Insulin during pregnancy, labour and delivery

Area of Science:

• Obstetrics and Gynecology
• Endocrinology
• Metabolic Disorders

Background:

• Optimal glycemic control is paramount for favorable pregnancy outcomes in women with pre-existing or gestational diabetes.
• HbA1c provides a general measure, but daily glucose profiles are essential for precise insulin therapy adjustments.
• Hypoglycemia poses a significant risk, potentially leading to unawareness, necessitating a balance between hyperglycemia and hypoglycemia prevention.

Purpose of the Study:

• To review current understanding and management strategies for glycemic control in pregnancies complicated by diabetes.
• To discuss the complexities of insulin therapy, including insulin types, administration methods, and monitoring techniques.
• To highlight the importance of individualized insulin management throughout pregnancy, labor, and postpartum.

Main Methods:

• Review of existing literature on glycemic control and insulin therapy in diabetic pregnancies.
• Analysis of HbA1c values, daily glucose profiles, and self-monitoring of blood glucose (SMBG).
• Discussion of insulin types (human vs. analogue) and administration methods (CSII vs. MDI).

Main Results:

• Short-acting insulin analogues (aspart, lispro) have demonstrated safety in pregnancy.
• Long-acting insulin analogues (detemir, glargine) are used off-label; human long-acting insulin is an alternative.
• Continuous subcutaneous insulin infusion (CSII) and multiple-dose insulin (MDI) have not shown superiority in trials, but quality of life aspects require further assessment.
• Insulin requirements fluctuate, with increased needs post-midterm and higher hypoglycemia risk in the first trimester.

Conclusions:

• Individualized insulin therapy, balancing glycemic targets, is critical for managing diabetes in pregnancy.
• Careful monitoring and adjustment of insulin are necessary, especially during the first trimester and postpartum.
• Emerging technologies like continuous glucose monitoring (CGM) may offer improved insights but require further validation.