What do systematic reviews say?

Insulin vs anti‐diabetic agent

Insulin showed no clear difference in caesarean section compared with anti‐diabetic agent (moderate certainty).

• Insulin for the treatment of women with gestational diabetes 2017 · Cochrane Headline outcomes only
  RR 1.03 [0.93, 1.14]
  17 studies · 1988 participants
  Moderate

Human insulin vs animal insulin (Different insulin types within similar insulin regimens)

• Different insulin types and regimens for pregnant women with pre‐existing diabetes 2017 · Cochrane Headline outcomes only
  no estimate extracted
  0 studies · 0 participants
  GRADE not reported

Insulin Aspart (+ NPH) vs human insulin (+ NPH insulin)

The review found no eligible studies for this question.

• Different insulin types and regimens for pregnant women with pre‐existing diabetes 2017 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

Pre‐mixed insulin (70 NPH/30 REG) vs self‐mixed split dose insulin (Different insulin regimens with similar insulin types used within the regimen)

It is very uncertain whether pre‐mixed insulin (70 NPH/30 REG) changes caesarean section 4 compared with self‐mixed split dose insulin (Different insulin regimens with… (very low certainty).

• Different insulin types and regimens for pregnant women with pre‐existing diabetes 2017 · Cochrane Headline outcomes only
  RR 0.57 [0.25, 1.32]
  1 study · 93 participants
  Very low

Insulin injected with a Novolin pen vs insulin injected with a needle or syringe (Different insulin regimens with similar insulin types used within the regimen)

It is very uncertain whether insulin injected with a Novolin pen changes caesarean section 4 compared with insulin injected with a needle or syringe (Different insulin… (very low certainty).

• Different insulin types and regimens for pregnant women with pre‐existing diabetes 2017 · Cochrane Headline outcomes only
  RR 0.38 [0.15, 0.97]
  1 study · 93 participants
  Very low

Insulin Detemir + prandial insulin Aspart vs NPH insulin + prandial insulin Aspart (Different insulin types within similar insulin regimens)

• Different insulin types and regimens for pregnant women with pre‐existing diabetes 2017 · Cochrane Headline outcomes only
  no estimate extracted
  0 studies · 0 participants
  GRADE not reported

Lispro vs regular insulin (Different insulin types within similar insulin regimens)

It is very uncertain whether lispro changes caesarean section compared with regular insulin (Different insulin types within similar insulin… (very low certainty).

• Different insulin types and regimens for pregnant women with pre‐existing diabetes 2017 · Cochrane Headline outcomes only
  RR 0.59 [0.25, 1.39]
  1 study · 33 participants
  Very low

Metformin vs insulin

Maternal outcomes: oral anti‐diabetic agent (metformin) may leads to lower caesarean section compared with insulin (low certainty).

• Oral anti‐diabetic agents for women with established diabetes/impaired glucose tolerance or previous gestational… 2017 · Cochrane Headline outcomes only
  RR 0.73 [0.61, 0.88]
  3 studies · 241 participants
  Low

CSII vs MDI: maternal outcomes

It is very uncertain whether CSII changes caesarean section compared with MDI: maternal outcomes (very low certainty).

• Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes 2016 · Cochrane Headline outcomes only
  RR 1.09 [0.66, 1.77]
  3 studies · 71 participants
  Very low