Management of Automated Insulin Delivery Systems in Pregnant Individuals With Type 1 Diabetes: Practical Tips and System-Specific Workarounds.

Background

Automated insulin delivery (AID) systems are increasingly used off-label in pregnancy for type 1 diabetes management, yet most current algorithms were not designed for the unique metabolic demands of gestation. This guide provides practical, evidence-based, and system-specific workarounds to safely optimise the six major commercial and open-source AID systems for use in pregnancy.

Methods

This narrative review synthesises recommendations from major clinical practice guidelines (American Diabetes Association, Diabetes Canada), the 2026 international consensus statement on continuous glucose monitoring and AID use in pregnancy, and key findings from landmark clinical trials (CRISTAL, CIRCUIT, and AiDAPT). A targeted literature search of PubMed, Embase, and Cochrane Library (January 2018-February 2026) was performed using keywords, including 'automated insulin delivery', 'closed-loop', 'type 1 diabetes', and 'pregnancy'. Tips were derived from peer-reviewed studies, consensus guidelines, and clinical experience of the authors; the source of each tip is identified throughout the text.

Results

A comprehensive set of 43 practical tips is presented, covering preconception optimisation, trimester-specific insulin adjustments, prandial management strategies, system-specific workarounds for Tandem Control-IQ, Medtronic 780G, Omnipod 5, twiist, CamAPS FX, and Do-It-Yourself Loop, and protocols for special situations including antenatal corticosteroid administration, labour and delivery, and the postpartum period.

Conclusion

By combining a deep understanding of AID system limitations with proactive, data-driven clinical strategies, clinicians can help individuals living with type 1 diabetes safely navigate the complexities of pregnancy, improve glycaemic levels, and enhance maternal and neonatal safety.