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Myo-inositol, probiotics and micronutrient supplementation from preconception for glycemia in pregnancy: NiPPeR international multi-center double-blind randomized controlled trial

Myo-inositol, probiotics and micronutrient supplementation from preconception for glycemia in pregnancy: NiPPeR international multi-center double-blind randomized controlled trial
Myo-inositol, probiotics and micronutrient supplementation from preconception for glycemia in pregnancy: NiPPeR international multi-center double-blind randomized controlled trial

OBJECTIVE Better preconception metabolic and nutritional health are hypothesized to promote gestational normoglycemia and reduce preterm birth, but evidence supporting improved outcomes with nutritional supplementation starting preconception is limited. RESEARCH DESIGN AND METHODS This double-blind randomized controlled trial recruited from the community 1,729 U.K., Singapore, and New Zealand women aged 18–38 years planning conception. We investigated whether a nutritional formulation containing myo-inositol, probiotics, and multiple micronutrients (intervention), compared with a standard micronutrient supplement (control), taken preconception and throughout pregnancy could improve pregnancy outcomes. The primary outcome was combined fasting, 1-h, and 2-h postload glycemia (28 weeks’ gestation oral glucose tolerance test). RESULTS Between 2015 and 2017, participants were randomized to control (n 5 859) or intervention (n 5 870); 585 conceived within 1 year and completed the primary outcome (295 intervention, 290 control). In an intention-to-treat analysis adjusting for site, ethnicity, and preconception glycemia with prespecified P < 0.017 for multiplicity, there were no differences in gestational fasting, 1-h, and 2-h glycemia between groups (β [95% CI] log e mmol/L intervention vs. control 0.004 [ 0.018 to 0.011], 0.025 [ 0.014 to 0.064], 0.040 [0.004–0.077], respectively). Between the intervention and control groups there were no significant differences in gestational diabetes mellitus (24.8% vs. 22.6%, adjusted risk ratio [aRR] 1.22 [0.92–1.62]), birth weight (adjusted β 5 0.05 kg [ 0.03 to 0.13]), or gestational age at birth (mean 39.3 vs. 39.2 weeks, adjusted β 5 0.20 [ 0.06 to 0.46]), but there were fewer preterm births (5.8% vs. 9.2%, aRR 0.43 [0.22–0.82]), adjusting for prespecified covariates. CONCLUSIONS Supplementation with myo-inositol, probiotics, and micronutrients preconception and in pregnancy did not lower gestational glycemia but did reduce preterm birth.

1935-5548
1091-1099
Godfrey, Keith
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Barton, Sheila
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El-Heis, Sarah
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Kenealy, Timothy
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Nield, Heidi
837b180c-0a9e-49ba-bc2e-a899ef761d34
Baker, Philip N.
e1cd37f8-ad89-4ec9-852a-0de07468abab
Chong, Yap-Seng
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Cutfield, Wayne
a01589bd-5b82-49fa-89e1-137e6f59e24d
Chan, Shiao-Yng
3c9d8970-2cc4-430a-86a7-96f6029a5293
Godfrey, Keith
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
Barton, Sheila
4f674382-ca0b-44ad-9670-e71a0b134ef0
El-Heis, Sarah
6d7d2e03-3d63-4510-8b7e-fcbe4653db13
Kenealy, Timothy
c032e16b-65a8-4156-bc79-422f6c0e7079
Nield, Heidi
837b180c-0a9e-49ba-bc2e-a899ef761d34
Baker, Philip N.
e1cd37f8-ad89-4ec9-852a-0de07468abab
Chong, Yap-Seng
7043124b-e892-4d4b-8bb7-6d35ed94e136
Cutfield, Wayne
a01589bd-5b82-49fa-89e1-137e6f59e24d
Chan, Shiao-Yng
3c9d8970-2cc4-430a-86a7-96f6029a5293

Godfrey, Keith, Barton, Sheila, El-Heis, Sarah, Kenealy, Timothy, Nield, Heidi, Baker, Philip N., Chong, Yap-Seng, Cutfield, Wayne and Chan, Shiao-Yng (2021) Myo-inositol, probiotics and micronutrient supplementation from preconception for glycemia in pregnancy: NiPPeR international multi-center double-blind randomized controlled trial. Diabetes Care, 44 (5), 1091-1099. (doi:10.2337/dc20-2515).

Record type: Article

Abstract

OBJECTIVE Better preconception metabolic and nutritional health are hypothesized to promote gestational normoglycemia and reduce preterm birth, but evidence supporting improved outcomes with nutritional supplementation starting preconception is limited. RESEARCH DESIGN AND METHODS This double-blind randomized controlled trial recruited from the community 1,729 U.K., Singapore, and New Zealand women aged 18–38 years planning conception. We investigated whether a nutritional formulation containing myo-inositol, probiotics, and multiple micronutrients (intervention), compared with a standard micronutrient supplement (control), taken preconception and throughout pregnancy could improve pregnancy outcomes. The primary outcome was combined fasting, 1-h, and 2-h postload glycemia (28 weeks’ gestation oral glucose tolerance test). RESULTS Between 2015 and 2017, participants were randomized to control (n 5 859) or intervention (n 5 870); 585 conceived within 1 year and completed the primary outcome (295 intervention, 290 control). In an intention-to-treat analysis adjusting for site, ethnicity, and preconception glycemia with prespecified P < 0.017 for multiplicity, there were no differences in gestational fasting, 1-h, and 2-h glycemia between groups (β [95% CI] log e mmol/L intervention vs. control 0.004 [ 0.018 to 0.011], 0.025 [ 0.014 to 0.064], 0.040 [0.004–0.077], respectively). Between the intervention and control groups there were no significant differences in gestational diabetes mellitus (24.8% vs. 22.6%, adjusted risk ratio [aRR] 1.22 [0.92–1.62]), birth weight (adjusted β 5 0.05 kg [ 0.03 to 0.13]), or gestational age at birth (mean 39.3 vs. 39.2 weeks, adjusted β 5 0.20 [ 0.06 to 0.46]), but there were fewer preterm births (5.8% vs. 9.2%, aRR 0.43 [0.22–0.82]), adjusting for prespecified covariates. CONCLUSIONS Supplementation with myo-inositol, probiotics, and micronutrients preconception and in pregnancy did not lower gestational glycemia but did reduce preterm birth.

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Accepted/In Press date: 10 February 2021
e-pub ahead of print date: 29 March 2021
Published date: 1 May 2021
Additional Information: Funding Information: The authors thank the participants and their families for their enthu-siastic involvement in the study, the study research staff and hospital clinical staff at participating centers and operational support staff for contributions to the trial, and the members of the independent data monitoring and safety committee for invaluable contributions and for overseeing the conduct of the trial. Funding and Duality of Interest. Public good funding for this investigator-led study is through the Medical Research Council (U.K.) (MRC) as part of an MRC award to the MRC Lifecourse Epidemiology Unit (MC_UU_12011/ 4); the Singapore National Research Foundation, National Medical Research Council (NMRC) (NMRC/TCR/012-NUHS/2014); the National University of Singapore (NUS) and the Agency for Science, Technology and Research (SG) as part of the Growth, Development and Metabolism Programme of the Singapore Institute for Clinical Sciences (H17/01/a0/005); and as part of Gravida, a New Zealand Government Centre of Research Excellence. Funding for provision of the intervention and control drinks and to cover aspects of the fieldwork for the study was provided by Soci?et?e Des Produits Nestl?e S.A. under a research agreement with the University of Southampton, Auckland UniServices Ltd., Singapore Institute for Clinical Sciences, National University Hospital Singapore PTE Ltd., and NUS. K.M.G. is supported by the National Institute for Health Research (NIHR) (Senior Investigator Award NF-SI-0515-10042), NIHR Southampton 1000DaysPlus Global Nutrition Research Group (17/63/154), and NIHR Southampton Biomedical Research Center (IS-BRC-1215-20004); the British Heart Foundation (RG/15/17/3174); and the European Union (Erasmus 1 Programme Early Nutrition eAcademy Southeast Asia 573651-EPP-1-2016-1-DE-EPPKA2-CBHE-JP and ImpENSA 598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP). S.-Y.C. is supported by a Singapore NMRC Clinician Scientist Award (NMRC/CSA-INV/0010/2016). K.M.G., Y.S.C., W.C., and S.-Y.C. report grants from Soci?et?e Des Produits Nestl?e S.A. during the conduct of the study and are co-inventors on patent filings by Nestl?e S.A. relating to the NiPPeR intervention or its components. K.M.G., S.J.B., Y.S.C., W.C., and S.-Y.C. are part of an academic consortium that has received grants from Abbott Nutrition, Nestl?e S.A., Danone, and BenevolentAI Bio Ltd. outside the submitted work. K.M.G. has received reimbursement for speaking at conferences sponsored by companies selling nutritional products. S.-Y.C. has received reimbursement and honoraria into her research funds from Nestl?e S.A. for a half-day consultancy and for speaking at a conference. No other potential conflicts of interest relevant to this article were reported.The funders had no role in the data collection and analysis and the decision to submit for publication. Funding Information: Acknowledgments. The authors thank the participants and their families for their enthusiastic involvement in the study, the study research staff and hospital clinical staff at participating centers and operational support staff for contributions to the trial, and the members of the independent data monitoring and safety committee for invaluable contributions and for overseeing the conduct of the trial. Funding and Duality of Interest. Public good funding for this investigator-led study is through the Medical Research Council (U.K.) (MRC) as part of an MRC award to the MRC Lifecourse Epidemiology Unit (MC_UU_12011/ 4); the Singapore National Research Foundation, National Medical Research Council (NMRC) (NMRC/TCR/012-NUHS/2014); the National University of Singapore (NUS) and the Agency for Science, Technology and Research (SG) as part of the Growth, Development and Metabolism Programme of the Singapore Institute for Clinical Sciences (H17/01/a0/005); and as part of Gravida, a New Zealand Government Centre of Research Excellence. Funding for provision of the intervention and control drinks and to cover aspects of the fieldwork for the study was provided by Société Des Produits Nestlé S.A. under a research agreement with the University of Southampton, Auckland UniServices Ltd., Singapore Institute for Clinical Sciences, National University Hospital Singapore PTE Ltd., and NUS. K.M.G. is supported by the National Institute for Health Research (NIHR) (Senior Investigator Award NF-SI-0515-10042), NIHR Southampton 1000DaysPlus Global Nutrition Research Group (17/63/154), and NIHR Southampton Biomedical Research Center (IS-BRC-1215-20004); the British Heart Foundation (RG/15/17/3174); and the European Union (Erasmus 1 Programme Early Nutrition eAca-demy Southeast Asia 573651-EPP-1-2016-1-DE-EPPKA2-CBHE-JP and ImpENSA 598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP). S.-Y.C. is supported by a Singapore NMRC Clinician Scientist Award (NMRC/CSA-INV/0010/2016). K.M.G., Y.S.C., W.C., and S.-Y.C. report grants from Société Des Produits Nestlé S.A. during the conduct of the study and are co-inventors on patent filings by Nestlé S.A. relating to the NiPPeR intervention or its components. K.M.G., S.J.B., Y.S.C., W.C., and S.-Y.C. are part of an academic consortium that has received grants from Abbott Nutrition, Nestlé S.A., Da-none, and BenevolentAI Bio Ltd. outside the submitted work. K.M.G. has received reimbursement for speaking at conferences sponsored by companies selling nutritional products. S.-Y.C. has received reimbursement and honoraria into her research funds from Nestlé S.A. for a half-day consultancy and for speaking at a conference. No other potential conflicts of interest relevant to this article were reported. Publisher Copyright: © 2021 by the American Diabetes Association.

Identifiers

Local EPrints ID: 447043
URI: http://eprints.soton.ac.uk/id/eprint/447043
ISSN: 1935-5548
PURE UUID: 1a66233b-2266-434b-8f2b-1084346b0d4b
ORCID for Keith Godfrey: ORCID iD orcid.org/0000-0002-4643-0618
ORCID for Sheila Barton: ORCID iD orcid.org/0000-0003-4963-4242
ORCID for Sarah El-Heis: ORCID iD orcid.org/0000-0003-4277-7187

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Date deposited: 02 Mar 2021 17:31
Last modified: 17 Mar 2024 06:20

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Contributors

Author: Keith Godfrey ORCID iD
Author: Sheila Barton ORCID iD
Author: Sarah El-Heis ORCID iD
Author: Timothy Kenealy
Author: Heidi Nield
Author: Philip N. Baker
Author: Yap-Seng Chong
Author: Wayne Cutfield
Author: Shiao-Yng Chan

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