While the majority of women with preexisting diabetes need increasing doses of insulin with advancing gestation, a proportion need a reduction in insulin dose in late pregnancy. Falling insulin requirements may be considered a clinical manifestation of the glycemic vascular interface between the fetoplacental unit and the mother, raising concerns of fetoplacental compromise and prompting increased maternal and fetal monitoring and early delivery in some cases.
In this presentation, emerging literature on falling insulin requirements and its association with adverse outcomes, placental biomarkers and ultrasound parameters will be discussed.