Higher Plasma Myo-Inositol in Pregnancy Associated with Reduced Postpartum Blood Loss: Secondary Analyses of the NiPPeR Trial

Chang, Hsin F.; Yong, Hannah E. J.; Zhang, Han; Wong, Jui-Tsung; Barton, Sheila J.; Titcombe, Philip; Albert, Benjamin B.; El-Heis, Sarah; Nield, Heidi; Ong, Judith; Lavelle, Luca; Ramos-Nieves, J. Manuel; Godin, Jean-Philippe; Silva-Zolezzi, Irma; Cutfield, Wayne S.; Godfrey, Keith M.; Chan, Shiao-Yng; the NiPPeR Study Group,

doi:10.3390/nu16132054

Open AccessArticle

Higher Plasma Myo-Inositol in Pregnancy Associated with Reduced Postpartum Blood Loss: Secondary Analyses of the NiPPeR Trial

by

Hsin F. Chang

^1,†,

Hannah E. J. Yong

^2,†

,

Han Zhang

²,

Jui-Tsung Wong

²,

Sheila J. Barton

³

,

Philip Titcombe

³,

Benjamin B. Albert

⁴,

Sarah El-Heis

^3,5,

Heidi Nield

³,

Judith Ong

¹,

Luca Lavelle

⁶

,

J. Manuel Ramos-Nieves

⁶,

Jean-Philippe Godin

⁶,

Irma Silva-Zolezzi

⁷,

Wayne S. Cutfield

⁴

,

Keith M. Godfrey

^3,5

,

Shiao-Yng Chan

^1,2,8,*

and

the NiPPeR Study Group

^‡

¹

Department of Obstetrics and Gynaecology, National University Hospital, Singapore 119074, Singapore

²

Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore 117609, Singapore

³

MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, UK

⁴

Liggins Institute and a Better Start—National Science Challenge, The University of Auckland, Auckland 1023, New Zealand

⁵

NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK

⁶

Nestlé Research Centre, 1000 Lausanne, Switzerland

⁷

Research & Development, Nestlé Product Technology Center—Nutrition, 1800 Vevey, Switzerland

⁸

Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

^‡

Members of the NiPPeR Study Group authors for the Medline citation are listed in the Acknowledgments.

Nutrients 2024, 16(13), 2054; https://doi.org/10.3390/nu16132054

Submission received: 11 June 2024 / Revised: 19 June 2024 / Accepted: 26 June 2024 / Published: 27 June 2024

(This article belongs to the Section Nutrition in Women)

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Abstract

We previously reported that a combined myo-inositol, probiotics, and enriched micronutrient supplement (intervention) taken preconception and in pregnancy reduced postpartum blood loss (PBL) and major postpartum hemorrhage compared with a standard micronutrient supplement (control), as secondary outcomes of the NiPPeR trial. This study aimed to identify the intervention components that may contribute to this effect. Associations of plasma concentrations of myo-inositol and vitamins B2, B6, B12, and D at preconception (before and after supplementation), early (~7-weeks), and late pregnancy (~28-weeks) with PBL were assessed by multiple linear regression, adjusting for site, ethnicity, preconception BMI, parity, and previous cesarean section. Amongst 583 women, a higher concentration of myo-inositol in early pregnancy was associated with a PBL reduction [β_adj −1.26 (95%CI −2.23, −0.29) mL per µmol/L myo-inositol increase, p = 0.011]. Applying this co-efficient to the increase in mean 7-week-myo-inositol concentration of 23.4 µmol/L with the intervention equated to a PBL reduction of 29.5 mL (~8.4% of mean PBL of 350 mL among controls), accounting for 84.3% of the previously reported intervention effect of 35 mL. None of the examined vitamins were associated with PBL. Therefore, myo-inositol may be a key intervention component mediating the PBL reduction. Further work is required to determine the mechanisms involved.

Keywords: postpartum hemorrhage; inositols; B-vitamins; vitamin D; prenatal nutritional supplement

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MDPI and ACS Style

Chang, H.F.; Yong, H.E.J.; Zhang, H.; Wong, J.-T.; Barton, S.J.; Titcombe, P.; Albert, B.B.; El-Heis, S.; Nield, H.; Ong, J.; et al. Higher Plasma Myo-Inositol in Pregnancy Associated with Reduced Postpartum Blood Loss: Secondary Analyses of the NiPPeR Trial. Nutrients 2024, 16, 2054. https://doi.org/10.3390/nu16132054

AMA Style

Chang HF, Yong HEJ, Zhang H, Wong J-T, Barton SJ, Titcombe P, Albert BB, El-Heis S, Nield H, Ong J, et al. Higher Plasma Myo-Inositol in Pregnancy Associated with Reduced Postpartum Blood Loss: Secondary Analyses of the NiPPeR Trial. Nutrients. 2024; 16(13):2054. https://doi.org/10.3390/nu16132054

Chicago/Turabian Style

Chang, Hsin F., Hannah E. J. Yong, Han Zhang, Jui-Tsung Wong, Sheila J. Barton, Philip Titcombe, Benjamin B. Albert, Sarah El-Heis, Heidi Nield, Judith Ong, and et al. 2024. "Higher Plasma Myo-Inositol in Pregnancy Associated with Reduced Postpartum Blood Loss: Secondary Analyses of the NiPPeR Trial" Nutrients 16, no. 13: 2054. https://doi.org/10.3390/nu16132054

APA Style

Chang, H. F., Yong, H. E. J., Zhang, H., Wong, J.-T., Barton, S. J., Titcombe, P., Albert, B. B., El-Heis, S., Nield, H., Ong, J., Lavelle, L., Ramos-Nieves, J. M., Godin, J.-P., Silva-Zolezzi, I., Cutfield, W. S., Godfrey, K. M., Chan, S.-Y., & the NiPPeR Study Group. (2024). Higher Plasma Myo-Inositol in Pregnancy Associated with Reduced Postpartum Blood Loss: Secondary Analyses of the NiPPeR Trial. Nutrients, 16(13), 2054. https://doi.org/10.3390/nu16132054

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Higher Plasma Myo-Inositol in Pregnancy Associated with Reduced Postpartum Blood Loss: Secondary Analyses of the NiPPeR Trial

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