Diabetes is the most common pre-existing medical condition complicating pregnancy. Pregnant women with preexisting
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.Why is it important to do this review?
1) There is no up-to-date high quality systematic review available to inform clinical decisions regarding the
optimal insulin type and regimen to use in order to improve pregnancy outcome in women with diabetes.
2) There is medical uncertainty surrounding the safety and efficacy of new insulin drugs which have become
available in recent years and in a vulnerable group such as pregnant women, this needs to be prioritised. Our
proposed Cochrane review may help reduce this uncertainty by providing a critical summary and synthesis of the
best available research evidence. This review may also improve outcomes for pregnant women with DM and
their babies.
3) According to the National Health Service (NHS), there has been a 50% increase in the diagnosis of diabetes
in people aged 40 years or less in the past five years and given that this will include women
