A Practical Approach to Insulin Pump, Continuous Glucose Monitoring, and Automated Insulin Delivery in the Management of Type 1 Diabetes in Pregnancy

Objective: The objective of this study is to provide clinicians with practical, pregnancy-specific guidance for initiating and optimizing continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), and automated insulin delivery (AID) in pregnancies complicated by Type 1 diabetes (T1D). Study Design: Narrative review of key trials and device labeling, paired with pragmatic algorithms for antepartum titration, intrapartum management, and postpartum dose reduction. Results: CGM improves glycemic metrics and neonatal outcomes in T1D pregnancy. Continuation of CSII during labor is safe and achieves similar or improved glycemic control compared with intravenous insulin strategies. Hybrid closed-loop AID increases time in the pregnancy target range of 60 to 140 mg/dL and reduces time above range without increasing severe hypoglycemia. Because the majority of AID systems are used off-label in pregnancy, clinicians need explicit protocols for pump failure, ketone monitoring, steroid exposure, and prevention of euglycemic diabetic ketoacidosis. Conclusion: With frequent review and clear escalation pathways, diabetes technology can help achieve pregnancy glycemic targets across gestation, labor, and the early postpartum period. Key Points: · Technology optimization: in order to adapt standard pump algorithms to strict pregnancy-specific glycemic targets, clinicians must employ "off-label" strategies, such as lowering active insulin time.. · Dynamic dosing: insulin requirements fluctuate significantly by gestational age, peaking at 1.0 µ/kg in late pregnancy before requiring an immediate 50% reduction postpartum to prevent severe hypoglycemia.. · Intrapartum safety: continuing insulin pump therapy during labor is safe and often results in improved glycemic control and patient satisfaction compared with switching to intravenous insulin..