Insulin Analogue Therapy in Pregnancy with Diabetes

T he occurrence of congenital malformations continues to be the leading cause of mortality and serious morbidity in infants of mothers with type 1 and type 2 diabetes in spite of advancement in understanding pregnancy metabolism and treatment. The perinatal morbidity also remains relatively high in women who develop glucose intolerance of any degree with onset or first recognition during pregnancy, gestational diabetes mellitus. Thus the fetus of pre-gestational diabetic women, gestational diabetic women, or any woman with abnormal glucose tolerance in pregnancy is at risk of developing either congenital malformation or morbidity in the form of macrosomia and other metabolic disorders. Clinical trials have established that preconceptional care and attaining good glycemic control during all the trimesters of pregnancy have resulted in striking reduction in maternal and fetal morbidity. Thus it has become imperative, to obtain optimum glycemic control and at the same time to avoid hypoglycemia during pregnancy. Perinatal outcome data indicates that the best level to maintain fasting plasma glucose [FPG] is ≤ 90 mg/dl and 2 hr post prandial glucose [PPG] level ≤ 120 mg/dl1. Maintaining plasma glucose ≤ 120 mg at 1 hour is gaining importance1.