An update on the use of inositols in preventing gestational diabetes mellitus (GDM) and neural tube defects (NTDs)

ABSTRACT

Introduction

Obstetric history and maternal body composition and lifestyle may be associated with serious complications both for the mother, such as gestational diabetes mellitus (GDM), and for the fetus, including congenital malformations such as neural tube defects (NTDs).

Areas covered

In view of the recent knowledge, changes in nutritional and physical activity habits ameliorate glycemic control during pregnancy and in turn improve maternal and neonatal health outcomes. Recently, a series of small clinical and experimental studies indicated that supplemenation with inositols, a family of insulin sensitizers, was associated with beneficial impact for both GDM and NTDs.

Expert opinion

Herein, we discuss the most significant scientific evidence supporting myo-inositol administration as a prophylaxis for the above-mentioned conditions.

KEYWORDS:

• D-chiro-inositol (DCI)
• gestational diabetes mellitus (GDM)
• insulin resistance
• myo-inositol (MI)
• neural tube defects (NTDs)
• prevention

Article highlights

• Gestational diabetes mellitus (GDM) and neural tube defects (NTDs) may be highly dependent on maternal nutritional habits, especially on the lack of glycemic control.

• Myo-inositol (MI), because of its role as second messenger of insulin and insulin sensitizer, can prevent the onset of GDM, as well as reduce the risk of recurrence of NTDs, leading to the achievement of a healthy pregnancy.

• After insulin stimulation, MI is transformed into DCI, through an NAD-NADH-dependent epimerase, to maintain a suitable MI:DCI ratio, required for tissue metabolism.

• The concomitant administration of MI and DCI seems to perform less well than MI alone, and when the two stereoisomers were directly compared, women treated with MI alone compared to those who received MI plus DCI or DCI alone showed largest benefit.

• For congenital malformations like NTDs, MI peri-conceptional supplementation could represent a novel means of prevention, particularly in those women resistant to folic acid (FA) supplementation.

Declaration of interest

V Unfer is an employee at Lo. Li. Pharma s.r.l., Rome, Italy. F Facchinetti has been a consultant of the same company. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.