Does Inositol Help Lower the Risk Gestational Diabetes?

In this episode, we explore the role of inositol in gestational diabetes prevention—what it is, how it works, and what the research says. Drawing from a recent comprehensive review, I break down the evidence on supplementation, dosage, safety, and the key limitations dietitians should be aware of. If you’re supporting clients through pregnancy, this episode will give you practical, evidence-based insights to guide your practice.

References and blog post:

https://www.whnlearninghub.com/post/does-inositol-help-prevent-gestational-diabetes-a-comprehensive-review-for-dietitians 

Share you feedback or suggestions for future episodes: hello@whnlearning.com 

Learn more about upcoming courses, resources and our newsletter: www.whnlearninghub.com 

Transcript

0:00

Hi, and welcome to the Femme Health Nutrition Podcast. My name is Nilou Deilami. I'm a registered dietician and founder of the Women's Health Nutrition Learning Hub, a platform where dieticians and nutrition professionals can learn about all things related to female health and nutrition. If you haven't already, you can check out the website, at whnlearninghub.com. On the website, you can find many blog posts on women's health related topics As well as some free resources you can download. You can also join my newsletter where I send biweekly research updates on various topics as well as share new courses and learning opportunities, and I do want to share that I will be launching my next course, which will be on menstrual cycles and menstrual disorders like PCOS and endometriosis and PMS at the end of this month, so if you're interested in that, I have the link for my website as well as the course in the episode description below. And if you're new to the podcast, welcome. I'm so glad you're here and joining us on this journey of learning and growth as professionals. and to those of you who've been listening for a while, a huge thank you for your continued support and commitment to advancing women's health nutrition. And whether you're a new listener or have been tuning in for a while, if you found any value in this. Podcast, I would be so appreciative if you'd subscribe or leave a rating or share the podcast with others. These are signals that will help me know that this work is meaningful and resonating, and it encourages me to keep on going and creating more content. And before we jump into today's topic, I just want to mention as always that this podcast is intended as an educational podcast for dieticians, healthcare professionals, and anyone interested in female health and nutrition. And the content that's covered in this podcast is not intended as medical advice. If you have any questions or concerns about your health, please do consult with your healthcare team. Now, today we're diving into a supplement that's been receiving a lot of attention for its potential use in managing polycystic ovarian syndrome, and that supplement is inositol. But today we're actually looking at whether it can be used for another condition and that is gestational diabetes. so today we'll talk a little bit about what gestational diabetes is and why it happens in some individuals. We'll talk about inositol and the mechanisms behind how it works, and we'll then look at the actual evidence. So we'll look at some of the randomized control trials, meta-analysis reviews that have looked at this supplement and its impact on gestational diabetes risk and. Towards the end, we'll talk about safety dosing and also how we as dieticians and healthcare providers can possibly integrate this into our care and how to have conversations with our clients about it. So let's get into it. So gestational diabetes is a type of carbohydrate intolerance that, first occurs during pregnancy, And the prevalence varies globally, depending on the diagnostic criteria that's used and the population that's being studied. Now when it comes to the pathophysiology, what happens that in pregnancy, placental hormones like human placental, lactogen, progesterone, and cortisol tend to increase insulin resistance, and typically the pancreatic beta cells will compensate. By producing more insulin so it can manage those increasing blood sugars. But when the compensation isn't enough, we have maternal hyperglycemia or high blood sugar in the pregnant individual. Now, why this really matters is that for the mother or for the pregnant individual, there's a higher risk of preeclampsia, C-section, and also progression to type two diabetes later in life. For the fetus, there's a risk that the baby will grow too large and this can complicate delivery. There's also a risk that once the baby is delivered, that there will be what we call neonatal hyperglycemia or low blood sugar in the baby.'cause the baby's used to being in an environment where blood sugar is high. And respiratory distress, and also just other complications with delivery, From a long-term health perspective, that baby may go on to have a higher risk of obesity and metabolic disease later in life as well. So it's really important to screen for gestational diabetes appropriately and to treat it appropriately. Now, most guidelines recommend a two-step approach to screening for gestational diabetes. Different places will use different approaches, but the Diabetes Canada recommendations are a two step approach. First, an oral glucose tolerance challenge. With 50 grams of glucose at 24 to 28 weeks, and if that's abnormal, then followed by a 75 gram oral glucose tolerance test. And there are specific cutoffs for that, in terms of the blood sugar. You can read the exact. Numbers the Diabetes Canada reference that I've included in the show notes. Now when somebody is diagnosed with gestational diabetes, they are usually referred to a clinic. At least that's how it works here in Canada. They are referred to a multidisciplinary clinic where there's usually a dietician, a nurse, and an endocrinologist, and patients are then monitored throughout their pregnancy. What is involved is usually checking the blood sugar several times a day. Again, it will depend on what the endocrinologist thinks is appropriate for that individual carbohydrate modification, so eating a specific amount of carbohydrates. And there's also guidance on things like meal timing and meal composition. So for example, including protein and fiber with each meal. And some patients will require either medication like metformin or insulin. now there's been a little bit of buzz around whether inositol, which is a supplement, can help prevent gestational diabetes. So what is inositol? It is a sugar alcohol and it's found in fruits, beans, grains, nuts. And we also produce in inositol endogenously. So several organs in the body, including the ovaries, for example, will produce in inositol. and there are several forms of, in Atol, The two that are included in the research, most are Myo, inositol and D Chiro inositol. And the way they work is that they both act as secondary messengers in insulin signaling. They make insulin more effective by moving glucose transporters called Glu four transporters to the surface of the cells, and this helps pull glucose out of the blood and into the cells for energy. and individuals who have polycystic ovarian syndrome. The research does show that in inositol can improve insulin sensitivity, menstrual regularity, ovulation and also fertility, especially in individuals who have PCOS. And now these benefits are also being studied in the area of gestational diabetes. So let's dive into some of the research that has been done, So there was one randomized control trial that was done in 2013 and included 220 participants, and these participants had, BMIs of 25 to 30, and they were given two grams of my inositol and 200 micrograms of folic acid twice daily for the first trimester. Versus a placebo control. Interestingly, the risk of gestational diabetes dropped from 27.4% to 11.6% in the Inital group, which was a statistically significant drop. And there are several other reviews and meta-analyses that have kind of pulled together all the evidence. And there was one that found that my. myo-inositol cut gestational diabetes rates from around 28%, down to just 18%, especially when the supplementation was started in early pregnancy. There was another meta-analysis of five trials that showed a 51% reduction in gestational diabetes risk and actually even suggested benefits Beyond blood sugar, including lowering preterm birth rates. And there was this other large systematic review with over 1300 participants. And this review also confirmed that taking four grams of myo-inositol daily not only reduced gestational diabetes risk, but also lowered fasting and post meal glucose during the oral glucose tolerance test for these individuals. Other benefits reported in these systematic reviews are possibly reduced need for insulin therapy, lower fasting insulin, and increased insulin sensitivity scores. So across the board, it seems like myo-inositol supplementation consistently lowers the risk of gestational diabetes and can improve markers of glucose control in these individuals. Now, while the research we have currently does show some promise, we do need to think about the gaps in the research as well. So most of the studies have small sample sizes, and they also had a high risk of bias. So, for example, many of the studies that were included in the systematic reviews and the meta-analyses were actually not double-blinded. From a population and subject diversity standpoint, the majority of studies have been conducted in Italian populations, which does tend to limit the generalizability of these findings. We don't really have any long-term or longitudinal studies to see if the Inositol has any effects on the long-term health of the offspring, such as the risk of childhood obesity, or metabolic syndrome. This still remains unclear. And most of the studies have looked at just myo- inositol. we don't have many studies that look at both myo and D Chiro- Inositol which seems to be a little bit more effective, than myo-inositol alone in the PCOS population. So this is something that would be interesting to look at as well. From a safety perspective inositol is generally well tolerated and safe. There are mild gastrointestinal symptoms, sometimes like a bit of bloating and maybe looser stools in some people. and at this time, no adverse outcomes have been reported in pregnancy. from a dosing perspective, most research supports a dose of four grams of myo-inositol daily, typically divided into two gram doses, usually in the morning and the evening. And this is similar to the dose that is recommended for PCOS. However, this being said, if there's someone who is considering trying an inositol during pregnancy, it is recommended that they consult with their OB GYN endocrinologist or their gestational diabetes team. so how can healthcare professionals translate this into practice? always position in AOL as more of a complimentary tool rather than a replacement for nutrition and lifestyle interventions. And if somebody is thinking of starting supplementation, the research at this time shows that the earlier it started, the more effective it can be. And again, just to emphasize this, it is important to clear this with the OB before starting any sort of supplement, including in. There is also a need for better research, so we need randomized control trials that are larger and more diverse. It would be interesting to see a comparison of Myo-Inositol on its own versus Myo-inositol with D Chiro Inositol Also to figure out when is the best timing? Is it preconception? Is it first trimester? And it would also be interesting to look at long-term benefits. So if somebody takes inositol during pregnancy, does that then influence risk of diabetes or metabolic syndrome later in life? So the bottom line is nasal obviously isn't going to replace the standard care that we already have for gestational diabetes, but it's compelling to learn more about, to see what role it can play in the prevention and management of gestational diabetes. And for those of us who work with these individuals who are at risk, it's great to stay ahead of this research and to be able to give evidence-based and nuanced information to our clients. So again, if you would like to stay up to date on gestational diabetes and all other topics related to women's health, please feel free to visit the WHN Learning Hub website and you can sign up to the newsletter and you can look at the blog posts where I update all of this information regularly. Thank you so much for tuning in. If you found this episode helpful, please feel free to share it with your colleagues and consider giving this episode rating. If you have any feedback for me, if you have any ideas on future episodes, feel free to reach out at hello@whnlearninghub.com I'll include that email in the show notes as well. Thank you again, and I hope you have a lovely day.