As d-chiro inositol is commonly used by women with PCOS, many of whom are try
ing to conceive, a common question regarding DCI is whether it is safe to take during pregnancy. 
This is a difficult question to answer categorically. It’s a very personal choice. All I can do is tell you what I know and what I would do if I were pregnant.
There have not been, nor are there ever likely to be, studies done on the safety of DCI during pregnancy. As it is not patentable, being identical to a substance manufactured in nature, there is insufficient monetary incentive for anyone to fund these studies. On the other hand, I can tell you that:
- DCI is a substance found in healthy human bodies, which plays a critical role in carbohydrate metabolism through the insulin signalling pathway.
- We take supplemental DCI because women with PCOS/IR etc appear to have a defect in inositol metabolism which prevents us from obtaining DCI from food, manufacturing it from inositol in vivo and also makes us excrete whatever DCI we do manage to obtain many times more quickly than other human beings. In summary, we are restoring the status quo, rather than taking a nutrient in doses larger than normally obtained through the diet in order to achieve a pseudo-pharmaceutical effect.
- DCI is naturally derived, close to 100% pure chemically and is something that can be found in some foods.
- By regulating carbohydrate metabolism and normalising elevated insulin and blood glucose levels, DCI helps to balance female reproductive hormones, by preventing the inhibition of progesterone production which occurs with elevated levels of testosterone (a side effect of elevated insulin levels). Progesterone is essential for sustaining pregnancy. It is the ‘pregnancy hormone’. If there is insufficient progesterone, miscarriage is likely. Progesterone insufficiency is the leading cause of miscarriage amongst women with PCOS. The placenta will takeover progesterone production from around the 12th week, which is when the risk of miscarriage is greatly reduced.
- During pregnancy, insulin sensitivity is dulled in everyone, not just those with PCOS/IR. All women are at higher risk of diabetes during pregnancy or in later life partially as a result of pregnancy. Gestational diabetes is usually transitory, resolving after birth, however, it increases the risk of diabetes in later life for both the mother and the child. Elevated insulin and blood sugar levels during pregnancy have a negative effect on the foetus.
- Women with PCOS have higher rates of:
- Miscarriage
- Gestational diabetes
- Pregnancy-induced high blood pressure (preeclamsia)
- Premature delivery
- Babies born to women with PCOS have a higher risk of spending time in a neonatal intensive care unit or of dying before, during, or shortly after birth. Most of the time, these problems occur in multiple-birth babies (twins, triplets).
As the main cause of hormonal imbalance in women with PCOS stems from insulin resistance, normalising insulin sensitivity seems like a good way to reduce the risk of these things happening during pregnancy.
I cannot advise you on the right course of action – this is a decision that ultimately only you can make, in conjunction with your doctor.
All I can do is share with you what I would do. If I were pregnant I would definitely continue taking my DCI. I consider it likely to be an exceptionally safe substance. I believe that the risks of not taking it vastly outweigh any potential risks of taking it.
If you or your doctor have any further questions, please let me know. I’m here to help.
Kind regards,
.
Hi Anne,
We exchanged emails in November and I bought some DCI from you. As I said I was trying to conceive, you also recommended I take 4g myo inositol daily alongside 1.2g DCI (the right dose for my weight). I started taking myo on 25 November, DCI on 19 December, and on 27 December I found out I was pregnant for the first time! My doctor has now told me to stop taking both and to go back on metformin – something I really don’t want to do. I feel the inositol combination has been instrumental in this success and reading your info above on taking DCI during pregnancy reassures me greatly. Having googled a lot today to no avail, I was wondering what your views were on:
- continuing with the same dosage of both types of inositol during pregnancy (or is one enough? If so, DCI over myo?);
- taking metformin as well as DCI and/or myo inositol (not what I want to do really but interested in exploring);
- the risk of inositol causing uterine contractions (potentially causing miscarriage/early labour) – something I’ve seen discussed on SoulCysters – set against the point that adequate progesterone production should protect from this risk?
I would of course bear your thoughts in mind when coming to my own decision rather than taking them as a recommendation! I also thought it would be better to comment for the benefit of anyone else in this position.
I cannot thank you enough already!
Laura
Hi Laura,
Congratulations! I’m so pleased for you.
Information I think you may find relevant in making your decision includes:
Metformin crosses the placenta and is also excreted in breastmilk, so your baby would also be affected by the drug if you took it whilst pregnant or breastfeeding, although it is not considered likely to do harm.
The rationale behind the use of metformin in pregnancy, is that it has a beneficial effect on several parameters in women with PCOS, which can cause complications during pregnancy, including an improvement in insulin sensitivity, reduction in blood lipids and blood glucose and insulin levels. Insulin is a growth hormone and excessive insulin during a pregnancy can result in a large birthweight infant, with a predisposition themselves towards insulin resistance and diabetes in later life. There are however, plenty of non-pharmaceutical methods of improving insulin sensitivity including d-chiro inositol, chromium picolinate, N-acetylcysteine, exercise and magnesium. Taking a multivitamin specifically formulated for pregnancy is generally recommended.
Duranteau L, Lefevre P, Jeandidier N, Simon T, Christin-Maitre S. Should physicians prescribe metformin to women with polycystic ovary syndrome PCOS?, Ann Endocrinol (Paris). 2010 Jan 13 PMID: 20079483
The above study found that the efficacy of metformin in PCOS was very limited. It recommended that metformin only be prescribed to women with PCOS who had a BMI of >35 which is in the morbidly obese category, or if they actually had concurrent diabetes. For other women with PCOS not meeting those criteria, it found that the risks outweighed the benefits.
Zhuo Z, Wang A, & Yu H. (2014) Effect of metformin intervention during pregnancy on the gestational diabetes mellitus in women with polycystic ovary syndrome: a systematic review and meta-analysis. Journal of diabetes research, 381231. PMID: 24963493
A meta-analysis published earlier this year found that there was no significant effect of metformin on the risk of gestational diabetes mellitus when taken during pregnancy. This is the primary reason for which metformin is prescribed during pregnancy.
Cassina M, Donà M, Di Gianantonio E, Litta P, & Clementi M. (2014) First-trimester exposure to metformin and risk of birth defects: a systematic review and meta-analysis. Human reproduction update, 20(5), 656-69. PMID: 24861556
Another meta-analysis published the same year examined the risk of birth defects from exposure to metformin in the first trimester of pregnancy and concluded “There is currently no evidence that metformin is associated with an increased risk of major birth defects in women affected by PCOS and treated during the first trimester. However larger ad hoc studies are warranted in order to definitely confirm the safety and efficacy of this drug in pregnancy.”
Vanky E, Stridsklev S, Heimstad R, Romundstad P, Skogøy K, Kleggetveit O, Hjelle S, von Brandis P, Eikeland T, Flo K…. (2010) Metformin versus placebo from first trimester to delivery in polycystic ovary syndrome: a randomized, controlled multicenter study. The Journal of clinical endocrinology and metabolism, 95(12). PMID: 20926533
An earlier randomised, controlled, multi-centre trial looked for benefits to taking metformin during pregnancy for a broader range of complications than just gestational diabetes, but concluded “Metformin treatment from first trimester to delivery did not reduce pregnancy complications in PCOS.” The study also stated “Metformin is not approved for this indication, and evidence for this practice is lacking.”
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 the incidence of maternal gestational diabetes mellitus and fetal outcomes: a randomized controlled trial. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 26(10), 967-72. PMID: 23327487
The above randomised controlled study found that in women who were at high risk of gestational diabetes mellitus (GDM) and actually had elevated fasting blood sugar during the first trimester (or very early second trimester) were able to reduce their risk of developing GDM by taking 4 grams of myoinositol per day. Other studies have found a reduction in risk with 2 g per day.
Malvasi A, Casciaro F, Minervini MM, Kosmas I, Mynbaev OA, Pacella E, Monti Condesnitt V, Creanza A, Di Renzo GC, & Tinelli A. (2014) Myo-inositol, D-chiro-inositol, folic acid and manganese in second trimester of pregnancy: a preliminary investigation. European review for medical and pharmacological sciences, 18(2), 270-4. PMID: 24488919
The above study published earlier this year found that a combination of d-chiro inositol, myo-inositol, manganese and folic acid had a positive effect on cholesterol with significantly lower LDL, lower triglycerides and lower blood sugar levels after 30 days of treatment in the 2nd trimester of pregnancy. The dose used was Each dose contained: 2000 mg myo-inositol, 400 mg d-chiro-inositol, 400 µg folic acid, and 10 mg manganese, once per day. These are the same reasons cited for prescribing metformin.
Cogram P, Tesh S, Tesh J, Wade A, Allan G, Greene ND, & Copp AJ. (2002) D-chiro-inositol is more effective than myo-inositol in preventing folate-resistant mouse neural tube defects. Human reproduction (Oxford, England), 17(9), 2451-8. PMID: 12202440
The above rodent study found that DCI may offer a protective effect against neural tube defects above that with folic acid conferred. Of course, the results of animal studies are not always transferrable to humans, however, it was an interesting line of research.
As you say, the decision is yours and you must be comfortable with the choice you make and the potential life-long effects of that decision on your child. I hope that some of the above studies might be of use to you in better informing your doctor about the current scientific opinion on the value of inositols versus metformin in pregnancy.
As you have had such a strongly positive reaction to the inositols so far, in ovulating and conceiving, were I in your shoes, as a normal weight woman with PCOS, I would definitely continue to take the DCI and MYO, ensure I was getting at least 30 minutes of gentle to moderate exercise, such as walking each day and control my diet to ensure a low glycaemic load (total carbohydrate content) and glycaemic index (how quickly those carbohydrates are metabolised into glucose) and not take metformin unless it was an absolute last resort, for instance, in the event of worsening blood glucose control. I would also buy a blood glucometer to monitor my fasting blood sugar regularly throughout the pregnancy.
Once again, congratulations Laura and very best wishes for a smooth pregnancy and a healthy baby!
I contacted the study at UCL (UK) that is currently using Inositol for spina bifida in pregnant women. Below is the response I received.
“In our clinical trial we used inositol at 1 g per day, up to 12 weeks of pregnancy – we stopped treatment at that time because we focussed on neural tube defects in the baby (which happen earlier than 12 weeks) and this is the stage at which folic acid supplements are also stopped. We didn’t find any indication of a harmful effect either I our patients or in another 20 women who decided to take inositol themselves (at around 1g per day – up to 1.5g per day).”