It is well known that good metabolic control maintained throughout pregnancy reduces maternal and fetal complications in diabetes. Before conception and throughout pregnancy,
insulin therapy needs to be optimized and, in this context, the
insulin analogs currently available in the market may help to achieve good metabolic control. 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 aspart and
lispro strongly suggest that they have no adverse maternal or fetal effects during pregnancy in women with pregestational and
gestational diabetes, and that their use results in improved
glycemic control, fewer
hypoglycemic episodes, and improved patient satisfaction. At present there are no published data on the use of glulisine in pregnancy.
Insulin glargine during pregnancy is not recommended but, in the last years, larger surveys (retrospective and case-control studies) have been published on this field and, to date, results of about 335 pregnancies with
type 1 diabetes are available showing an incidence of congenital malformation similar to that obtained with human
insulin. There are no published data concerning the use of detemir in pregnancy but the results of a prospective study are expected in 2010.