SUMMARY: Insulin is a hormone produced by the pancreas to regulate carbohydrate and fat metabolism. Insulin is required for glucose uptake by the body and is indicated in the treatment of diabetes mellitus. Insulin may be derived from human, porcine or recombinant sources and is administered via subcutaneous injection or continuous subcutaneous infusion. 

Uncontrolled diabetes in pregnancy is associated with an increased risk of adverse maternal and fetal outcomes including congenital malformations, fetal macrosomia, pre-eclampsia, preterm delivery, delivery-related complications such as shoulder dystocia, intrauterine death and neonatal hypoglycaemia. Adequate treatment is thus essential to ensure maternal glycaemic control. Close monitoring of maternal glucose levels is required during pregnancy as insulin requirements alter throughout pregnancy and should be assessed frequently. 

Insulin is safe to use under normal therapeutic conditions in pregnancy and does not cross the placenta. Adverse outcomes reported for diabetic pregnancies are thought to be related to glycaemic control, rather than a direct consequence of exposure to insulin. Exposure to insulin at any stage of pregnancy would not usually be regarded as medical grounds for termination of pregnancy. In cases where maternal glycaemic control is difficult referral to a specialist diabetes clinic may be warranted. 

Please report ALL cases of drug and/or chemical exposure in pregnancy to UKTIS by telephoning the service on 0844 892 0909 or by printing and completing a pregnancy reporting form, providing as many patient identifiers as possible to enable follow up of pregnancy outcome. This vital information enables UKTIS to provide evidence-based advice for future enquiries and to conduct surveillance of potential and known teratogens. 

For case specific advice please contact UKTIS on 0844 892 0909.