Optimizing Automated Insulin Delivery Systems for Pregnancy

Automated insulin delivery (AID) systems have revolutionized modern diabetes care outside of pregnancy, but none of the AID systems currently available in the U.S. are approved for use during pregnancy, none have glucose targets low enough to achieve the stricter fasting glucose targets recommended during pregnancy, and none have algorithms that were designed to respond to the amplified oscillations in glycemia that occur in pregnancy or the progressive changes in insulin resistance observed over the course of gestation. Despite these limitations, many women elect to continue using AID off label during pregnancy based on consideration of individual clinical factors and preferences. This article presents some commonly encountered challenges to off-label AID use and CGM interpretation during pregnancy, along with suggested best-practice workarounds to optimize the care of pregnant individuals with diabetes using AID.