From Belton, South Carolina, USA:
I would like to ask you to reconsider the answer you gave to a question a woman had regarding Lantus (insulin glargine) injections during pregnancy. She was concerned because of the Lantus animal study with rabbits in which five rabbits out of the litter whose mother was receiving Lantus, were born with cerebral dilation. The study also failed to mention if the rabbit already had diabetes or not. You suggested that a pregnant woman should switch back to other, less reliable insulins until later in her pregnancy, but if you look at the actual study, it shows that the rabbits were given seven times the normal amount of Lantus as compared to the amount humans would inject.
Studies show that poor control of diabetes in the first trimester has a significant correlation with birth defects, much more so than a woman who is achieving good control through the use of Lantus with the slight risk suggested by the study. It seems apparent that a dose of anything at seven times the normal rate would be more harmful than attaining good control using a standard dosage of Lantus.
I couldn't help but think of the studies in the '80's regarding Nutrasweet and the mice who ingested many times the normal rate, resulting in various cancers. I'm not a doctor, but it honestly seems as if the better course of treatment in early pregnancy would be optimal control, which is much more difficult to achieve using earlier versions of insulin.
In principal, I agree with you. However, in today's medical-legal climate, if anyone has a bad outcome that may not even be related to a medication, but there is scientific literature (no matter how questionable) to support the notion of incorrect usage of medication, then it can place a doctor in a difficult position. That is why most physicians would not deviate from the standard of care.
[Editor's comment: Lantus, like many other newer medications, has not been evaluated in clinical trials in pregnant women. SS]
Original posting 28 Oct 2002
Posted to Family Planning
Last Updated: Tuesday April 06, 2010 15:09:37
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