Insulin Aspart in Diabetic Pregnancy: State of the Art

Abstract

Pregnancy in women with diabetes is associated with an increased risk of obstetric complications and perinatal mortality. Maintenance of near-normal glycemia during pregnancy can bring the prevalence of fetal, neonatal and maternal complications closer to that of the nondiabetic population. Changes in insulin requirements during pregnancy necessitate short-acting insulins for postprandial control of hyperglycemia. The fast-acting insulin analogue insulin aspart has been tested in a large, randomized trial of pregnant women with Type 1 diabetes and offers benefits in control of postprandial hyperglycemia with a tendency towards fewer episodes of severe hypoglycemia compared with human insulin. Treatment with insulin aspart was associated with a tendency toward fewer fetal losses and preterm deliveries than treatment with human insulin. Insulin aspart could not be detected in the fetal circulation and no increase in insulin antibodies was found. Thus, the use of insulin aspart in pregnancy is regarded safe.Pregnancy outcome among women with Type 1 or Type 2 diabetes is still significantly poorer than in the background population [1]. This review will focus on pregnant women with Type 1 diabetes. Optimal glycemic control is crucial in order to reduce the risk of congenital malformations, stillbirth, macrosomia, preeclampsia and preterm delivery [2][3][4][5]. The results of population-based cohort studies conducted in Europe, mainly using human insulin, demonstrate unequivocally that women with Type 1 diabetes have an increased risk of late fetal loss, with an approximate four-to five-fold increase in perinatal death and a four-to sixfold increase in stillbirth relative to the national background population [1][2][3][4][5][6].Reports have attributed the increased risk of congenital abnormalities in diabetic mothers to poor metabolic control during the critical period of organogenesis in the first trimester of pregnancy [7,8]. Population-based cohort studies have reported incidences of congenital malformations ranging from two-to ten-times higher than the background population in the UK [6]. The risk of major congenital abnormalities among offspring of women with diabetes is predominantly accounted for by congenital heart disease, bone malformations and neural tube anomalies [1].The rate of premature deliveries (defined as delivery before 37 weeks' gestation) are four-to five-fold higher among pregnant women with diabetes compared with the general maternity population [7]. The rate of preterm delivery in the UK diabetic population was 36%, compared with 7% for the general maternity population. Preterm infants of women with pregestational diabetes are at significantly greater risk of complications, including hyperbilirubinemia, respiratory disorders, hypertrophic cardiomyopathy and asphyxia, than those born to nondiabetic mothers [7].Macrosomia is probably mediated by fetal hyperinsulinemia in response to maternal hyperglycemia. Recent studies report that rates of macrosomia (>90th percentile weight for gestational ag...