Abstract
Diabetes during pregnancy has been linked to unfavorable maternal-fetal outcomes. Human insulins are the first drug of choice because of the proven safety in their use. However, there are still questions about the use of insulin analogs during pregnancy. The objective of the present study was to determine the effectiveness of insulin analogs compared with human insulin in the treatment of pregnant women with diabetes through a systematic review with meta-analysis. The search comprised the period since the inception of each database until July 2017, and the following databases were used: MEDLINE, CINAHL, EMBASE, ISI Web of Science, LILACS, Scopus, SIGLE and Google Scholar. We have selected 29 original articles: 11 were randomized clinical trials and 18 were observational studies. We have explored data from 6,382 participants. All of the articles were classified as having an intermediate to high risk of bias. The variable that showed favorable results for the use of insulin analogs was gestational age, with a mean difference of - 0.26 (95 % confidence interval [CI]: 0.03-0.49; p = 0.02), but with significant heterogeneity (Higgins test [I2] = 38%; chi-squared test [χ2] = 16.24; degree of freedom [DF] = 10; p = 0.09). This result, in the clinical practice, does not compromise the fetal well-being, since all babies were born at term. There was publication bias in the gestational age and neonatal weight variables. To date, the evidence analyzed has a moderate-to-high risk of bias and does not allow the conclusion that insulin analogs are more effective when compared with human insulin to treat diabetic pregnant women.
Highlights
Diabetes mellitus (DM) is currently a serious public health issue
The objective of the present study was to determine the effectiveness of insulin analogs compared with human insulin in the treatment of pregnant women with diabetes through a systematic review with meta-analysis
We have explored data from 6,382 participants
Summary
Diabetes mellitus (DM) is currently a serious public health issue. It may be estimated that there are 425 million adults with DM worldwide, with a projection of 629 million in 2045.1 Diabetes mellitus stands as the main metabolic complication of pregnancy, and may occur in two different clinical contexts: the woman has a previous diagnosis of diabetes (previous DM) or develops it during the pregnancy (gestational DM [GDM]).[2]Persistent hyperglycemia is a harmful factor for all pregnancies. It may be estimated that there are 425 million adults with DM worldwide, with a projection of 629 million in 2045.1 Diabetes mellitus stands as the main metabolic complication of pregnancy, and may occur in two different clinical contexts: the woman has a previous diagnosis of diabetes (previous DM) or develops it during the pregnancy (gestational DM [GDM]).[2]. Patients with previous DM are in a more serious situation, since hyperglycemia may influence negatively, on pregnancy, since the period of fertilization and implantation.[3,4] Possible complications for the child are: congenital malformations, macrosomia, spontaneous abortion, perinatal asphyxia, traumas during childbirth, hypoglycemia, and respiratory distress syndrome, among others. Negative consequences may occur in the long-term, both for the mother and the child, such as increased risk of obesity, glucose intolerance, and type 2 DM for the child. The mother, on the other hand, is more susceptible to a gestational DM relapse, dyslipidemia, type 2 DM, and systemic arterial hypertension.[3,4,5,6]
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