Prospective trials have demonstrated that there is a reduced
likelihood of macrosomic deliveries when insulin therapy is
applied to all women with GDM.
55-58 While conventionally only
the use of human insulins was advised during GDM, recent
data has demonstrated the benefits of insulin analogues during
pregnancy. Insulin aspart and insulin lispro have been shown
to be safe and effective for use during pregnancy.59,60 Insulin
aspart is more effective than human insulin in decreasing
postprandial glucose (PPG) concentrations (difference in PPG:
-0.40%, P = 0.044) and is associated with lower hypoglycaemia
(major hypoglycaemia, 1.4 vs. 2.1 episodes/year exposure).61 In a
randomized, parallel-group, open-label, multinational trial, there
were 137 and 131 live births and 14 and 21 foetal losses, perinatal
mortality was 14 and 22 per 1000 births; number of congenital
malformations were 6 and 9 and birth weight corrected for
gestational age was 3438 g (± 71.5) and 3555 g (± 72.9; P = 0.091)
for insulin aspart and human insulin respectively.62