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Treatment With Insulin and Its Analogs in Pregnancies Complicated by Diabetes

From the Sansum Diabetes Research Institute, Santa Barbara, California

Address correspondence and reprint requests to Lois Jovanovic, Sansum Diabetes Research Institute, Santa Barbara, CA 93105. E-mail: ljovanovic@sansum.org

Abbreviations: GDM, gestational diabetes mellitus

The first 300 words of the full text of this article appear below.

	INTRODUCTION

 
Before the advent of insulin in 1922, <100 pregnancies in diabetic women were reported; most likely, these women had type 2 and not type 1 diabetes (1). Even with this assumption, these cases of diabetes and pregnancy were associated with a >90% infant mortality rate and a 30% maternal mortality rate. As late as 1980, physicians were still counseling diabetic women to avoid pregnancy. This philosophy was justified because of the poor obstetric history in 30–50% of diabetic women. Improved infant mortality rates finally occurred after 1980, when treatment strategies stressed better control of maternal plasma glucose levels, once self-monitoring of blood glucose and A1C became available. As the pathophysiology of pregnancy complicated by diabetes has been elucidated and as management programs have achieved and maintained near-normoglycemia throughout pregnancy complicated by diabetes, perinatal mortality rates have decreased to levels seen in the general population (2–5). This review reports the literature on the safety and efficacy of insulin analogs in pregnancy and thereby enables the clinician to choose the optimal insulin treatment protocol to achieve and maintain normoglycemia throughout pregnancies complicated by diabetes.

	RATIONALE FOR THE USE OF NON-IMMUNOGENIC INSULINS DURING PREGNANCY—

 
Maternal glucose freely crosses the placenta. Maternal insulin does not cross the placenta unless it is bound to IgG antibody, which carries it through the placenta or insulin is forced through the placenta by high perfusion (6,7). Diabetic fetopathy is thought to be the result of fetal hyperinsulinemia (1–9). Thus, our treatment must be designed to normalize maternal blood glucose concentrations without the use of exogenous insulins that cross the placenta.

Placental transfer of insulin complexed with immunoglobulin has also been associated with fetal macrosomia in mothers with near-normal glycemic control during gestation. Menon et al. (8) reported that antibody-bound insulin transferred . . . [Full Text of this Article]

	LONG-ACTING INSULIN ANALOGS—

 

	POTENTIAL RISKS ASSOCIATED WITH INSULIN ANALOGS

 
Insulin and IGF-I receptor binding affinity

	SUMMARY AND NEEDED RESEARCH—

 

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