Continuing AID During Childbirth in Women With T1D
Anna L. Emanuel, Misja Sprengers, Richard G. IJzerman, Rebecca C. Painter and Sarah E. Siegelaar
Automated insulin delivery in women with type 1 diabetes during the peripartum period: Maintaining autonomy while optimizing care – review and clinical evaluation. J Diabetes Complications. 2026 Sep;40(9):109365.
Automated insulin delivery (AID) systems are increasingly used by women with type 1 diabetes (T1D) during pregnancy. But what should happen when labour starts? Traditionally, women with T1D have often been switched from their usual insulin therapy to an intravenous insulin and glucose infusion during labour and delivery.
In this review and clinical evaluation, Diabeter NL/Diabeter Center Amsterdam/Amsterdam UMC researchers examined whether women can safely continue using their own AID system throughout the peripartum period – from hospital admission for delivery until discharge. The authors combined evidence from clinical trials and guidelines with their own clinical experience at Amsterdam UMC.
KEY FINDINGS
- Continuing AID during labour appears safe and effective: In the CRISTAL trial, women who continued AID during labour and delivery spent 71.5% of the time within the pregnancy-specific glucose range (3.5–7.8 mmol/L), compared with 63.1% with standard insulin therapy. This improvement was achieved without an increase in hypoglycaemia.
- AID may help women maintain control over their own diabetes management: Women given the choice often preferred to continue their usual insulin pump rather than switch to intravenous insulin. According to the authors, maintaining the woman's usual treatment can support autonomy during childbirth while also reducing invasiveness and workload for healthcare staff.
- Clinical experience supports continuing AID: Between 2021 and 2025, Amsterdam UMC managed 89 pregnancies in women with T1D, of which 37 involved AID. Among the 32 pregnancies with complete outcome data, 29 women – 90.6% – continued their AID system during delivery.
- No severe maternal glucose events occurred among these 29 women: None experienced severe hypoglycaemia (<3.0 mmol/L) or severe hyperglycaemia (>15.0 mmol/L) during labour and delivery. One woman experienced mild hypoglycaemia.
- Neonatal hypoglycaemia remained common: It occurred in 16 of the 29 newborns (55.2%), although the authors note that this is comparable to previously reported rates in pregnancies complicated by T1D. Importantly, there were no cases of severe neonatal hypoglycaemia requiring prolonged NICU admission.
- AID may also be beneficial after delivery: Insulin requirements fall rapidly after the placenta is delivered, increasing the risk of maternal hypoglycaemia. Previous studies reviewed by the authors suggest that AID can help manage this transition. In the extended AiDAPT trial, for example, women using AID spent 72% of time in range during the first six months postpartum compared with 54% with standard care, without a difference in hypoglycaemia.
These findings support continuing AID during labour and delivery when this is preferred by the woman and can be done safely. This requires a functioning AID system, a woman or trained support person who can operate it, appropriately trained healthcare professionals, and a clear backup plan. Intravenous insulin should be reserved for situations in which safe continuation of AID is no longer possible.
Importantly, continuing a familiar AID system may not only provide effective glucose management but also help women maintain autonomy and control over their diabetes management during childbirth.
CONCLUDING THE AUTHORS STATE
“Together, these findings suggest that continuation of AID during the peripartum period appears to be effective and safe."
Please click here for the link to the full text.