Insulin analogs and pregnancy

Abstract

Diabetes during pregnancy is a major risk factor for poor fetal, neonatal, and maternal outcomes; however, the risk can be greatly reduced by early institution of medical nutritional therapy and insulin treatment. Maintaining maternal glycemia as near to normal as possible reduces the risk of congenital anomalies, macrosomia, neonatal hypoglycemia, and large-for-gestational-age infants. Achieving normoglycemia has usually been accomplished with human insulin. However, the newer rapid-acting insulin analogs lispro and aspart, when compared to regular human insulin, demonstrate both efficacy and safety for the treatment of diabetes during pregnancy. NPH insulin is the only basal insulin that has been studied in pregnancy. There are not yet any published controlled studies evaluating the long-acting insulin analogs for use in pregnancy.