Different insulin types and regimens for pregnant women with pre-existing diabetes

Lead Researcher:

Dr Sinéad O’Neill

Award Date:

31 December 2014

Host Institution:

University College Cork

Scheme:

Cochrane Training Fellowships

Summary:

Diabetes is the most common pre-existing medical condition complicating pregnancy. Pregnant women with pre-existing type 1 or type 2 diabetes mellitus (DM) are at an increased risk of several adverse maternal, fetal and neonatal complications including preterm delivery, pre-eclampsia, macrosomia, intra-uterine death as well as cardiac, congenital and renal malformations. Hyperglycaemia is an important determinant of several of these adverse outcomes and hence the mainstay of the medical management of pre-existing diabetes during pregnancy is the careful monitoring of blood glucose levels with adjustment of diet and insulin therapy to achieve good glycaemic control. Target fasting blood glucose values between 3.5 and 5.9 mmol/litre and one-hour postprandial blood glucose below 7.8 mmol/litre have been recommended for pregnant diabetic women by the National Institute for Health and Clinical Excellence (NICE) and a variety of insulin types and regimens can be used to attain these targets. This review aims to compare the efficacy and safety of different insulin types and regimens in pregnant women with pre-existing diabetes.