Skip to main content

Inositol for the prevention of gestational diabetes: a systematic review and meta-analysis of randomized controlled trials



Inositol (ISL) embraces a family of simple carbohydrates with insulin-sensitizing properties, whose most common isoforms are Myo-inositol (MYO) and d-chiro inositol (DCI). The aim of the present study was to assess the efficacy and safety of ISL supplementation during pregnancy for the prevention of gestational diabetes (GDM).


We conducted a systematic literature search in electronic databases until October 2017. We included all randomized controlled trials (RCTs) comparing pregnant women with GDM who were randomized to either ISL (i.e., intervention group) or either placebo or no treatment (i.e., control group). The primary outcome was the preventive effect on GDM, defined as the rate of GDM in women without a prior diagnosis of GDM. Pooled results were expressed as odds ratio (OR) with a 95% confidence interval (95% CI).


Five RCTs were included (including 965 participants). ISL supplementation was associated with lower rate of GDM (OR 0.49, 95% CI 0.24–1.03, p = 0.01) and lower preterm delivery rate (OR 0.35, 95% CI 0.17–0.74, p = 0.006). No adverse effects were reported. Adjusting for the type of intervention (MYO 2 g twice daily vs MYO 1100 mg plus DCI 27.6 mg daily), a significant effect was found only in patients receiving 2 g MYO twice daily.


ISLs administration during pregnancy appears to be safe and may represent a novel strategy for GDM prevention. In particular, the double administration of MYO 2 g per day may improve the glycemic homeostasis and may reduce GDM rate and preterm delivery rate.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Baz B, Riveline JP, Gautier JF (2016) Endocrinology of pregnancy: gestational diabetes mellitus: definition, aetiological and clinical aspects. Eur J Endocrinol 174(2):R43–R51

    Article  CAS  Google Scholar 

  2. Caissutti C, Berghella V (2017) Scientific evidence for different options for GDM screening and management: controversies and review of the literature. Biomed Res Int 2017:2746471

    Article  Google Scholar 

  3. Farrar D, Simmonds M, Bryant M, Sheldon TA, Tuffnell D, Golder S, Dunne F, Lawlor DA (2016) Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis. BMJ 13(354):i4694

    Article  Google Scholar 

  4. Vitagliano A, Noventa M, Gizzo S (2015) Is it time to consider patients suffering from endometriosis-related infertility as “novel candidates” for targeted peri-conceptional d-chiro inositol supplementation? Hypothesis, rationale and some considerations. J Assist Reprod Genet 32(3):407–408

    Article  Google Scholar 

  5. Pintaudi B, Di Vieste G, Bonomo M (2016) The effectiveness of Myo-inositol and d-chiro inositol treatment in type 2 diabetes. Int J Endocrinol 2016:9132052

    Article  Google Scholar 

  6. Dell’Edera D, Sarlo F, Allegretti A, Simone F, Lupo MG, Epifania AA (2017) The influence of d-chiro-inositol and d-myo-inositol in pregnant women with glucose intolerance. Biomed Rep. 7(2):169–172

    Article  Google Scholar 

  7. Muscogiuri G, Palomba S, Laganà AS, Orio F (2016) Inositols in the treatment of insulin-mediated diseases. Int J Endocrinol 2016:3058393

    PubMed  PubMed Central  Google Scholar 

  8. Noventa M, Vitagliano A, Quaranta M, Borgato S, Abdulrahim B, Gizzo S (2016) Preventive and therapeutic role of dietary inositol supplementation in periconceptional period and during pregnancy: a summary of evidences and future applications. Reprod Sci 23(3):278–288

    Article  CAS  Google Scholar 

  9. Nas K, Tűű L (2017) A comparative study between myo-inositol and metformin in the treatment of insulin-resistant women. Eur Rev Med Pharmacol Sci 21(2 Suppl):77–82

    CAS  PubMed  Google Scholar 

  10. Costabile L, Unfer V (2017) Treatment of gestational diabetes mellitus with myo-inositol: analyzing the cutting edge starting from a peculiar case. Eur Rev Med Pharmacol Sci. 21(2 Suppl):73–76

    CAS  PubMed  Google Scholar 

  11. Crawford TJ, Crowther CA, Alsweiler J, Brown J (2015) Antenatal dietary supplementation with myo-inositol in women during pregnancy for preventing gestational diabetes. Cochrane Database Syst Rev. 12:CD011507

    Google Scholar 

  12. Santamaria A, Di Benedetto A, Petrella E, Pintaudi B, Corrado F, D’Anna R, Neri I, Facchinetti F (2016) Myo-inositol may prevent gestational diabetes onset in overweight women: a randomized, controlled trial. J Matern Fetal Neonatal Med 29(19):3234–3237

    Article  Google Scholar 

  13. Farren M, Daly N, McKeating A, Kinsley B, Turner MJ, Daly S (2017) The prevention of gestational diabetes mellitus with antenatal oral inositol supplementation: a randomized controlled trial. Diabetes Care 40(6):759–763

    Article  CAS  Google Scholar 

  14. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097

    Article  Google Scholar 

  15. Corrado F, D’Anna R, Di Vieste G, Giordano D, Pintaudi B, Santamaria A, DiBenedetto A (2011) The effect of myoinositol supplementation on insulin resistance inpatients with gestational diabetes. Diabet Med 28(8):972–975

    Article  CAS  Google Scholar 

  16. Matarrelli B, Vitacolonna E, D’Angelo M, Pavone G, Mattei PA, Liberati M, Celentano C (2013) Effect of dietary myo-inositol supplementation in pregnancy on theincidence of maternal gestational diabetes mellitus and fetal outcomes: a randomized controlled trial. J Matern Fetal Neonatal Med 26(10):967–972

    Article  CAS  Google Scholar 

  17. Malvasi A, Kosmas I, Mynbaev OA, Sparic R, Gustapane S, Guido M, Tinelli A (2017) Can trans resveratrol plus d-chiro-inositol and myo-inositol improve maternal metabolic profile in overweight pregnant patients? Clin Ther 168(4):e240–e247

    CAS  Google Scholar 

  18. Lubin V, Shojai R, Darmon P, Cosson E (2016) A pilot study of gestational diabetes mellitus not controlled by diet alone: first-line medical treatment with myoinositol may limit the need for insulin. Diabetes Metab 42(3):192–195

    Article  CAS  Google Scholar 

  19. Ferrari F, Facchinetti F, Ontiveros AE, Roberts RP, Saade MM, Blackwell SC, Sibai BM, Refuerzo JS, Longo M (2016) The effect of combined inositol supplementation on maternal metabolic profile in pregnancies complicated by metabolic syndrome and obesity. Am J Obstet Gynecol 215(4):503.e1–503.e8

    Article  CAS  Google Scholar 

  20. Groenen PM, Roes EM, Peer PG, Merkus HM, Steegers EA, Steegers-Theunissen RP (2006) Myo-inositol, glucose and zinc concentrations determined in the preconceptional period, during and after pregnancy. Eur J Obstet Gynecol Reprod Biol 127(1):50–55

    Article  CAS  Google Scholar 

  21. Facchinetti F, Pignatti L, Interdonato ML, Neri I, Bellei G, D’Anna R (2013) Myoinositol supplementation in pregnancies at risk for gestational diabetes. Interim analysis of a randomized controlled trial (RCT). Am J Obstet Gynecol 208(1):S36 (ISN: 0002-9378)

    Article  Google Scholar 

  22. Malvasi A, Casciaro F, Minervini MM, Kosmas I, Mynbaev OA, Pacella E, MontiCondesnitt V, Creanza A, Di Renzo GC, Tinelli A (2014) Myo-inositol, d-chiro-inositol, folic acid and manganese in secondtrimester of pregnancy: a preliminaryinvestigation. Eur Rev Med Pharmacol Sci 18(2):270–274

    CAS  PubMed  Google Scholar 

  23. D’Anna R, Scilipoti A, Giordano D, Caruso C, Cannata ML, Interdonato ML, Corrado F, Di Benedetto A (2013) myo-Inositol supplementation and onset of gestational diabetes mellitus in pregnant women with a family history of type 2 diabetes: a prospective, randomized, placebo-controlled study. Diabetes Care 36(4):854–857

    Article  Google Scholar 

  24. DʼAnna R, Di Benedetto A, Scilipoti A, Santamaria A, Interdonato ML, Petrella E, Neri I, Pintaudi B, Corrado F, Facchinetti F (2015) Myo-inositol supplementation for prevention of gestational diabetes in obese pregnant women: a randomized controlled trial. Obstet Gynecol 126(2):310–315

    Article  Google Scholar 

  25. International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva Ad, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3):676–682

    Article  Google Scholar 

  26. Ferrara A (2007) Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care 30(Suppl 2):S141–S146 (Erratum in: Diabetes Care. 2007 Dec;30(12):3154)

    Article  Google Scholar 

  27. Poomalar GK (2015) Changing trends in management of gestational diabetes mellitus. World J Diabetes 6(2):284–295

    Article  Google Scholar 

  28. Rajput M, Bairwa M, Rajput R (2014) Prevalence of gestational diabetes mellitus in rural Haryana: a community-based study. Indian J Endocrinol Metab 18(3):350–354

    Article  Google Scholar 

  29. McCance DR (2011) Pregnancy and diabetes. Best Pract Res Clin Endocrinol Metab 25(6):945–958

    Article  CAS  Google Scholar 

  30. Vitagliano A, Quaranta M, Noventa M, Gizzo S (2015) “Empiric” inositol supplementation in normal-weight non insulin resistant women with polycystic ovarian disease: from the absence of benefit to the potential adverse effects. Arch Gynecol Obstet 291(5):955–957

    Article  Google Scholar 

  31. Celentano C, Matarrelli B, Mattei PA, Pavone G, Vitacolonna E, Liberati M (2016) Myo-Inositol supplementation to prevent gestational diabetes mellitus. Curr Diab Rep 16(3):30

    Article  Google Scholar 

  32. Laganà AS, Garzon S, Casarin J, Franchi M, Ghezzi F (2018) Inositol in polycystic ovary syndrome: restoring fertility through a pathophysiology-based approach. Trends Endocrinol Metab 29(11):768–780

    Article  Google Scholar 

  33. Larner J, Craig JW (1996) Urinary myo-inositol-to-chiro-inositol ratios and insulin resistance. Diabetes Care 19(1):76–78

    Article  CAS  Google Scholar 

  34. Heimark D, McAllister J, Larner J (2014) Decreased myo-inositol to chiro-inositol (M/C) ratios and increased M/C epimerase activity in PCOS theca cells demonstrate increased insulin sensitivity compared to controls. Endocr J 61(2):111–117 (Epub 2013 Nov 2)

    Article  CAS  Google Scholar 

  35. Pundir J, Psaroudakis D, Savnur P, Bhide P, Sabatini L, Teede H, Coomarasamy A, Thangaratinam S (2018) Inositol treatment of anovulation in women with polycystic ovary syndrome: a meta-analysis of randomised trials. BJOG 125(3):299–308

    Article  CAS  Google Scholar 

  36. Pintaudi B, Di Vieste G, Bonomo M (2016) The effectiveness of Myo-inositol and d-chiro inositol treatment in type 2 diabetes. Int J Endocrinol 2016:9132052

    Article  Google Scholar 

  37. Laganà AS, Vitagliano A, Noventa M, Ambrosini G, D’Anna R (2018) Myo-inositol supplementation reduces the amount of gonadotropins and length of ovarian stimulation in women undergoing IVF: a systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet 298(4):675–684

    Article  Google Scholar 

  38. Papaleo E, Unfer V, Baillargeon JP, De Santis L, Fusi F, Brigante C, Marelli G, Cino I, Redaelli A, Ferrari A (2007) Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction. Gynecol Endocrinol 23(12):700–703

    Article  CAS  Google Scholar 

  39. Plows JF, Budin F, Andersson RA, Mills VJ, Mace K, Davidge ST, Vickers MH, Baker PN, Silva-Zolezzi I, Stanley JL (2017) The effects of Myo-Inositol and B and D vitamin supplementation in the db/+mouse model of gestational diabetes mellitus. Nutrients.

  40. Orrù B, Circo R, Logoteta P, Petousis S, Carlomagno G (2017) Finding the best therapeutic approach for PCOS: the importance of inositol(s) bioavailability. Eur Rev Med Pharmacol Sci 21(2 Suppl):83–88

    PubMed  Google Scholar 

Download references



Author information

Authors and Affiliations



AV: Conceptualization, data curation, formal analysis, investigation, methodology, original draft writing. GS: Investigation, validation, formal analysis original draft writing, review and editing. EC: Supervision, review and editing. SV: Validation, original draft writing, review and editing. FD: Manuscript review and editing. GA: Supervision, validation, review and editing. VB: Conceptualization, project administration, supervision, review and editing

Corresponding author

Correspondence to Amerigo Vitagliano.

Ethics declarations

Conflict of interest

Nothing to declare.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Figure S1

: PRISMA Flow-Diagram (PDF 176 kb)

Figure S2

: Risk of bias graph. Authors’ judgment about each risk of bias item for included studies. (PDF 281 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Vitagliano, A., Saccone, G., Cosmi, E. et al. Inositol for the prevention of gestational diabetes: a systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet 299, 55–68 (2019).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Inositol
  • Gestational diabetes
  • Diabetes prevention
  • Preterm delivery
  • Maternal–fetal health