Insulin Analogs and Pregnancy

Diabetes during pregnancy is a major risk factor for poor fetal, neonatal,and maternal outcomes; however, the risk can be greatly reduced by earlyinstitution of medical nutritional therapy and insulin treatment. Maintainingmaternal glycemia as near to normal as possible reduces the risk of congenitalanomalies, macrosomia, neonatal hypoglycemia, and large-for-gestational-ageinfants. Achieving normoglycemia has usually been accomplished with humaninsulin. However, the newer rapid-acting insulin analogs lispro and aspart,when compared to regular human insulin, demonstrate both efficacy and safetyfor the treatment of diabetes during pregnancy. NPH insulin is the only basalinsulin that has been studied in pregnancy. There are not yet any publishedcontrolled studies evaluating the long-acting insulin analogs for use inpregnancy.