Inositol taken alongside folic acid may be most effective in preventing neural tube defects

Women at risk of carrying babies with spina bifida and other neural tube defects may benefit from taking inositol, also called vitamin B8, alongside folic acid during pregnancy, suggests research from a team at the UCL Institute of Child Health, the research partner of Great Ormond Street Hospital.

The finding, published in the British Journal of Nutrition, comes from the PONTI study (Prevention of Neural Tube defects by Inositol), a four year study of a small number of women with a history of pregnancies affected by neural tube defects (NTDs).

The trial was made possible thanks to funding from Sparks (the Children’s Medical Research Charity) and the Medical Research Council, with additional support from the NIHR Biomedical Research Centre, Newlife Foundation for Disabled Children, and Great Ormond Street Hospital Children’s Charity.

It is one of over 1000 research projects being carried out at Great Ormond Street Hospital and the UCL Institute of Child Health as part of their research programme, which aims to develop treatments and cures for conditions affecting children and adolescents.

Folic acid is routinely recommended to women during early pregnancy to prevent NTDs, such as spina bifida and anencephaly, which affect around 1 in every 1000 pregnancies, or 700 a year in the UK. Despite being effective in many cases, some women who take folic acid still go on to carry babies with NTDs.

Researchers at the UCL Institute of Child Health, led by Professor Andrew Copp, have now shown that, in a group of ‘high risk’ women, inositol taken alongside folic acid before and during pregnancy could be more effective at preventing NTDs than folic acid alone.

The team studied 99 women aged between 22 and 40 who had a previous pregnancy affected by a NTD and were planning to get pregnant again in the next year. Half of the women agreed to be randomly assigned to groups who were directed to take either 5 mg of folic acid daily or 5 mg of folic acid plus 1 g of inositol daily. The other women chose not to be randomised but many decided to take 5 mg of folic acid plus 1g of inositol in their next pregnancy. Woman took their supplements in tablet form up to a year prior to conception and for the first three months of pregnancy.

Of the 99 women, 57 went on to have pregnancies during the study period. Three of these pregnancies were affected by NTD, all in women who took folic acid alone. No pregnancies in the group who took folic acid and inositol were affected by a NTD and no adverse effects were reported in any of the women or their babies.

The researchers now recommend a study of a larger group of women planning pregnancies, in order to confirm the beneficial effects of inositol.

Andrew Copp, Professor of Developmental Neurobiology and the lead researcher, says: “Folic acid is vital for women to take when planning a pregnancy, in order to avoid NTDs. However, we know that folic acid is not effective in all cases, and some women have pregnancies affected by NTDs despite taking the supplement. Our results suggest that taking folic acid and inositol together may provide greater protection for this group of women, giving them a better chance of having a baby without the disorder.”

He cautions, however: “Our findings certainly do not mean that pregnant women should stop taking folic acid and start taking inositol instead.  Rather, our research suggests that women who have had one pregnancy affected by an NTD may be best advised to take both folic acid and inositol when planning their next pregnancy.  This should be done under supervision of their GP or obstetrician.”

Professor Gudrun Moore, Sparks Chief Scientific Advisor and Professor of Clinical and Molecular Genetics, UCL Institute of Child Health, says: “This study indicates that taking folic acid and inositol together prior to and during pregnancy may help prevent neural tube defects particularly in women with a previous history of these conditions. Sparks very much welcomes this research and the data, although from a small group, should now allow a larger trial to be carried out.”

Anne-Marie's story

Anne Marie Hodkinson's first daughter, Yasmine (now aged 8), was born with spinal bifida. While trying for another child, Anne Marie took part in the UCL Institute of Child Health study of a small number of women with a history of pregnancies affected by neural tube defects (NTDs). After taking inositol and folic acid before and during early pregnancy, her second daughter Zara was born in 2010 without an NTD.

"When we were trying for a baby the first time around, I ignored medical information about spinal bifida as I had been taking folic acid for two or three years so I didn't think it was something I would have to worry about. When we first found out about Yasmine's condition it was a huge shock. I had no idea that folic acid wouldn't work for me.

"After I had Yasmine, I saw this trial mentioned in an article in a magazine for families and individuals affected by spina bifida and hydrocephalus. We decided that, as and when we planned to have another child, we would look into it. When the time came, I contacted the research team and they took my medical background. I was given a higher dosage of folic acid than I had taken before and another bottle of tables - either the inositol or a placebo. I started taking the tablets before I got pregnant and for about 3 months afterwards. At different stages I sent urine samples to the research team. It was a very easy process - it was all done by telephone and post and I didn't have to leave my house to take part.

"Once we got to the 20 week scan and found out that everything was fine, I notified the team and they followed up with a questionnaire. Zara was born four months later with no problems.

"Yasmine is now 8, attends mainstream school and is very sociable. She is a wheelchair user so every day activities that I take for granted are obviously more difficult for Yasmine. For example, travelling on London Underground isn't fun! Everything takes a little bit more thought and preparation but there are normally ways around most problems. Ultimately, my aspirations for Yasmine are exactly the same as my aspirations for Zara. I hope that they'll go to university, have a career, live independently, and get married and have children if they want to.

"Yasmine is marvellous and I wouldn't change her but you wouldn't wish the health effects of spinal bifida on anybody. If I had known about inositol earlier, I would have taken it."