Cochrane · systematic review · CD011880
Different insulin types and regimens for pregnant women with pre‐existing diabetes
O'Neill, SM, Kenny, LC, Khashan, AS, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
Pregnancy and ChildbirthAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
42
current version
GRADE rated
11
No studies
7
Included studies
NR
No studies 7 · 16.7%Ungraded 24 · 57.1%Very low 11 · 26.2%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Lispro versus regular insulin (Different insulin types within similar insulin regimens)
Population: pregnant women with pre‐existing diabetes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Macrosomia Lispro vs regular insulin (Different insulin types within similar insulin regimens) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Perinatal death Lispro vs regular insulin (Different insulin types within similar insulin regimens) | no estimate extracted | 1 study · 33 participants | Very low Downgraded: risk of bias |
Pre‐eclampsia Lispro vs regular insulin (Different insulin types within similar insulin regimens) | RR 0.68 [0.35, 1.3] | 1 study · 33 participants | Very low Downgraded: risk of bias |
Caesarean section Lispro vs regular insulin (Different insulin types within similar insulin regimens) | RR 0.59 [0.25, 1.39] | 1 study · 33 participants | Very low Downgraded: risk of bias |
Fetal anomaly Lispro vs regular insulin (Different insulin types within similar insulin regimens) | RR 0.35 [0.02, 8.08] | 1 study · 33 participants | Very low Downgraded: risk of bias |
Birth trauma, including shoulder dystocia, nerve palsy, and fracture Lispro vs regular insulin (Different insulin types within similar insulin regimens) | no estimate extracted | 1 study · 33 participants | Very low Downgraded: risk of bias |
Composite outcome measure of neonatal morbidity Lispro vs regular insulin (Different insulin types within similar insulin regimens) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Human insulin versus animal insulin (Different insulin types within similar insulin regimens)
Population: pregnant women with pre‐existing diabetes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Macrosomia Human insulin vs animal insulin (Different insulin types within similar insulin regimens) | RR 0.22 [0.01, 4.3] | 1 study · 42 participants | Very low Downgraded: risk of bias |
Perinatal death Human insulin vs animal insulin (Different insulin types within similar insulin regimens) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Pre‐eclampsia Human insulin vs animal insulin (Different insulin types within similar insulin regimens) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Caesarean section Human insulin vs animal insulin (Different insulin types within similar insulin regimens) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Fetal anomaly Human insulin vs animal insulin (Different insulin types within similar insulin regimens) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Birth trauma including shoulder dystocia, nerve palsy, and fracture Human insulin vs animal insulin (Different insulin types within similar insulin regimens) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Composite outcome measure of neonatal morbidity Human insulin vs animal insulin (Different insulin types within similar insulin regimens) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Pre‐mixed insulin (70 NPH/30 REG) versus self‐mixed split dose insulin (Different insulin regimens with similar insulin types used within the regimen)
Population: pregnant women with pre‐existing diabetes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Macrosomia Pre‐mixed insulin (70 NPH/30 REG) vs self‐mixed split dose insulin (Different insulin regimens with similar insulin types used within the regimen) | RR 0.49 [0.09, 2.54] | 1 study · 93 participants | Very low |
Perinatal death Pre‐mixed insulin (70 NPH/30 REG) vs self‐mixed split dose insulin (Different insulin regimens with similar insulin types used within the regimen) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Pre‐eclampsia Pre‐mixed insulin (70 NPH/30 REG) vs self‐mixed split dose insulin (Different insulin regimens with similar insulin types used within the regimen) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Caesarean section 4 Pre‐mixed insulin (70 NPH/30 REG) vs self‐mixed split dose insulin (Different insulin regimens with similar insulin types used within the regimen) | RR 0.57 [0.25, 1.32] | 1 study · 93 participants | Very low |
Fetal anomaly Pre‐mixed insulin (70 NPH/30 REG) vs self‐mixed split dose insulin (Different insulin regimens with similar insulin types used within the regimen) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Birth trauma including shoulder dystocia, nerve palsy, or fracture Pre‐mixed insulin (70 NPH/30 REG) vs self‐mixed split dose insulin (Different insulin regimens with similar insulin types used within the regimen) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Composite outcome measure of neonatal morbidity Pre‐mixed insulin (70 NPH/30 REG) vs self‐mixed split dose insulin (Different insulin regimens with similar insulin types used within the regimen) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Insulin injected with a Novolin pen versus insulin injected with a needle or syringe (Different insulin regimens with similar insulin types used within the regimen)
Population: pregnant women with pre‐existing diabetes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Macrosomia 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) | RR 0.21 [0.03, 1.76] | 1 study · 93 participants | Very low |
Perinatal death 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) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Pre‐eclampsia 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) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Caesarean section 4 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) | RR 0.38 [0.15, 0.97] | 1 study · 93 participants | Very low |
Fetal anomaly 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) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Birth trauma including shoulder dystocia, nerve palsy, or fracture 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) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Composite outcome measure of neonatal morbidity 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) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Insulin Aspart (+ NPH) compared to human insulin (+ NPH insulin) for pregnant women with pre‐existing diabetes (Different insulin types within similar insulin regimens)
Population: pregnant women with pre‐existing diabetes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Macrosomia Insulin Aspart (+ NPH) vs human insulin (+ NPH insulin) | no estimate extracted | NR | No studies |
Perinatal death Insulin Aspart (+ NPH) vs human insulin (+ NPH insulin) | no estimate extracted | NR | No studies |
Pre‐eclampsia Insulin Aspart (+ NPH) vs human insulin (+ NPH insulin) | no estimate extracted | NR | No studies |
Caesarean section Insulin Aspart (+ NPH) vs human insulin (+ NPH insulin) | no estimate extracted | NR | No studies |
Fetal anomaly Insulin Aspart (+ NPH) vs human insulin (+ NPH insulin) | no estimate extracted | NR | No studies |
Birth trauma including shoulder dystocia, nerve palsy and fracture Insulin Aspart (+ NPH) vs human insulin (+ NPH insulin) | no estimate extracted | NR | No studies |
Composite outcome measure of neonatal morbidity Insulin Aspart (+ NPH) vs human insulin (+ NPH insulin) | no estimate extracted | NR | No studies |
Insulin Detemir + prandial insulin Aspart versus NPH insulin + prandial insulin Aspart (Different insulin types within similar insulin regimens)
Population: pregnant women with pre‐existing diabetes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Macrosomia Insulin Detemir + prandial insulin Aspart vs NPH insulin + prandial insulin Aspart (Different insulin types within similar insulin regimens) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Perinatal death Insulin Detemir + prandial insulin Aspart vs NPH insulin + prandial insulin Aspart (Different insulin types within similar insulin regimens) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Pre‐eclampsia Insulin Detemir + prandial insulin Aspart vs NPH insulin + prandial insulin Aspart (Different insulin types within similar insulin regimens) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Caesarean section Insulin Detemir + prandial insulin Aspart vs NPH insulin + prandial insulin Aspart (Different insulin types within similar insulin regimens) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Fetal anomaly (major) Insulin Detemir + prandial insulin Aspart vs NPH insulin + prandial insulin Aspart (Different insulin types within similar insulin regimens) | RR 3.15 [0.33, 29.67] | 1 study · 162 participants | Very low Downgraded: risk of bias, imprecision |
Birth trauma including shoulder dystocia, nerve palsy, or fracture Insulin Detemir + prandial insulin Aspart vs NPH insulin + prandial insulin Aspart (Different insulin types within similar insulin regimens) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Composite outcome measure of neonatal morbidity Insulin Detemir + prandial insulin Aspart vs NPH insulin + prandial insulin Aspart (Different insulin types within similar insulin regimens) | no estimate extracted | 0 studies · 0 participants | Ungraded |