The prevalence of diabetes among women of reproductive age is increasing, in part due to the increase in type 2 diabetes. Despite available pharmacologic treatments such as oral medication and insulin, efficacy and safety data for use during pregnancy are limited, and changes in insulin requirements throughout pregnancy further complicate management. Insulin is the preferred pharmacologic treatment option for pregnant women with gestational and preexisting diabetes. Deciding which type of insulin to use during pregnancy depends on several factors. The pharmacodynamic profile of each insulin type, dosing, delivery systems, monitoring, and the quality of efficacy and safety data are all important considerations. Evidence from randomized controlled studies is preferred over data from other types of studies of pregnant individuals. Furthermore, exciting advances in delivery systems and monitoring technology may improve medication-taking behavior and/or lead to better pregnancy outcomes for women with diabetes. In this review, we examine the management of both gestational and preexisting diabetes, including trimester-specific glucose targets, data from randomized controlled trials for each insulin type, and advances in technology.
Sandler et al. (Thu,) studied this question.