{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T23:04:07Z","timestamp":1780009447379,"version":"3.53.1"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The objective of this study is to provide clinicians with practical, pregnancy-specific guidance for initiating and optimizing continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), and automated insulin delivery (AID) in pregnancies complicated by Type 1 diabetes (T1D).<\/jats:p>\n                  <jats:p>Narrative review of key trials and device labeling, paired with pragmatic algorithms for antepartum titration, intrapartum management, and postpartum dose reduction.<\/jats:p>\n                  <jats:p>CGM improves glycemic metrics and neonatal outcomes in T1D pregnancy. Continuation of CSII during labor is safe and achieves similar or improved glycemic control compared with intravenous insulin strategies. Hybrid closed-loop AID increases time in the pregnancy target range of 60 to 140\u2009mg\/dL and reduces time above range without increasing severe hypoglycemia. Because the majority of AID systems are used off-label in pregnancy, clinicians need explicit protocols for pump failure, ketone monitoring, steroid exposure, and prevention of euglycemic diabetic ketoacidosis.<\/jats:p>\n                  <jats:p>With frequent review and clear escalation pathways, diabetes technology can help achieve pregnancy glycemic targets across gestation, labor, and the early postpartum period.<\/jats:p>","DOI":"10.1055\/a-2854-5752","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T23:04:26Z","timestamp":1776380666000},"page":"1072-1081","source":"Crossref","is-referenced-by-count":0,"title":["A Practical Approach to Insulin Pump, Continuous Glucose Monitoring, and Automated Insulin Delivery in the Management of Type 1 Diabetes in Pregnancy"],"prefix":"10.1055","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3373-7971","authenticated-orcid":false,"given":"Maggie","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Maternal Fetal Medicine, Inova Fairfax Hospital, Fairfax, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan G.","family":"Maayeh","sequence":"additional","affiliation":[{"name":"Department of Maternal Fetal Medicine, Virginia Health Sciences, Eastern Virginia Medical School at Old Dominion University, Norfolk, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George R.","family":"Saade","sequence":"additional","affiliation":[{"name":"Department of Maternal Fetal Medicine, Virginia Health Sciences, Eastern Virginia Medical School at Old Dominion University, Norfolk, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Saad","sequence":"additional","affiliation":[{"name":"Department of Maternal Fetal Medicine, Inova Fairfax Hospital, Fairfax, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"issue":"03","key":"ref2","first-page":"92","article-title":"Type 1 diabetes mellitus and pregnancy","volume":"3","author":"R Vargas","year":"2010","journal-title":"Rev Obstet Gynecol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.1016\/S0140-6736(17)32400-5","article-title":"Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial","volume":"390","author":"D S Feig","year":"2017","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1186\/1471-2458-14-134","article-title":"The INSPIRED study: a randomised controlled trial of the Whole Person Model of disease self-management for people with type 2 diabetes","volume":"14","author":"D M Clarke","year":"2014","journal-title":"BMC Public Health"},{"issue":"17","key":"ref5","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1056\/NEJMoa2303911","article-title":"Automated insulin delivery in women with pregnancy complicated by type 1 diabetes","volume":"389","author":"T TM Lee","year":"2023","journal-title":"N Engl J Med"},{"issue":"08","key":"ref6","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.2337\/dc22-0078","article-title":"Continuous glucose monitoring metrics and birth weight: informing management of type 1 diabetes throughout pregnancy","volume":"45","author":"E M Scott","year":"2022","journal-title":"Diabetes Care"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1177\/1932296821992373","article-title":"Variation of mean absolute relative differences of continuous glucose monitoring systems throughout the day","volume":"16","author":"S Pleus","year":"2022","journal-title":"J Diabetes Sci Technol"},{"issue":"10","key":"ref8","doi-asserted-by":"crossref","first-page":"e158","DOI":"10.2337\/dc15-1096","article-title":"Effect of acetaminophen on CGM glucose in an outpatient setting","volume":"38","author":"D M Maahs","year":"2015","journal-title":"Diabetes Care"},{"issue":"06","key":"ref10","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1177\/14791641211062155","article-title":"Use of continuous glucose monitoring trend arrows in the younger population with type 1 diabetes","volume":"18","author":"N Elbarbary","year":"2021","journal-title":"Diab Vasc Dis Res"},{"issue":"01","key":"ref12","first-page":"e52369","article-title":"Tandem T:Slim X2 insulin pump use in clinical practice among pregnant individuals with type 1 diabetes: a retrospective observational cohort study","volume":"16","author":"N Nandam","year":"2024","journal-title":"Cureus"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1186\/s12884-023-05481-0","article-title":"Closed-loop insulin delivery in pregnant women with type 1 diabetes (CRISTAL): a multicentre randomized controlled trial - 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