A Diabetes Care commentary argues that pregnant women with type 1 diabetes have been left behind by automated insulin delivery (AID). AID is now the recommended mode of insulin delivery in type 1 diabetes, but most FDA-approved systems are not labelled for pregnancy and are not designed to reach its lower glucose targets.
The practical problem is specific: most algorithms reduce insulin delivery when sensor glucose sits in the range that is optimal for the fetus, because they are tuned to non-pregnant targets. Pregnant women have also been broadly excluded from AID trials, so the evidence base for the systems in use is thin.
The authors call for pregnant women to be included in trials of new systems, for pregnancy-specific algorithms, and for real-world studies of current devices in the meantime. This is opinion, not new data, but it names a gap that affects every antenatal diabetes clinic running pumps.
- Ask every woman with type 1 diabetes on AID who is planning pregnancy which system she uses and whether it allows a lower target.
- Expect standard AID settings to under-deliver insulin at pregnancy glucose targets; review CGM time-in-range for pregnancy (63–140 mg/dL) at each visit.
- Consider manual or hybrid adjustments with the pump team rather than assuming the algorithm will adapt.
- Discuss off-label use honestly: most systems are not labelled for pregnancy.
Why it matters
The device that is standard care outside pregnancy may actively pull glucose away from fetal targets.
Don't overread it
This is a call to action, not a trial — it identifies a gap but does not show AID is harmful in pregnancy.
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