The use of insulin analogues in pregnancy

This article is a review on the use of insulin analogue drugs in pregnancy. The review covers the latest findings published recently in different medical journals.

Diabetes is the most common medical condition in pregnancy. Diabetes during pregnancy can lead to miscarriages, born abnormalities in the baby, and an oversized fetus (macrosomia), which can complicate birth and lead to caesarean surgery (a C-section). Pregnancy can also complicate diabetes in the mother. Good control of diabetes by balancing blood sugar levels is essential for a healthy mother and baby.

Insulin injections are often used in the management of diabetes. The major problem with insulin injections is hypoglycemia (dangerously low blood sugar levels). Insulin analogues are "insulin like" molecules that cause fewer hypoglycemic events than human insulin. Short acting insulin analogues act quickly, but for a short time. Insulin lispro, Insulin aspart, and Insulin glulisine are all types of short acting insulin analogues. Long acting insulin analogues disperse in the body over time in lower doses. Insulin glargine and Insulin detemir are examples of long acting insulin analogues.

3 trials were reviewed concerning the use of insulin aspart (NovoLog) in pregnancy. Compared to human insulin, some trials showed it resulted in fewer miscarriages, hypoglycemic events, and lower birth weights. However, another trial showed no difference between the drugs.

More than 15 trials were reviewed concerning the use of insulin lispro (Humalog) in pregnancy. Results were different in each trial. Most trials comparing insulin lispro to human insulin showed no difference in the number of miscarriages, or in birth weights, between the groups.

There is no published data on the use of Insulin glulisine (Apidra) in pregnancy.

Trials comparing insulin detemir (Levemir) and Insulin Glargine (Lantus) to a long acting human insulin (NPH) showed no difference in the number of negative fetal outcomes between the drugs.

Overall, both insulin lispro and insulin aspart are safe for use in pregnancy. They are both classified by the FDA as class B drugs for pregnancy. This means they do not increase the risk of harm to the fetus. Both drugs may reduce the risk of an oversized fetus compared to human insulin. However, there is no evidence that fetal outcome is better with any these drugs. The use of Insulin glulisine in pregnancy cannot be recommended.

Many of the trials reviewed in this article were of small size, or were not preformed in a controlled manner. In addition, the writers of this review were also the researchers in some of the clinical trials being reviewed.

Consult with your physician on how to better control diabetes during pregnancy with new insulin analogues.