title: Safety of insulin analogues as compared with human insulin in pregnancy.
abstract: BACKGROUND
  Diabetes during pregnancy may lead to maternal, fetal and neonatal complications. In order to limit unwarranted outcomes, strict glycemic control is essential. In the past, human insulin was the only insulin formulation administered in pregnancy. However, insulin analogues have also been used for this indication in recent years.
  
  
  METHODS
  This article reviews the published data regarding the safety of insulin analogue use during pregnancy. We present the qualities, advantages and pitfalls of insulin analogue use in pregnancy compared with human insulin. Insulins lispro, aspart and detemir are safe in pregnant women with type 1 diabetes. Correspondingly, they were reclassified for the treatment of pregnant women with diabetes from category C to category B. For insulin glargine use in pregnancy, most studies are small and retrospective. Yet, no major safety concerns were reported. Insulin glulisine and degludec have not been studied in pregnancy.
  
  
  CONCLUSIONS
  Insulin analogues are viable therapeutic options for diabetes in pregnancy, specifically lispro, aspart and detemir. Though data in limited, their safety and efficacy are comparable with human insulin. Remarkably, the analogues are superior to human insulin regarding hypoglycaemia risk. More data, specifically for their use in pregnancies complicated by gestational diabetes or type 2 diabetes, is needed.
authors.affiliation: a Division of Maternal Fetal Medicine, Helen Schneider Hospital for Women , Rabin Medical Center , Petah Tikva , Israel.
authors.forename: Yoel
authors.initials: Y
authors.lastname: Toledano
authors.affiliation: a Division of Maternal Fetal Medicine, Helen Schneider Hospital for Women , Rabin Medical Center , Petah Tikva , Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Hadar
authors.affiliation: a Division of Maternal Fetal Medicine, Helen Schneider Hospital for Women , Rabin Medical Center , Petah Tikva , Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Hod
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D016640:Diabetes, Gestational / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000145:classification; D007231:Infant, Newborn; D061386:Insulin, Regular, Human / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification; D061385:Insulins / Q000008:administration & dosage* / Q000009:adverse effects / Q000145:classification; D011247:Pregnancy
chemical_list: D007004:Hypoglycemic Agents; D061386:Insulin, Regular, Human; D061385:Insulins
keywords: Aspart; detemir; diabetes mellitus; glargine; glulisine; insulin; lispro; perinatal outcomes; pregnancy; safety