Table 1.

Insulins available for use in pregnancy in selected regions

Insulin	Comments [32, 33]
Human
Regular insulin	No restrictions on use in diabetes during pregnancy; does not cross the placental barrier
NPH insulin (isophane insulin)	No restrictions on use in diabetes during pregnancy; does not cross the placental barrier
Rapid-acting insulin analogs
Insulin aspart	Can be used in pregnancy; data from two clinical trials (total of 349 exposed pregnancies) do not indicate any adverse effect on pregnancy or feto-neonatal health compared with human insulin
Insulin glulisine	Caution should be exercised when prescribing to pregnant women, and the drug should only be used if the potential benefit justifies the potential risk to the fetus; there are no well-controlled clinical studies, and data are limited in pregnant women (fewer than 300 pregnancy outcomes)
Insulin lispro	Can be used in pregnancy; data from a large number of exposed pregnancies do not indicate any adverse effect on pregnancy or feto-neonatal health
Intermediate- and long-acting insulin analogs
Insulin detemir	Can be considered during pregnancy, but any potential benefit must be weighed against possible increased risk of adverse pregnancy outcomes; results of one clinical trial suggest possible increased risk of serious adverse maternal outcomes compared with isophane insulin; post-marketing data from an additional 250 outcomes from pregnant women exposed to insulin detemir suggest no maternal or feto-neonatal toxicity
Insulin degludec	No clinical experience in pregnant women
Insulin glargine	May be considered during pregnancy, if necessary; no clinical data on exposed pregnancies from controlled clinical studies available; data from pregnant women (between 300 and 1000 pregnancy outcomes) indicate no adverse effects on pregnancy, nor malformative or feto-neonatal toxicity
ILPS	Limited clinical experience in pregnancy

ILPS insulin lispro protamine suspension, NPH neutral protamine Hagedorn