SUN-534 - Automated Insulin Delivery in Type 1 Diabetes Pregnancy: Updated Systematic Review and Meta-Analysis

Pregnancy in women with type 1 diabetes mellitus (T1DM) carries a high risk of maternal and neonatal complications, largely due to the difficulty of maintaining optimal glycemic control in the setting of progressive insulin resistance. Automated insulin delivery (AID) systems offer a promising strategy to improve glucose management; however, evidence supporting their use during pregnancy remains limited. This study aimed to evaluate the efficacy of AID systems in pregnant women with T1DM and to assess their impact on insulin management, glycemic control, and maternal–neonatal outcomes.
A systematic search of MEDLINE (PubMed), Cochrane CENTRAL, and EMBASE identified nine eligible studies. Data were extracted using Microsoft Excel, including study characteristics, participant demographics, interventions, and outcomes. The primary outcome was time in target glucose range (TIR; 63–140 mg/dL). Secondary outcomes included time below and above range, as well as maternal and neonatal outcomes such as gestational hypertension, pre-eclampsia, preterm birth, neonatal hypoglycaemia, NICU admission, respiratory distress, macrosomia, small for gestational age, and large for gestational age.
Nine studies including 559 participants were included. Automated insulin delivery (AID) significantly improved glycaemic control, increasing time in range (mean difference +6.76%, 95% CI 2.18–11.33; p=0.0038) and reducing hypoglycaemic exposure (mean difference −0.88%, 95% CI −1.53 to −0.22; p=0.0091). Hyperglycaemic exposure showed a non-significant numerical reduction (mean difference −4.49%, 95% CI −9.65 to 0.67; p=0.0879). Pooled maternal outcomes included gestational hypertension (11.8%) and pre-eclampsia (13.3%). Neonatal outcomes included preterm birth (30.7%), neonatal hypoglycaemia (40.3%), NICU admission (27.8%), macrosomia (22.5%), low small-for-gestational-age prevalence (2.6%), and high large-for-gestational-age prevalence (54.1%). These findings underscore the clinical relevance of AID in improving glycaemic control while maintaining maternal and neonatal safety in high-risk T1DM pregnancies.
Our study demonstrates that automated insulin delivery (AID) systems are associated with clinically meaningful improvements in glycaemic control during pregnancy, including increased time in range and reduced hypoglycaemic exposure, without worsening hyperglycaemia. Maternal outcomes were comparable to expected rates in pregnancies complicated by type 1 diabetes, while neonatal outcomes reflected the persistent baseline risk in this population. This work represents the most recent and largest systematic review and meta-analysis to date, incorporating randomized controlled trials and real-world evidence to evaluate AID use in pregnant women with type 1 diabetes.

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