INS and hyperinsulinism: Data from previous studies showed that the perinatal mortality and stillbirth rates were higher in pregnant women with DM1 than in the general population.47, 50, 51 Persistent fetal hyperinsulinemia results in higher oxygen uptake and metabolic rates, which consequently increase the risk of fetal hypoxemia and mortality.52 The analysis of this outcome showed that there was no difference between the use of insulin analogs and the use of human insulins on perinatal death.