title: Insulin analogues in the treatment of diabetes in pregnancy.
abstract: Pregnancy affects both maternal and fetal metabolism, and even in non-diabetic women, it exerts a diabetogenic effect. Among pregnant women, 2% to 14% develop gestational diabetes. Pregnancy can also occur in women with preexisting diabetes, which may predispose the fetus to many alterations in organogenesis, restrict growth, and the mother, to some diabetes-related complications, such as retinopathy and nephropathy, or to acceleration of the course of these complications, if they are already present. Women with gestational diabetes generally start their treatment with diet and lifestyle changes; when these changes are not enough for optimal glycemic control, insulin therapy must then be considered. Women with type 2 diabetes using oral hypoglycemic agents are advised to change to insulin therapy. Those with preexisting type 1 diabetes should start intensive glycemic control. As basal insulin analogues have frequently been used off-label in pregnant women, there is a need to evaluate their safety and efficacy. The aim of this review is to report the use of both short- and long-acting insulin analogues during pregnancy and to enable clinicians, obstetricians, and endocrinologists to choose the best insulin treatment for their patients.
authors.affiliation: Department of Internal Medicine, Bauru's Diabetics Association, Bauru, SP, Brazil.
authors.forename: Carlos Antonio
authors.initials: CA
authors.lastname: Negrato
authors.forename: Renan Magalhães
authors.initials: RM
authors.lastname: Montenegro Junior
authors.forename: Lilia Maria
authors.initials: LM
authors.lastname: Von Kostrisch
authors.forename: Maria Fatima
authors.initials: MF
authors.lastname: Guedes
authors.forename: Rosiane
authors.initials: R
authors.lastname: Mattar
authors.forename: Marilia B
authors.initials: MB
authors.lastname: Gomes
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D049528:Insulin, Long-Acting / Q000627:therapeutic use*; D061266:Insulin, Short-Acting / Q000627:therapeutic use*; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000188:drug therapy*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D061266:Insulin, Short-Acting