Approach to the Patient Using Diabetes Technology in Pregnancy

Diabetes in pregnancy increases risk for complications for the pregnant patient and neonate. Tight glycemic control to maintain glucose levels as close to nondiabetic ranges as possible can lower risk for these complications. Achieving strict glycemic targets can be challenging, and technologies including continuous glucose monitors (CGMs) and hybrid closed-loop (HCL) insulin pumps have the potential to improve diabetes control and pregnancy outcomes. The aim of this review is to present and appraise the current data about use of these technologies in pregnancy. In pregnancies with type 1 diabetes (T1D), CGM can improve glycemic control and reduce risk for neonatal complications. International consensus guidelines recommend more than 70% time in pregnancy target range (TIR) of 63 to 140 mg/dL (3.5-7.8 mmol/L), and there are data to suggest higher TIR in pregnancies with T1D can reduce risk for neonatal complications including fetal overgrowth and pregnancy complications like preeclampsia. Recent randomized controlled trials have demonstrated improved glycemic outcomes with use of HCL insulin pumps in pregnancy with T1D, though the results vary depending on the system used and available glycemic targets. In pregnancies with type 2 diabetes (T2D) and gestational diabetes mellitus (GDM), retrospective data suggest CGM can improve glycemia but there are limited data about outcomes or optimal CGM targets. Studies have reported glycemic measures for pregnancies without diabetes, which may serve as a guide for further outcomes studies of T2D and GDM. Access to diabetes technology and the necessary health care systems to support use of these devices may be barriers that contribute to health care disparities.