Safety of insulin analogs during pregnancy: a meta-analysis

Abstract

Aspart, glargine, and detemir are safe treatment options for diabetes during pregnancy; these insulin analogs did not increase complications for the mothers or fetuses in our study. However, lispro was related to higher birth weight and increased rate of LGA in neonates. More high-quality randomized controlled trials are needed to clarify the best treatment options for diabetes during pregnancy.

Systematic Literature Review of Basal Bolus Insulin Analogue Therapy during Pregnancy

“…They reported no significant difference in the maternal and neonatal outcomes in patients using aspart, glargine, and determir. However, insulin lispro was associated with higher birth weight and an increased rate of LGA newborns, similar to the findings of the previous meta-anaylsis [33].…”

“…They also found higher rate of macrosomia in the lispro group (14.5%) compared to regular insulin (11.5%), although the increase was not significant [26]. The two meta-analysis published by Gonzalez et al [32] and Lv et al [33] both reported an increased rate of LGA newborns, along with increased birth weight in the latter. The earlier study only included four studies and limited to T1DM, which does not fully provide compelling evidence.…”

“…One article by Gonzalez Blanco et al [32] looking at only T1DM, included four studies into their analysis revealed no differences in maternal or neonatal outcomes with the exception of a higher rate of LGA newborns (RR 1.38[1.14-1.68]) [32]. A larger and more recent meta-analysis by Lv et al [33] assessed the safety of four insulin analogs: lispro, aspart, glargine, and determir. Twenty-four studies met their inclusion criteria which involved both pre-gestational and gestational diabetic pregnant patients.…”

“…The earlier study only included four studies and limited to T1DM, which does not fully provide compelling evidence. The metaanalysis conducted by Lv et al [33], which included 24 studies with a total of 3724 women, provided stronger data to support the possibility that insulin lispro is associated with increased birth weight and rate of LGA newborns. However, this significance is not apparent with the use of insulin aspart in comparison to regular insulin.…”

Caring for pregnant women whose diabetes antedates pregnancy: is there room for improvement?

“…It was also shown to result in similar overall glycaemic control and neonatal outcomes when compared with short-acting (regular) insulin [19]. In contrast, a meta-analysis of observational studies using insulin lispro concluded that its use during pregnancy is associated with a decrease in severe maternal hypoglycaemia and a decrease in hyperbilirubinaemia in infants, but it is also associated with an increase in infants born LGA [20]. Of the long-acting insulins, only insulin detemir and insulin glargine have been studied during pregnancy.…”