It has been demonstrated that good metabolic control maintained throughout pregnancy can reduce maternal and fetal complications in diabetes. To achieve good metabolic control, before conception and throughout pregnancy,
insulin therapy needs to be optimized, and, in this context, the new
insulins currently on the market may help. We therefore review here what is known about the potential benefits and risks related to the use of these new
insulins in pregnancy. Clinical and experimental data on
insulin lispro strongly suggest that
lispro does not have adverse maternal or fetal effects during pregnancy in women with preexisting diabetes, and also that its use in these women results in improved
glycemic control, fewer
hypoglycemic episodes, and improved patient satisfaction. In women with
gestational diabetes mellitus (GDM), the use of
insulin lispro is efficient in reducing
postprandial hyperglycemia and some neonatal features related to
hyperglycemia, thus stressing its usefulness in this condition. As for
insulin aspart, clinical data on GDM patients shows the same efficacy as
insulin lispro in lowering
postprandial hyperglycemia, indicating that
insulin aspart may be used in GDM when this condition is characterized by
postprandial hyperglycemia. The results of a multicentric study now in progress on the efficacy and safety of
insulin aspart in type 1 pregnant diabetic patients will definitely be useful in establishing whether this
insulin is safe in pregnancy. For the moment, the use of
insulin glargine during pregnancy is not recommended owing to the lack of data on maternal and fetal effects.