| Abstract: |
Diabetes during pregnancy is a major risk factor for poor fetal, neonatal, and maternal outcomes; however, this risk can be greatly reduced by the early use of medical nutrition therapy (MNT) and insulin treatment. This article explores the use of insulin analogs and pregnancy, focusing on the newer, rapid-acting insulin analogs lispro and aspart. The author stresses that maintaining maternal glycemic as near to normal as possible reduces the risk of congenital anomalies, macrosomia, neonatal hypoglycemia, and large-for-gestational-age infants. Topics include pregestational diabetes; gestational diabetes mellitus (GDM); the use of NPH insulin during pregnancy; current categories for drug use in pregnancy; long-acting insulin analogs, such as glargine and detemir, problems with retinopathy and insulin analogs; concerns about congenital anomalies and insulin analogs; and macrosomia and insulin analogs. The author concludes that, when compared with human regular insulin, the rapid-acting insulin analogs are effective at reducing hyperglycemia during pregnancy, with a safety profile that resulted in a lower incidence of neonatal complications. The long-acting insulin analogs do not yet have sufficient safety evaluation in clinical studies to warrant their use during pregnancy. The article includes a patient treatment algorithm as a guideline for all insulin-requiring pregnant women with type 2 diabetes, GDM, or type 1 diabetes. 1 figure. 7 tables. 67 references. |