Is inositol safe to take during early pregnancy for women with Polycystic Ovary Syndrome (PCOS)?

Inositol Safety and Efficacy in Pregnancy for PCOS

While inositol appears to be safe and potentially beneficial for women with PCOS during early pregnancy, there is insufficient high-quality evidence from guidelines to definitively recommend its continued use throughout pregnancy. 1

Safety and Benefits of Inositol in PCOS

• Myo-inositol is a promising treatment option for women with PCOS that can restore ovulatory activity and improve fertility without significant side effects 2, 3
• Myo-inositol combined with folic acid (typically 4000mg myo-inositol + 400μg folic acid daily) has been shown to restore ovulation in approximately 70% of women with PCOS 4
• Myo-inositol works by improving insulin receptor activity, which helps address the insulin resistance common in PCOS 2
• Pregnancy rates of 15.1-40% have been reported in women with PCOS using myo-inositol, comparable or potentially superior to metformin 3, 4

Inositol Use During Pregnancy

• The Cochrane review on inositol for subfertile women with PCOS notes very low-quality evidence regarding its effects on live birth rates and miscarriage rates 1
• There is insufficient evidence from high-quality guidelines specifically addressing the continuation of inositol during early pregnancy in women with PCOS
• The American College of Obstetricians and Gynecologists (ACOG) does not specifically mention inositol in their guidelines for PCOS management during pregnancy 5

Alternative PCOS Treatments During Pregnancy

• Metformin appears to be safe during pregnancy according to ACOG guidelines, though documentation on its effects in early pregnancy is limited 5
• Weight management is a cornerstone of PCOS treatment, with even modest weight loss of 5% improving both metabolic and reproductive abnormalities 5, 6
• For pruritus related to cholestasis that may occur during pregnancy, treatments like cholestyramine, rifampin, or S-adenosyl-L-methionine (SAMe) may be used 5

Clinical Recommendations

• For women with PCOS who became pregnant while using inositol:

  • Discuss with your healthcare provider about continuing inositol during early pregnancy, weighing potential benefits against limited safety data 1
  • Consider transitioning to treatments with more established safety profiles in pregnancy if concerned 5
  • Monitor for improvements in insulin sensitivity and metabolic parameters if continuing inositol 7

• For all pregnant women with PCOS:

  • Focus on appropriate weight management during pregnancy 5, 6
  • Monitor for pregnancy complications that occur at higher rates in women with PCOS 5
  • Consider vitamin K monitoring if cholestasis develops during pregnancy 5

Potential Pitfalls and Caveats

• The evidence base for inositol use in pregnancy is limited, with most studies focusing on pre-conception and fertility outcomes rather than pregnancy outcomes 1
• Women should not start inositol during pregnancy without medical supervision due to limited safety data 1
• Avoid combining inositol with other insulin-sensitizing agents during pregnancy without medical supervision 5
• Be aware that pregnancy itself may alter PCOS symptoms and medication requirements 5