New Insulin to Treat Pregestational Diabetes in Pregnancy

The reduction of maternal and fetal complications in pregnancies complicated by diabetes can be obtained primarily with a stabilization of the metabolic control. Before conception and throughout pregnancy, insulin therapy needs to be optimized and, in such context, the insulin analogs currently available in the market may help to achieve good metabolic control. This paper aims at reviewing the current knowledge about their use in pregnancy. Clinical and experimental data on insulin aspart and lispro in women with pregestational and gestational diabetes strongly suggest that these have no adverse maternal or fetal effects and that their use results in improved glycemic control, fewer hypoglycemic episodes, and improved patient satisfaction. The same effects can be speculated for the new fast-aspart and for the biosimilar lispro. Few data have been published on the use of glulisine in pregnancy. On the basis of a randomized clinical trial, insulin detemir can be used in pregnancy; also, data from retrospective trials with glargine in pregnancy have demonstrated that this is not teratogenic for the fetus. The same conclusions can be drawn for biosimilar glargine and for Gla U300. The ongoing perspective study on degludec provides us with a noteworthy information for its safety on pregnancy. Although the new insulins have features of pharmacokinetics and pharmacodynamics that could significantly improve the maternal and fetal outcomes of pregnancies complicated by pregestational diabetes, the results obtained up to now are less positive than expected. Undoubtedly, randomized trials with the aim of evaluating the specific maternal and fetal outcomes to give clear evidence are lacking.