Abstract
To evaluate the effectiveness of the different insulin therapies on obstetrics-fetal outcomes in women with pregestational diabetes mellitus. We enrolled 147 pregnant women with pre-existing type 1 or 2 diabetes mellitus. Clinical and biochemical parameters were analysed in relation to obstetric and fetal outcomes. 14.2% received treatment with Neutral Protamine Hagedorn insulin and short-acting insulin analogues; 19% with premixed human insulin; 40.1% with insulin glargine and lispro, 6.2% with detemir and aspart and 20% with continuous subcutaneous insulin infusion. All 5 types of treatment achieved a reduction of the mean HbA1c during pregnancy (p = 0.01). Pre-pregnancy care was carried out for 48% of patients. We found no statistically significant differences between the different insulin therapies and the obstetric-fetal outcomes. In conclusión, the different insulin therapies used in patients with pregestational diabetes mellitus does not seem to affect obstetric-fetal outcomes.
Highlights
To evaluate the effectiveness of the different insulin therapies on obstetrics-fetal outcomes in women with pregestational diabetes mellitus
Insulin is the treatment of choice for pregestational diabetes mellitus (PGDM), there is no clear evidence of a difference between regular human insulin and other types of insulin in gestational diabetes[7]
Most of them were treated with glargine and lispro except for one who was treated with Neutral Protamine Hagedorn (NPH) insulin and lispro
Summary
To evaluate the effectiveness of the different insulin therapies on obstetrics-fetal outcomes in women with pregestational diabetes mellitus. The different insulin therapies used in patients with pregestational diabetes mellitus does not seem to affect obstetric-fetal outcomes. 1% of all pregnant women present pregestational diabetes mellitus (PGDM), this prevalence is increasing[2]. The short-acting insulin analogues (lispro and aspart) are comparable in immunogenicity to rapid human insulin and they are not teratogenic They achieve the objectives of postprandial control with lower risk of hypoglycaemia[10]. The long-acting insulin analogues (detemir and glargine) improve the fasting plasma glucose and glucose fluctuations without an increased incidence of nocturnal hypoglycaemia[9] and they have not demonstrated significant adverse effects on outcomes of the pregnancy[9,10]. Since 2012, the Food and Drug Administration (FDA) has reclassified basal insulins from category “C” to “B” and so they can be used in pregnancy[9]
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