Automated Insulin Delivery in Pregnancy: What the Evidence Shows

Automated insulin delivery (AID)—technology that adjusts insulin based on continuous glucose readings—has moved from experimental use to real-world implementation for people managing Type 1 diabetes during pregnancy. A comprehensive new review of clinical evidence found that selected AID systems can improve important pregnancy-specific glucose metrics, particularly time in range and overnight blood sugar stability.

However, the improvements aren't universal across all systems. The evidence is system-specific, meaning results from one device don't necessarily apply to another. Current trials are also limited in size when it comes to measuring effects on maternal and neonatal (newborn) health outcomes—the ultimate measures of safety and benefit that matter most to families.

The research emphasizes an important insight: automated insulin delivery in pregnancy works best when viewed as a 'socio-technical intervention.' Translation: the technology itself is only part of the picture.

Success also depends on understanding how pregnancy changes the body's insulin needs, how users interact with the device day-to-day, the quality of diabetes education provided, the expertise of the care team, how antenatal care is organized, planning for delivery, adjusting insulin doses after birth, and access to specialist support. When all these elements work together, outcomes improve. When they don't, even excellent technology may fall short.

The review examined evidence for three systems: CamAPS FX, MiniMed 780G, and Tandem Control-IQ. Each has supporting data showing benefits in pregnancy, but the evidence varies in strength and scope. Clinicians and patients should understand that data from one system cannot be assumed to apply to the others.

While glucose control metrics have improved with selected systems, significant questions remain unanswered. Current research doesn't provide definitive evidence about how automated insulin delivery affects long-term maternal health, neonatal outcomes, or complications during pregnancy and delivery. This is a critical area where more robust, well-powered studies are needed to give families and clinicians full confidence in the benefits and risks.

The evidence review identified important equity concerns: implementation of automated insulin delivery in pregnancy looks very different depending on whether healthcare systems are well-resourced or lower-resource. Access to these systems, training for healthcare providers, specialist support, and continuous glucose monitoring supplies are not evenly distributed globally. Any effort to translate this technology into routine care must address these disparities to ensure pregnant people with Type 1 diabetes can benefit regardless of where they live or their economic circumstances.

The field has now moved beyond asking whether selected AID systems can improve blood sugar numbers. The next challenge is determining how healthcare services can effectively implement these systems in ways that are safe, sustainable, and fair for all.

Source: Journal of diabetes research. Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.