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Review
. 2022 Oct 21;14(1):154.
doi: 10.1186/s13098-022-00925-7.

Maternal and neonatal outcomes with the use of long acting, compared to intermediate acting basal insulin (NPH) for managing diabetes during pregnancy: a systematic review and meta-analysis

Jijiao Wang #  1 , Xiaochen Ji #  1 , Ting Liu  2 , Nan Zhao  3
Affiliations
Review

Maternal and neonatal outcomes with the use of long acting, compared to intermediate acting basal insulin (NPH) for managing diabetes during pregnancy: a systematic review and meta-analysis

Jijiao Wang et al. Diabetol Metab Syndr. .

Abstract

Background: To assess the impact of long-acting insulin analogues, compared to intermediate acting neutral protamine Hagedron (NPH), on maternal, perinatal and neonatal outcomes.

Methods: Studies for inclusion in the review were identified using a structured search strategy in PubMed, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) database. Studies that were randomized controlled trials or observational in design were considered for inclusion. Eligible studies should have compared the maternal, perinatal and neonatal outcomes between pregnant women with gestational diabetes mellitus (GDM) managed by intermediate acting (NPH) and by long-acting insulin analogues. Statistical analysis was performed using STATA software.

Results: We found 17 studies to be eligible for inclusion. The mean gestational weight gain and risk of maternal hypoglycaemia, hypertensive disorder, caesarean delivery, spontaneous abortion, endometritis and wound infection or dehiscence were similar among pregnant women with GDM managed using long-acting insulin analogues and NPH. Those receiving long-acting insulin analogues had significantly lower HbA1c values in the second (WMD - .09, 95% CI 0.12, - 0.06; N = 4) and third trimester (WMD - 0.08, 95% CI - 0.14, - 0.02; N = 12). The mean gestational age and birth weight and risk of perinatal mortality, prematurity, large for gestational age, small for gestational age, shoulder dystocia and congenital abnormalities was similar among babies in both groups. No statistically significant differences in risk of admission to neonatal intensive care unit, respiratory distress, neonatal hypoglycaemia, 5 min APGAR score of < 7, neonatal hyperbilirubinemia and sepsis was observed. The quality of pooled evidence, as per GRADE criteria, was judged to be "very low" for all the maternal and neonatal outcomes considered.

Conclusions: Findings suggest no significant differences in the maternal, perinatal and neonatal outcomes between intermediate and long-acting insulin analogues. The results provide support for use of long-acting insulin analogues in women with GDM. However, evidence is still needed from high quality randomized controlled trials to arrive at a recommendation for inclusion in routine clinical care.

Keywords: Complications; Detemir; Glargine; Intermediate acting insulin; Long-acting insulin analogues; Meta-analysis; NPH; Neonatal outcomes; Neutral protamine Hagedron; Obstetric outcomes.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Selection process of the studies included in the review
Fig. 2
Fig. 2
Maternal outcomes in women with gestational diabetes receiving long-acting insulin analogues (glargine and/or detemir), compared to intermediate acting neutral protamine Hagedron
Fig. 3
Fig. 3
Maternal gestational weight gain (Kg) and glycosylated haemoglobin (HbA1c, %) in women with gestational diabetes receiving long-acting insulin analogues (glargine and/or detemir), compared to intermediate acting neutral protamine Hagedron
Fig. 4
Fig. 4
Birth outcomes in women with gestational diabetes receiving long-acting insulin analogues (glargine and/or detemir), compared to intermediate acting neutral protamine Hagedron
Fig. 5
Fig. 5
Neonatal morbidity and associated clinical outcomes in women with gestational diabetes receiving long-acting insulin analogues (glargine and/or detemir), compared to intermediate acting neutral protamine Hagedron
Fig. 6
Fig. 6
Mean gestational age and birth weight in neonates born to mothers with gestational diabetes receiving long-acting insulin analogues (glargine and/or detemir), compared to intermediate acting neutral protamine Hagedron
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