A double-blind, placebo-controlled trial examining myo-inositol supplementation in pregnant women with polycystic ovary syndrome found no significant benefits for preventing pregnancy complications, contradicting earlier smaller studies that suggested protective effects. This definitive negative result settles a longstanding question in reproductive endocrinology and provides crucial guidance for clinical practice. The findings have important implications for the estimated 6-12% of reproductive-age women with PCOS who face elevated risks of gestational diabetes, preeclampsia, and preterm birth. Previous smaller trials had suggested myo-inositol might reduce these complications, leading some clinicians to recommend routine supplementation despite limited evidence. This larger, more rigorous trial design likely overcame the statistical power limitations and potential selection biases that may have produced false-positive signals in earlier research. The negative outcome reinforces the principle that promising preliminary findings require validation in adequately powered studies before becoming standard care. For patients, this eliminates both the financial burden of unnecessary supplementation and potential concerns about untested interventions during pregnancy, while redirecting focus toward evidence-based PCOS management strategies.