myo-Inositol and Onset of Gestational DM in Pregnant Women
myo-Inositol and Onset of Gestational DM in Pregnant Women
Objective—To check the hypothesis that myo-inositol supplementation may reduce gestational diabetes mellitus (GDM) onset in pregnant women with a family history of type 2 diabetes.
Research Design and Methods—A 2-year, prospective, randomized, open-label, placebo-controlled study was carried out in pregnant outpatients with a parent with type 2 diabetes who were treated from the end of the first trimester with 2 g myo-inositol plus 200 μg folic acid twice a day (n = 110) and in the placebo group (n = 110), who were only treated with 200 μg folic acid twice a day. The main outcome measure was the incidence of GDM in both groups. Secondary outcome measures were as follows: the incidence of fetal macrosomia (>4,000 g), gestational hypertension, preterm delivery, caesarean section, shoulder dystocia, neonatal hypoglycemia, and neonatal distress respiratory syndrome. GDM diagnosis was performed according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations.
Results—Incidence of GDM was significantly reduced in the myo-inositol group compared with the placebo group: 6 vs. 15.3%, respectively (P = 0.04). In the myo-inositol group, a reduction of GDM risk occurrence was highlighted (odds ratio 0.35). A statistically significant reduction of fetal macrosomia in the myo-inositol group was also highlighted together with a significant reduction in mean fetal weight at delivery. In the other secondary outcome measures, there were no differences between groups.
Conclusions—myo-Inositol supplementation in pregnant women with a family history of type 2 diabetes may reduce GDM incidence and the delivery of macrosomia fetuses.
Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy It is associated with an increased risk for the fetus, including macrosomia and birth injuries for shoulder dystocia, and also for the newborn, such as neonatal hypoglycemia, respiratory distress syndrome, and childhood obesity. Maternal risks include caesarean delivery, hypertensive disorders, and an increased risk of developing type 2 diabetes later in life. Recently, the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study, a multicenter, observational study, evaluated the relationship between maternal hyperglycemia and adverse pregnancy outcomes The study demonstrated a clear and continuous relationship between maternal hyperglycemia and increasing rates of large-for-gestational-age infants, fetal hyperinsulinemia, neonatal hypoglycemia, and caesarean delivery. After, the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) published recommendations for the diagnosis and classification of hyperglycemia during pregnancy In accordance with a very recent report, these new criteria could increase the number of GDM diagnoses to more than double, particularly in women at risk. Among strategies to reduce the occurrence of GDM in high-risk pregnancies, insulin-sensitizing substances, such as metformin, have been used throughout the pregnancy with contrasting results. Another substance primarily used in polycystic ovary syndrome (PCOS), with the aim of lowering hyperinsulinemia and restoring ovarian function, was inositol; it was given either in the isomer d-chiro-inositol or in the myo-inositol isomer Inositol is normally present in cereals, corn, legumes, and meat, and the principal organ in which it is synthesized is the liver; consequently, it is considered a supplement. Recently, our group has shown that myo-inositol may reduce insulin resistance markers in women affected by GDM; thus, in this pilot study the first aim was to reduce GDM onset by giving myo-inositol from the first trimester in women at risk, in particular to those who have a parent affected by type 2 diabetes.
Abstract and Introduction
Abstract
Objective—To check the hypothesis that myo-inositol supplementation may reduce gestational diabetes mellitus (GDM) onset in pregnant women with a family history of type 2 diabetes.
Research Design and Methods—A 2-year, prospective, randomized, open-label, placebo-controlled study was carried out in pregnant outpatients with a parent with type 2 diabetes who were treated from the end of the first trimester with 2 g myo-inositol plus 200 μg folic acid twice a day (n = 110) and in the placebo group (n = 110), who were only treated with 200 μg folic acid twice a day. The main outcome measure was the incidence of GDM in both groups. Secondary outcome measures were as follows: the incidence of fetal macrosomia (>4,000 g), gestational hypertension, preterm delivery, caesarean section, shoulder dystocia, neonatal hypoglycemia, and neonatal distress respiratory syndrome. GDM diagnosis was performed according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations.
Results—Incidence of GDM was significantly reduced in the myo-inositol group compared with the placebo group: 6 vs. 15.3%, respectively (P = 0.04). In the myo-inositol group, a reduction of GDM risk occurrence was highlighted (odds ratio 0.35). A statistically significant reduction of fetal macrosomia in the myo-inositol group was also highlighted together with a significant reduction in mean fetal weight at delivery. In the other secondary outcome measures, there were no differences between groups.
Conclusions—myo-Inositol supplementation in pregnant women with a family history of type 2 diabetes may reduce GDM incidence and the delivery of macrosomia fetuses.
Introduction
Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy It is associated with an increased risk for the fetus, including macrosomia and birth injuries for shoulder dystocia, and also for the newborn, such as neonatal hypoglycemia, respiratory distress syndrome, and childhood obesity. Maternal risks include caesarean delivery, hypertensive disorders, and an increased risk of developing type 2 diabetes later in life. Recently, the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study, a multicenter, observational study, evaluated the relationship between maternal hyperglycemia and adverse pregnancy outcomes The study demonstrated a clear and continuous relationship between maternal hyperglycemia and increasing rates of large-for-gestational-age infants, fetal hyperinsulinemia, neonatal hypoglycemia, and caesarean delivery. After, the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) published recommendations for the diagnosis and classification of hyperglycemia during pregnancy In accordance with a very recent report, these new criteria could increase the number of GDM diagnoses to more than double, particularly in women at risk. Among strategies to reduce the occurrence of GDM in high-risk pregnancies, insulin-sensitizing substances, such as metformin, have been used throughout the pregnancy with contrasting results. Another substance primarily used in polycystic ovary syndrome (PCOS), with the aim of lowering hyperinsulinemia and restoring ovarian function, was inositol; it was given either in the isomer d-chiro-inositol or in the myo-inositol isomer Inositol is normally present in cereals, corn, legumes, and meat, and the principal organ in which it is synthesized is the liver; consequently, it is considered a supplement. Recently, our group has shown that myo-inositol may reduce insulin resistance markers in women affected by GDM; thus, in this pilot study the first aim was to reduce GDM onset by giving myo-inositol from the first trimester in women at risk, in particular to those who have a parent affected by type 2 diabetes.