Type 1 diabetes (T1D) during pregnancy is associated with a higher risk of adverse maternal and neonatal outcomes [1], [2], [3], [4]. Therefore, achieving near-normal glycemic targets before and during pregnancy is crucial. However, maintaining tight glycemic control is often challenging due to the complexities of insulin dose adjustments needed to accommodate the changes in insulin sensitivity throughout pregnancy and the delayed absorption of insulin later in pregnancy [5], [6]. Continuous glucose monitoring (CGM) has improved glycemic management and reduced pregnancy complications in women with T1D [7], [8]. The CONCEPTT trial demonstrated that CGM use led to lower HbA1c levels and improved neonatal outcomes compared to self-monitoring of blood glucose (SMBG). However, large-for-gestational age (LGA) prevalence remained high at 53 % [7]. A 5 % reduction in time in pregnancy range (TIRp) and a 5 % increase in time above pregnancy range (TARp) are associated with increased risks of LGA infants, neonatal hypoglycemia, and neonatal intensive care unit (NICU) admissions, indicating that small improvements in glycemic control could lead to substantial improvement of pregnancy outcomes [8].

International guidelines recommend a TIRp of > 70 % within 3.5–7.8 mmol/L (63–140 mg/dL), but many women only reach this target at the end of pregnancy [9]. While there is no evidence that insulin pumps (continuous subcutaneous insulin infusion, CSII) provide better outcomes than multiple daily injections (MDI), they offer greater flexibility for the changing insulin needs throughout pregnancy [10]. Automated insulin delivery (AID) systems improve diabetes management using real-time CGM data and predictive algorithms to automate insulin delivery, however, manual boluses are still needed at mealtime [10]. In non-pregnant populations with T1D, AID is associated with a 12 % increase in time in range (TIR) [3.9–10.0 mmol/L (70–180 mg/dL)], reduced hypoglycemia, and better quality of life compared to standalone pump therapy [11], [12], [13]. As more women with T1D start pregnancy using AID, questions arise about its safety and effectiveness during pregnancy. Furthermore, many women are reluctant to stop AID during pregnancy due to the perceived benefits. We review the current evidence on the use of AID in pregnancy and postpartum, providing clinical guidance and highlighting areas for future research