation becomes a crucial aspect of nurturing a healthy pregnancy. Always consult with healthcare professionals before incorporating any supplements into your prenatal care routine.

References:

(1) D'Anna R, Santamaria A, Alibrandi A, Corrado F, DI Benedetto A, Facchinetti F. Myo-Inositol for the Prevention of Gestational Diabetes Mellitus. A Brief Review. J Nutr Sci Vitaminol (Tokyo). 2019;65(Supplement):S59-S61. doi: 10.3177/jnsv.65.S59. PMID: 31619648.

(2) Asimakopoulos, G., Pergialiotis, V., Anastasiou, E. et al. Effect of dietary myo-inositol supplementation on the insulin resistance and the prevention of gestational diabetes mellitus: study protocol for a randomized controlled trial. Trials 21, 633 (2020). https://doi.org/10.1186/s13063-020-04561-

(3) Motuhifonua SK, Lin L, Alsweiler J, Crawford TJ, Crowther CA. Antenatal dietary supplementation with myo‐inositol for preventing gestational diabetes. Cochrane Database of Systematic Reviews 2023, Issue 2. Art. No.: CD011507. DOI: 10.1002/14651858.CD011507.pub3. Accessed 29 February 2024.

(4) Li L, Fang J. Myo-inositol supplementation for the prevention of gestational diabetes: A meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2022 Jun;273:38-43. doi: 10.1016/j.ejogrb.2022.04.009. Epub 2022 Apr 13. PMID: 35460931.

(5) Sobota-Grzeszyk A, Kuźmicki M, Szamatowicz J. Myoinositol in the Prevention of Gestational Diabetes Mellitus: Is It Sensible? J Diabetes Res. 2019 Dec 7;2019:3915253. doi: 10.1155/2019/3915253. PMID: 31886278; PMCID: PMC6925787.

(6) Motuhifonua SK, Lin L, Alsweiler J, Crawford TJ, Crowther CA. Antenatal dietary supplementation with myo-inositol for preventing gestational diabetes. Cochrane Database Syst Rev. 2023 Feb 15;2(2):CD011507. doi: 10.1002/14651858.CD011507.pub3. PMID: 36790138; PMCID: PMC9930614.

(7) Mashayekh-Amiri S, Mohammad-Alizadeh-Charandabi S, Abdolalipour S, Mirghafourvand M. Myo-inositol supplementation for prevention of gestational diabetes mellitus in overweight and obese pregnant women: a systematic review and meta-analysis. Diabetol Metab Syndr. 2022 Jul 6;14(1):93. doi: 10.1186/s13098-022-00862-5. PMID: 35794663; PMCID: PMC9258131.

(8) Guarnotta V, Cuva G, Imbergamo MP, Giordano C. Myoinositol supplementation in the treatment of gestational diabetes mellitus: effects on glycaemic control and maternal-foetal outcomes. BMC Pregnancy Childbirth. 2022 Jun 26;22(1):516. doi: 10.1186/s12884-022-04852-3. PMID: 35754028; PMCID: PMC9233779.

(9) Liu Q, Liu Z. The efficacy of myo-inositol supplementation to reduce the incidence of gestational diabetes: a meta-analysis. Gynecol Endocrinol. 2022 Jun;38(6):450-454. doi: 10.1080/09513590.2022.2071865. Epub 2022 May 16. PMID: 35575290.

(10) Greff D, Váncsa S, Váradi A, Szinte J, Park S, Hegyi P, Nyirády P, Ács N, Horváth EM, Várbíró S. Myoinositols Prevent Gestational Diabetes Mellitus and Related Complications: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2023 Sep 30;15(19):4224. doi: 10.3390/nu15194224. PMID: 37836508; PMCID: PMC10574514.

(11) Vitagliano A, Saccone G, Cosmi E, Visentin S, Dessole F, Ambrosini G, Berghella V. Inositol for the prevention of gestational diabetes: a systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet. 2019 Jan;299(1):55-68. doi: 10.1007/s00404-018-5005-0. Epub 2018 Dec 18. PMID: 30564926.