Pharmacotherapy for hyperglycemia in pregnancy - The new insulins

Hyperglycemia in pregnancy may lead to adverse maternal, fetal and neonatal outcomes. Tight glycemic control is prudent in order to reduce pregnancy complications. For many years, the gold standard pharmacological therapy during pregnancy was human insulin. Recently, insulin analogues were also introduced to clinical use in pregnancy. This brief review aims to summarize the information on the efficacy and safety of insulin analogue therapy during gestation. The strengths and pitfalls of insulin analogue administration during gestation, compared with human insulin, are presented. According to studies in pregnant women with type 1 diabetes, insulins lispro, aspart and detemir are efficacious and safe. Correspondingly, the FDA has reclassified them for the treatment of pregnant women with diabetes from category C to category B. Although large and prospective data on insulin glargine in gestation are still lacking, no major safety concerns were documented. No controlled trials with insulins glulisine and degludec were conducted in pregnancy. In sum, insulin analogues are practical therapeutic options for hyperglycemia in pregnancy, mainly due to their hypoglycemia risk reduction. More research for their use in pregnant women with gestational diabetes or type 2 diabetes should be conducted. Overall, their efficacy and safety is possibly comparable to human insulin.