Insulin Therapy in Pregnancy

Introduction to Insulin Therapy

Insulin is consistently recommended as the preferred agent for managing both type 1 and type 2 diabetes during pregnancy by major guidelines including the American Diabetes Association 1, 2
None of the currently available human insulin preparations, including NPH insulin, have been demonstrated to cross the placenta, making them safe options for pregnant patients 3

Both multiple daily insulin injections and continuous subcutaneous insulin infusion are reasonable delivery strategies during pregnancy 2
Early pregnancy is characterized by enhanced insulin sensitivity and lower glucose levels, which may require lower insulin doses 3
Insulin requirements typically increase linearly from around 16 weeks, often doubling compared to pre-pregnancy needs 3
Insulin requirements drop rapidly with delivery of the placenta 1, 3

Current guidelines and evidence do not specifically address the safety of insulin degludec in pregnancy 1, 2
The lack of specific safety data for degludec in pregnancy makes it a less preferred option compared to insulin glargine or NPH insulin 3

Pregnancy is a ketogenic state, and women with diabetes are at risk for diabetic ketoacidosis at lower blood glucose levels than in the non-pregnant state 1
Pregnant individuals with type 1 diabetes have an increased risk of hypoglycemia in the first trimester due to altered counter-regulatory responses 2, 3
Education about hypoglycemia prevention, recognition, and treatment is essential for pregnant patients using insulin and their family members 3
Pregnant individuals with diabetes should be prescribed low-dose aspirin 100–150 mg/day starting at 12 to 16 weeks of gestation to lower the risk of preeclampsia 3
Referral to a specialized center offering team-based care is recommended when available for pregnant individuals with diabetes 3