Higher early pregnancy plasma myo-inositol associates with increased postprandial glycaemia later in pregnancy: secondary analyses of the NiPPeR randomized controlled trial
Higher early pregnancy plasma myo-inositol associates with increased postprandial glycaemia later in pregnancy: secondary analyses of the NiPPeR randomized controlled trial
Aim: myo-inositol supplementation from ~13 weeks' gestation reportedly improves glycaemia regulation in metabolically at-risk women, with speculation that earlier supplementation might bring further improvement. However, the NiPPeR trial of a myo-inositol-containing supplement starting preconception did not lower gestational glycaemia in generally healthy women. We postulated that the earlier timing of supplementation influences the maternal metabolic adaptation for gestational glycaemia regulation.
Methods: in total, 585 women were recruited from Singapore, UK and New Zealand for the NiPPeR study. We examined associations of plasma myo-inositol concentrations at 7 and 28 weeks' gestation with 28 weeks plasma glucose (PG; fasting, and 1 h and 2 h in 75 g oral glucose tolerance test) and insulin indices using linear regression adjusting for covariates.
Results: higher 7-week myo-inositol, but not 28-week myo-inositol, associated with higher 1 h PG [βadj (95% confidence intervals) 0.05 (0.01, 0.09) loge mmol/L per loge μmol/L, p = .022] and 2 h PG [0.08 (0.03, 0.12), p = .001]; equivalent to 0.39 mmol/L increase in 2 h PG for an average 7-week myo-inositol increase of 23.4 μmol/L with myo-inositol supplementation. Higher 7-week myo-inositol associated with a lower 28-week Stumvoll index (first phase), an approximation of insulin secretion [-0.08 (-0.15, -0.01), p = .020] but not with 28-week Matsuda insulin sensitivity index. However, the clinical significance of a 7-week myo-inositol-related increase in glycaemia was limited as there was no association with gestational diabetes risk, birthweight and cord C-peptide levels. In-silico modelling found higher 28-week myo-inositol was associated with lower gestational glycaemia in White, but not Asian, women after controlling for 7-week myo-inositol effects.
Conclusion: to our knowledge, our study provides the first evidence that increasing first trimester plasma myo-inositol may slightly exacerbate later pregnancy post-challenge glycaemia, indicating that the optimal timing for starting prenatal myo-inositol supplementation needs further investigation.
gestational diabetes, glucose, inositol, insulin, pregnancy, supplementation
1658-1669
Chan, Shiao-Yng
3c9d8970-2cc4-430a-86a7-96f6029a5293
Zhang, Han
be995ae3-ca78-4f48-a3cf-02ed7ed20710
Wong, Jui-Tsung
c9b0cf5d-b75d-4a23-b13c-4e47f1fd83c3
Barton, Sheila J.
4f674382-ca0b-44ad-9670-e71a0b134ef0
Nield, Heidi
837b180c-0a9e-49ba-bc2e-a899ef761d34
El-Heis, Sarah
6d7d2e03-3d63-4510-8b7e-fcbe4653db13
Godfrey, Keith Mm
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
May 2024
Chan, Shiao-Yng
3c9d8970-2cc4-430a-86a7-96f6029a5293
Zhang, Han
be995ae3-ca78-4f48-a3cf-02ed7ed20710
Wong, Jui-Tsung
c9b0cf5d-b75d-4a23-b13c-4e47f1fd83c3
Barton, Sheila J.
4f674382-ca0b-44ad-9670-e71a0b134ef0
Nield, Heidi
837b180c-0a9e-49ba-bc2e-a899ef761d34
El-Heis, Sarah
6d7d2e03-3d63-4510-8b7e-fcbe4653db13
Godfrey, Keith Mm
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
Chan, Shiao-Yng, Zhang, Han and Wong, Jui-Tsung
,
et al. and NiPPeR Study Group
(2024)
Higher early pregnancy plasma myo-inositol associates with increased postprandial glycaemia later in pregnancy: secondary analyses of the NiPPeR randomized controlled trial.
Diabetes, Obesity and Metabolism, 26 (5), .
(doi:10.1111/dom.15468).
Abstract
Aim: myo-inositol supplementation from ~13 weeks' gestation reportedly improves glycaemia regulation in metabolically at-risk women, with speculation that earlier supplementation might bring further improvement. However, the NiPPeR trial of a myo-inositol-containing supplement starting preconception did not lower gestational glycaemia in generally healthy women. We postulated that the earlier timing of supplementation influences the maternal metabolic adaptation for gestational glycaemia regulation.
Methods: in total, 585 women were recruited from Singapore, UK and New Zealand for the NiPPeR study. We examined associations of plasma myo-inositol concentrations at 7 and 28 weeks' gestation with 28 weeks plasma glucose (PG; fasting, and 1 h and 2 h in 75 g oral glucose tolerance test) and insulin indices using linear regression adjusting for covariates.
Results: higher 7-week myo-inositol, but not 28-week myo-inositol, associated with higher 1 h PG [βadj (95% confidence intervals) 0.05 (0.01, 0.09) loge mmol/L per loge μmol/L, p = .022] and 2 h PG [0.08 (0.03, 0.12), p = .001]; equivalent to 0.39 mmol/L increase in 2 h PG for an average 7-week myo-inositol increase of 23.4 μmol/L with myo-inositol supplementation. Higher 7-week myo-inositol associated with a lower 28-week Stumvoll index (first phase), an approximation of insulin secretion [-0.08 (-0.15, -0.01), p = .020] but not with 28-week Matsuda insulin sensitivity index. However, the clinical significance of a 7-week myo-inositol-related increase in glycaemia was limited as there was no association with gestational diabetes risk, birthweight and cord C-peptide levels. In-silico modelling found higher 28-week myo-inositol was associated with lower gestational glycaemia in White, but not Asian, women after controlling for 7-week myo-inositol effects.
Conclusion: to our knowledge, our study provides the first evidence that increasing first trimester plasma myo-inositol may slightly exacerbate later pregnancy post-challenge glycaemia, indicating that the optimal timing for starting prenatal myo-inositol supplementation needs further investigation.
Text
Diabetes Obesity Metabolism - 2024 - Chan - Higher early pregnancy plasma myo‐inositol associates with increased
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More information
Accepted/In Press date: 8 January 2024
Published date: May 2024
Additional Information:
Funding information: National Research Foundation Singapore, Grant/Award Number: NMRC/TCR/012-NUHS/2014; Medical Research Council, Grant/Award Number: MC_UU_12011/4; Gravida, a New Zealand Government Centre of Research Excellence; Agency for Science, Technology and Research, Grant/Award Number: H17/01/a0/005; Société Des Produits Nestlé S.A.
Publisher Copyright:
© 2024 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.
Keywords:
gestational diabetes, glucose, inositol, insulin, pregnancy, supplementation
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Local EPrints ID: 486824
URI: http://eprints.soton.ac.uk/id/eprint/486824
ISSN: 1462-8902
PURE UUID: f0a15ce0-3655-46d9-90b6-e5d189ac69c7
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Date deposited: 06 Feb 2024 17:49
Last modified: 02 May 2024 01:45
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Author:
Shiao-Yng Chan
Author:
Han Zhang
Author:
Jui-Tsung Wong
Author:
Heidi Nield
Author:
Sarah El-Heis
Corporate Author: et al.
Corporate Author: NiPPeR Study Group
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