<i>Myo</i>-Inositol, Probiotics, and Micronutrient Supplementation From Preconception for Glycemia in Pregnancy: NiPPeR International Multicenter Double-Blind Randomized Controlled Trial
Keith M. Godfrey, Sheila J. Barton, Sarah El‐Heis, Timothy Kenealy, Heidi Nield, Philip N. Baker, Yap Seng Chong, Wayne S. Cutfield, Shiao‐Yng Chan, NiPPeR Study Group, Veronica Boyle, Shirong Cai, Ryan Carvalho, Julie Ann Guiao Castro, Mary Cavanagh, Hsin‐Fang Chang, Claudia Chi, Caroline E. Childs, Mary Foong‐Fong Chong, Cathryn A. Conlon, Cyrus Cooper, Paula Costello, Vanessa Cox, Marilou Ebreo, Judith Hammond, Nicholas C. Harvey, Richard I. G. Holt, Hazel Inskip, Mrunalini Jagtap, Neerja Karnani, Gene Jeon, Yung Seng Lee, Karen A. Lillycrop, See Ling Loy, Pamela Mahon, Chiara Nembrini, Sharon Ng, Justin M. O’Sullivan, Judith Ong, Gernalia Satianegara, Lynette Pei‐Chi Shek, Shu‐E Soh, Irma Silva‐Zolezzi, Karen Tan, Vicky Tay, Rachael W. Taylor, Elizabeth Huiwen Tham, Mya Thway Tint, Mark H. Vickers, Clare Wall, Gladys Woon, Wong Jui-Tsung Ray, Wei Ying, Mei Ling Chang, Hannah E. J. Yong
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 = 859) or intervention (n = 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 &lt; 0.017 for multiplicity, there were no differences in gestational fasting, 1-h, and 2-h glycemia between groups (β [95% CI] loge 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 = 0.05 kg [−0.03 to 0.13]), or gestational age at birth (mean 39.3 vs. 39.2 weeks, adjusted β = 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.