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Archives of Gynecology and Obstetrics
Published in: Archives of Gynecology and Obstetrics 1/2019

01-01-2019 | Review

Inositol for the prevention of gestational diabetes: a systematic review and meta-analysis of randomized controlled trials

Authors: Amerigo Vitagliano, Gabriele Saccone, Erich Cosmi, Silvia Visentin, Francesco Dessole, Guido Ambrosini, Vincenzo Berghella

Published in: Archives of Gynecology and Obstetrics | Issue 1/2019

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Abstract

Purpose

Inositol (ISL) embraces a family of simple carbohydrates with insulin-sensitizing properties, whose most common isoforms are Myo-inositol (MYO) and d-chiro inositol (DCI). The aim of the present study was to assess the efficacy and safety of ISL supplementation during pregnancy for the prevention of gestational diabetes (GDM).

Methods

We conducted a systematic literature search in electronic databases until October 2017. We included all randomized controlled trials (RCTs) comparing pregnant women with GDM who were randomized to either ISL (i.e., intervention group) or either placebo or no treatment (i.e., control group). The primary outcome was the preventive effect on GDM, defined as the rate of GDM in women without a prior diagnosis of GDM. Pooled results were expressed as odds ratio (OR) with a 95% confidence interval (95% CI).

Results

Five RCTs were included (including 965 participants). ISL supplementation was associated with lower rate of GDM (OR 0.49, 95% CI 0.24–1.03, p = 0.01) and lower preterm delivery rate (OR 0.35, 95% CI 0.17–0.74, p = 0.006). No adverse effects were reported. Adjusting for the type of intervention (MYO 2 g twice daily vs MYO 1100 mg plus DCI 27.6 mg daily), a significant effect was found only in patients receiving 2 g MYO twice daily.

Conclusions

ISLs 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.
Appendix
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Literature
1.
Baz B, Riveline JP, Gautier JF (2016) Endocrinology of pregnancy: gestational diabetes mellitus: definition, aetiological and clinical aspects. Eur J Endocrinol 174(2):R43–R51CrossRef
2.
Caissutti C, Berghella V (2017) Scientific evidence for different options for GDM screening and management: controversies and review of the literature. Biomed Res Int 2017:2746471CrossRef
3.
Farrar D, Simmonds M, Bryant M, Sheldon TA, Tuffnell D, Golder S, Dunne F, Lawlor DA (2016) Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis. BMJ 13(354):i4694CrossRef
4.
Vitagliano A, Noventa M, Gizzo S (2015) Is it time to consider patients suffering from endometriosis-related infertility as “novel candidates” for targeted peri-conceptional d-chiro inositol supplementation? Hypothesis, rationale and some considerations. J Assist Reprod Genet 32(3):407–408CrossRef
5.
Pintaudi B, Di Vieste G, Bonomo M (2016) The effectiveness of Myo-inositol and d-chiro inositol treatment in type 2 diabetes. Int J Endocrinol 2016:9132052CrossRef
6.
Dell’Edera D, Sarlo F, Allegretti A, Simone F, Lupo MG, Epifania AA (2017) The influence of d-chiro-inositol and d-myo-inositol in pregnant women with glucose intolerance. Biomed Rep. 7(2):169–172CrossRef
7.
Muscogiuri G, Palomba S, Laganà AS, Orio F (2016) Inositols in the treatment of insulin-mediated diseases. Int J Endocrinol 2016:3058393PubMedPubMedCentral
8.
Noventa M, Vitagliano A, Quaranta M, Borgato S, Abdulrahim B, Gizzo S (2016) Preventive and therapeutic role of dietary inositol supplementation in periconceptional period and during pregnancy: a summary of evidences and future applications. Reprod Sci 23(3):278–288CrossRef
9.
Nas K, Tűű L (2017) A comparative study between myo-inositol and metformin in the treatment of insulin-resistant women. Eur Rev Med Pharmacol Sci 21(2 Suppl):77–82PubMed
10.
Costabile L, Unfer V (2017) Treatment of gestational diabetes mellitus with myo-inositol: analyzing the cutting edge starting from a peculiar case. Eur Rev Med Pharmacol Sci. 21(2 Suppl):73–76PubMed
11.
Crawford TJ, Crowther CA, Alsweiler J, Brown J (2015) Antenatal dietary supplementation with myo-inositol in women during pregnancy for preventing gestational diabetes. Cochrane Database Syst Rev. 12:CD011507
12.
Santamaria A, Di Benedetto A, Petrella E, Pintaudi B, Corrado F, D’Anna R, Neri I, Facchinetti F (2016) Myo-inositol may prevent gestational diabetes onset in overweight women: a randomized, controlled trial. J Matern Fetal Neonatal Med 29(19):3234–3237CrossRef
13.
Farren M, Daly N, McKeating A, Kinsley B, Turner MJ, Daly S (2017) The prevention of gestational diabetes mellitus with antenatal oral inositol supplementation: a randomized controlled trial. Diabetes Care 40(6):759–763CrossRef
14.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097CrossRef
15.
Corrado F, D’Anna R, Di Vieste G, Giordano D, Pintaudi B, Santamaria A, DiBenedetto A (2011) The effect of myoinositol supplementation on insulin resistance inpatients with gestational diabetes. Diabet Med 28(8):972–975CrossRef
16.
Matarrelli B, Vitacolonna E, D’Angelo M, Pavone G, Mattei PA, Liberati M, Celentano C (2013) Effect of dietary myo-inositol supplementation in pregnancy on theincidence of maternal gestational diabetes mellitus and fetal outcomes: a randomized controlled trial. J Matern Fetal Neonatal Med 26(10):967–972CrossRef
17.
Malvasi A, Kosmas I, Mynbaev OA, Sparic R, Gustapane S, Guido M, Tinelli A (2017) Can trans resveratrol plus d-chiro-inositol and myo-inositol improve maternal metabolic profile in overweight pregnant patients? Clin Ther 168(4):e240–e247
18.
Lubin V, Shojai R, Darmon P, Cosson E (2016) A pilot study of gestational diabetes mellitus not controlled by diet alone: first-line medical treatment with myoinositol may limit the need for insulin. Diabetes Metab 42(3):192–195CrossRef
19.
Ferrari F, Facchinetti F, Ontiveros AE, Roberts RP, Saade MM, Blackwell SC, Sibai BM, Refuerzo JS, Longo M (2016) The effect of combined inositol supplementation on maternal metabolic profile in pregnancies complicated by metabolic syndrome and obesity. Am J Obstet Gynecol 215(4):503.e1–503.e8CrossRef
20.
Groenen PM, Roes EM, Peer PG, Merkus HM, Steegers EA, Steegers-Theunissen RP (2006) Myo-inositol, glucose and zinc concentrations determined in the preconceptional period, during and after pregnancy. Eur J Obstet Gynecol Reprod Biol 127(1):50–55CrossRef
21.
Facchinetti F, Pignatti L, Interdonato ML, Neri I, Bellei G, D’Anna R (2013) Myoinositol supplementation in pregnancies at risk for gestational diabetes. Interim analysis of a randomized controlled trial (RCT). Am J Obstet Gynecol 208(1):S36 (ISN: 0002-9378) CrossRef
22.
Malvasi A, Casciaro F, Minervini MM, Kosmas I, Mynbaev OA, Pacella E, MontiCondesnitt V, Creanza A, Di Renzo GC, Tinelli A (2014) Myo-inositol, d-chiro-inositol, folic acid and manganese in secondtrimester of pregnancy: a preliminaryinvestigation. Eur Rev Med Pharmacol Sci 18(2):270–274PubMed
23.
D’Anna R, Scilipoti A, Giordano D, Caruso C, Cannata ML, Interdonato ML, Corrado F, Di Benedetto A (2013) myo-Inositol supplementation and onset of gestational diabetes mellitus in pregnant women with a family history of type 2 diabetes: a prospective, randomized, placebo-controlled study. Diabetes Care 36(4):854–857CrossRef
24.
DʼAnna R, Di Benedetto A, Scilipoti A, Santamaria A, Interdonato ML, Petrella E, Neri I, Pintaudi B, Corrado F, Facchinetti F (2015) Myo-inositol supplementation for prevention of gestational diabetes in obese pregnant women: a randomized controlled trial. Obstet Gynecol 126(2):310–315CrossRef
25.
International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva Ad, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3):676–682CrossRef
26.
Ferrara A (2007) Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care 30(Suppl 2):S141–S146 (Erratum in: Diabetes Care. 2007 Dec;30(12):3154) CrossRef
27.
Poomalar GK (2015) Changing trends in management of gestational diabetes mellitus. World J Diabetes 6(2):284–295CrossRef
28.
Rajput M, Bairwa M, Rajput R (2014) Prevalence of gestational diabetes mellitus in rural Haryana: a community-based study. Indian J Endocrinol Metab 18(3):350–354CrossRef
29.
McCance DR (2011) Pregnancy and diabetes. Best Pract Res Clin Endocrinol Metab 25(6):945–958CrossRef
30.
Vitagliano A, Quaranta M, Noventa M, Gizzo S (2015) “Empiric” inositol supplementation in normal-weight non insulin resistant women with polycystic ovarian disease: from the absence of benefit to the potential adverse effects. Arch Gynecol Obstet 291(5):955–957CrossRef
31.
Celentano C, Matarrelli B, Mattei PA, Pavone G, Vitacolonna E, Liberati M (2016) Myo-Inositol supplementation to prevent gestational diabetes mellitus. Curr Diab Rep 16(3):30CrossRef
32.
Laganà AS, Garzon S, Casarin J, Franchi M, Ghezzi F (2018) Inositol in polycystic ovary syndrome: restoring fertility through a pathophysiology-based approach. Trends Endocrinol Metab 29(11):768–780CrossRef
33.
Larner J, Craig JW (1996) Urinary myo-inositol-to-chiro-inositol ratios and insulin resistance. Diabetes Care 19(1):76–78CrossRef
34.
Heimark D, McAllister J, Larner J (2014) Decreased myo-inositol to chiro-inositol (M/C) ratios and increased M/C epimerase activity in PCOS theca cells demonstrate increased insulin sensitivity compared to controls. Endocr J 61(2):111–117 (Epub 2013 Nov 2) CrossRef
35.
Pundir J, Psaroudakis D, Savnur P, Bhide P, Sabatini L, Teede H, Coomarasamy A, Thangaratinam S (2018) Inositol treatment of anovulation in women with polycystic ovary syndrome: a meta-analysis of randomised trials. BJOG 125(3):299–308CrossRef
36.
Pintaudi B, Di Vieste G, Bonomo M (2016) The effectiveness of Myo-inositol and d-chiro inositol treatment in type 2 diabetes. Int J Endocrinol 2016:9132052CrossRef
37.
Laganà AS, Vitagliano A, Noventa M, Ambrosini G, D’Anna R (2018) Myo-inositol supplementation reduces the amount of gonadotropins and length of ovarian stimulation in women undergoing IVF: a systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet 298(4):675–684CrossRef
38.
Papaleo E, Unfer V, Baillargeon JP, De Santis L, Fusi F, Brigante C, Marelli G, Cino I, Redaelli A, Ferrari A (2007) Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction. Gynecol Endocrinol 23(12):700–703CrossRef
39.
Plows JF, Budin F, Andersson RA, Mills VJ, Mace K, Davidge ST, Vickers MH, Baker PN, Silva-Zolezzi I, Stanley JL (2017) The effects of Myo-Inositol and B and D vitamin supplementation in the db/+mouse model of gestational diabetes mellitus. Nutrients. https://​doi.​org/​10.​3390/​nu9020141
40.
Orrù B, Circo R, Logoteta P, Petousis S, Carlomagno G (2017) Finding the best therapeutic approach for PCOS: the importance of inositol(s) bioavailability. Eur Rev Med Pharmacol Sci 21(2 Suppl):83–88PubMed
Metadata
Title
Inositol for the prevention of gestational diabetes: a systematic review and meta-analysis of randomized controlled trials
Authors
Amerigo Vitagliano
Gabriele Saccone
Erich Cosmi
Silvia Visentin
Francesco Dessole
Guido Ambrosini
Vincenzo Berghella
Publication date
01-01-2019
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 1/2019
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-018-5005-0

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