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    Possible fetal outcome of insulin aspart
    (Italian Society of Endocrinology (SIE), 2008) Kanat, M.; Tahtacı, M.
    The issue of whether insulin aspart and other analogues cross the human placenta is debated. We report a 31-yrold Type 2 diabetic multiparous woman who used insulin aspart at conception and during the first 6 weeks of pregnancy and had a baby with multiple congenital anomalies. She had excellent glucose control [glycated hemoglobulin (HbA1c) <5.6] with oral anti-diabetic agents when she came to our clinic and was considering becoming pregnant. Since she did not accept multiple injections, split dose insulin treatment was initiated [30% regular, 70% human isophane (NPH) insulin]. The patient’s blood glucose was regulated quite well during this treatment. However, the treatment was switched to analogue insulin at the same dosage (70% insulin aspart protamine suspension and 30% insulin aspart injection, Novo Nordisk formulation) by another doctor. At the next visit, she was 6-week pregnant; the analogue insulin was stopped and multiple injections were initiated (as mealtime regular and bedtime NPH) and this therapy was maintained until birth. No other drugs were used throughout the pregnancy. There was no consanguinity between parents. In the rest of the pregnancy, an optimal glucose regulation was provided (maximum fasting glucose <88 mg/dl, maximum post-prandial glucose <138 mg/dl, maximum HbA1c<6.1). She had a cesarean section at 29th gestational week and delivered a newborn with multiple congenital malformations including ambiguous genitalia due to 5-α reductase enzyme deficiency, anomalous course of left coronary artery, hemi-vertebra and horseshoe kidney. Theoretically, there could be at least 3 reasons explaining the fetal malformations in this baby: pre-gestational diabetes, maternal age, and insulin aspart that was used during the first 6 weeks of the pregnancy.