Practical Approach to Continuous Glucose Monitoring Interpretation and Automated Insulin Delivery Use in Pregnancy: Considerations for Obstetric Providers

Abstract

While automated insulin delivery (AID) systems have multiple well-established benefits outside of pregnancy and are widely used in non-pregnant individuals with type 1 diabetes (T1D), none of the commercially available AID systems in North America are approved for use during pregnancy. Use of commercially available AID systems off-label in pregnancy is currently limited by: (1) glucose targets higher than the fasting glucose target range recommended during pregnancy and (2) algorithms which were not designed for the dynamic changes in insulin resistance which occur across gestation. However, as AID use in the general population expands, many individuals will opt to continue using these systems off-label during pregnancy, and thus, guidance for providers regarding AID use and optimization during pregnancy is of the utmost importance. A cornerstone to the effective use of AID systems is the systematic and accurate interpretation of continuous glucose monitoring (CGM) data. One obstacle to the use of both CGM and AID systems by obstetric providers is the lack of comfort with CGM interpretation. We therefore present here: (1) a systematic approach to CGM interpretation during pregnancy and (2) practical guidance regarding AID use during pregnancy for individuals who opt to use commercially available AID systems off-label during pregnancy after consideration of individualized risks and benefits.