25th March 2011
Glargine (Lantus) use in pregnancy.
A recent report summarizing all the published studies on the use of Glargine (lantus) in pregnancy is encouraging (Annals of Pharmacotherapy, 45:9-16, 2011). From all the studies the authors had information on 331 women, either pregestational or gestational, and found no differences in fetal outcomes compared to NPH insulin. Glargine (Lantus) is a long acting analogue insulin that has the proven advantage of less night-time low glucose levels. However it also binds more avidly to the growth receptors on cells and this has caused a theoretical concern that has some doctors holding off using it in pregnancy.
The lead author, Dr Pollex, says that “these results increase the choices for women requiring basal insulin therapy in pregnancy” but acknowledges nearly all the studies looked at were retrospective and such studies are never as good as prospective ones in answering questions. I think glargine is likely safe in pregnancy but 331 women are not enough to know for certain. Levemir works much the same as glargine and if a long acting analogue is to be used in pregnancy it tends to be our first choice.
27th December 2010
A study from Cambridge, England looking at women with Type 1 or Type 2 diabetes found those who planned their pregnancy started with a lower A1c and had a lower chance of a poor outcome for the baby 1.3% versus 7.8% (Diabetes Care, volume 33, page 2514, 2010). While this paper reinforces the need for anyone with diabetes to plan their pregnancy and try and get the glucose controlled prior to conception an interesting point made by the lead author, Helen Murphy, suggested that what turned women away from seeking care pre conception was “too much emphasis on all the bad things that could happen and unrealistic sugar targets”. I guess we should accentuate the positive: the vast majority of women with diabetes can have a healthy baby, it takes work but it is worth it.