Real‐world use of automatic insulin delivery pumps in early pregnancy among women living with type 1 diabetes

Abstract Aims To investigate the clinical use, in early pregnancy in women living with type 1 diabetes (T1D), of automated insulin delivery (AID) systems lacking pregnancy‐specific algorithms and to evaluate the maternal and glycaemic outcomes associated with their implementation in routine care. Methods This observational study included women with T1D who used off‐label AID pumps during pregnancy. The AID pumps were switched to manual mode during the second trimester. Results Of the 37 women, 25 used the Tandem Control IQ, and 12 used the MiniMed 780G. The median age was 30.5 (28.0–34.0) years. Automatic functions were activated until the median gestational age was 18.9 weeks. Mean time in range pregnancy (TIRp) was 65.0%, 70.1% and 76.5% in the first, second and third trimesters, respectively. Only 10 women (27.0%) reached TIRp >70% in all trimesters. 34 women (91.9%) were prescribed adjunctive treatment with long‐acting insulin. 18 women (49%) delivered with caesarean section, and 12 (32.4%) had newborns large for gestational age. Conclusions This small observational cohort showed no major safety signals among women using AID pumps during early pregnancy or during the second and third trimesters when manual mode was combined with adjunctive long‐acting insulin. In this cohort, we also observed favourable glycaemic outcomes in later pregnancy, when most AID systems were used almost exclusively in manual mode.