Rates of depression, especially during the second and third trimesters of pregnancy, are substantial. Clinical and economic studies to estimate maternal and fetal consequences are needed.

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Insulin agents available for the treatment of diabetes mellitus include conventional insulins and insulin analogues. Insulin analogues were developed to mimic more closely the separate bolus and basal components of insulin secretion.1 Rapid-acting (bolus or mealtime) and longacting (basal or background) analogue formulations are available. This new class of drugs has been promoted as providing more flexible treatment schedules and a reduced risk of hypoglycemia relative to conventional insulins. 1The cost of insulin analogues exceeds that of conventional insulins.2,3 More than US$7.3 billion was spent globally on the purchase of insulin products in 2005 -an increase of 19% over the previous year.4 It has been suggested that the increased expenditure was due to both the increasing prevalence of diabetes and the increased use of insulin analogues. 5 We performed an analysis of the cost-effectiveness of insulin analogues compared with conventional insulins in the management of type 1 or type 2 diabetes in adults. MethodsThe economic model We used the Center for Outcomes Research Diabetes Model 6 to calculate the cost-effectiveness estimates. This model, described in detail by Palmer and colleagues, 6 has been validated against published clinical and epidemiologic studies (Figure 1). 7 Using data derived from the published literature, the model uses mathematical equations to determine the diabetes-related complications that would occur throughout a patient's life span. 6 The equations take into consideration risk factors such as age and hemoglobin A 1c levels, as well as patient characteristics, type of diabetes and history of diabetesrelated complications. 6 For type 1 and type 2 diabetes, correlation analyses produced R 2 estimates of 0.9778 and 0.8861, which demonstrate that simulations in the Center for Outcomes Research Diabetes Model 6 provide a reasonably accurate representation of patient outcomes in real-life settings. 7 We derived the clinical effects of therapy (hemoglobin A 1c , mild to moderate hypoglycemia and severe hypoglycemia), required as inputs for the model, from meta-analyses of randomized controlled trials (Table 1). [8][9][10] We compared rapidacting insulin analogues (insulin aspart and insulin lispro) with regular human insulin. We compared long-acting analogues (insulin glargine and insulin detemir) with neutral protamine Hagedorn insulin. For treatment comparisons, we

BackgroundThe purpose of this constructivist grounded theory study was to develop a theoretical model that explains women's processes of managing diagnosed depression when pregnant.MethodsWe explored the experiences of 19 women in Ontario who were diagnosed with depression during their pregnancy.ResultsThe model that emerged from the analysis was becoming the best mom that I can. Becoming the best mom that I can explains the complex process of the women's journey as they travel from the depths of despair, where the depression is perceived to threaten their pregnancy and their ability to care for the coming baby, to arrive at knowing the self and being in a better place. In order to reground the self and regain control of their lives, the women had to recognize the problem, overcome shame and embarrassment, identify an understanding healthcare provider, and consider the consequences of the depression and its management. When confronting and confining the threat of depression, the women employed strategies of overcoming barriers, gaining knowledge, and taking control. As a result of counseling, medication, or a combination of both, women felt that they had arrived at a better place.ConclusionFor many women, the idea that depression could occur during pregnancy was antithetical to their vision of the pregnant self. The challenge for a pregnant woman who is diagnosed with depression, is that effective care for her may jeopardize her baby's future health. This provides a dilemma for about-to-be parents and their healthcare providers. Improved awareness of depression during pregnancy on the part of healthcare professionals is needed to improve the women's understanding of this disorder and their ability to recognize and seek help with depression should it occur during the prenatal period. Further qualitative research is needed to determine the specific aspects that need to be addressed in such classes.

Depression during pregnancy is common, affecting an estimated 20% of women. However, conflicting data exist concerning the outcomes of this disorder. Thus, we reviewed studies that presented evidence for the use of antidepressants and those that examined untreated depression during the gestational period, in terms of clinical and epidemiological aspects.Observational studies have provided reassuring evidence of the safety of antidepressant use during pregnancy. However, due to the reluctance of healthcare providers to prescribe and patients to take medication during the obstetric period, approximately three-quarters of those diagnosed with depression remain untreated. Furthermore, healthcare providers apparently do not recognise the disorder in up to 50% of pregnant women who experience depression. Increased antidepressant dosing during pregnancy may be required to maintain euthymia; however, guidelines for effective dosing levels are absent. Consequently, many patients remain inadequately treated. Substantial maternal and fetal morbidity including substance abuse, functional impairment, increased risk of postnatal depression, and poor pregnancy outcomes have resulted from untreated depression.The consequences of those outcomes are likely to be associated with substantial clinical, social and economic burdens. An incidence-based assessment of the consequences of prenatal depression would be useful in order to: (i) establish the impact on the quality of life of these patients and their families; (ii) assess the associated economic burden on individual families and the healthcare system; and (iii) to provide epidemiological data to enable the provision of suitable management strategies for these patients.