PONTI Study: Maybe inositol is the magic bullet

The PONTI Study released its results right around the time we started our frozen cycle last time:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825100/

As expected, they reported that (at least in their small study) neural tube defects were less likely to appear in the group that took folic acid and inositol.

Of course, the authors note that although NTD recurrence is generally thought to be low in the literature, their study found it to be higher, likely because their participants were taking folic acid in their original NTD affected pregnancies, and thus were likely to have folic acid resistant NTDs:

In contrast, the great majority of women who entered our study had experienced an NTD despite taking 0·4 mg FA in their earlier pregnancy. One could argue that this group of women may have been particularly enriched for FA non-responsiveness, and thus might not have been particularly protected by FA usage in their subsequent pregnancy. Several studies have reported NTD persisting despite voluntary FA supplementation in a FA-fortified population( 5 , 6 ), leading to the conclusion that a significant proportion of NTD may be FA non-responsive( 34 , 35 ). Therefore, although such women will continue to have 4–5 mg FA prescribed for their subsequent pregnancies, it seems likely that additional supplement protection, perhaps by inositol, will be needed to reduce their otherwise high NTD recurrence risk.

In other words, talking folic acid drastically reduces incidence of NTDs, but does not eliminate them because it appears some NTDs are “folic acid resistant.”  For women who were already taking folic acid and had a NTD pregnancy, they’re (we’re) probably in the folic acid resistant group.  That sucks because the incidence of reoccurrence is probably much greater in that group. 

Also note that the PONTI study was relying on people to get pregnant naturally.  You’re in a different bucket if you have a NTD pregnancy AND infertility.  (Infertile women and IVF patients are far more likely to have pregnancies complicated by birth defects.)  Yuck.  (Not yuck for me—I’m not getting pregnant again.  But yuck for anyone who has a NTD pregnancy after going through IVF.) 

I guess we just have to cross our fingers and hope that the PONTI study researchers are right and inositol can help the folic acid resistant group… and that it does not cause any other issues.

I should mention that I took inositol for all of my pregnancies after my anencephaly pregnancy.  None of those pregnancies were successful, and at least one suffered from severe birth defects, but I also did not have a repeat NTD pregnancy.  (In my last pregnancy, the baby’s head appeared round.  Her spine was developing abnormally, and was not formed enough to diagnose spina bifida.)