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Am J Perinatol
DOI: 10.1055/a-2625-6437
Original Article

Diabetes Technology Use in Pregnancies with Type 1 Diabetes in the United States from 2009 to 2020

Nasim C. Sobhani 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
,
Yongmei Huang
2   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Kartik K. Venkatesh 
3   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Jason D. Wright
4   Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Alexander M. Friedman
5   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Timothy Wen
6   Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
7   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, California
› Author Affiliations
Funding None.
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Abstract

Objective

The use of continuous glucose monitors (CGM) and insulin pumps has revolutionized the care of patients with type 1 diabetes (T1D). Few data are available regarding the use of diabetes technology use in the pregnant T1D population. This study was conducted to evaluate temporal trends of diabetes technology use and predictors of use among pregnant individuals with TID in the United States from 2009 to 2020.

Study Design

MarketScan Research Databases from 2009 to 2020 were used to identify pregnant individuals with T1D who were and were not using CGM and/or insulin pumps. Joinpoint regression analysis was used to estimate the average annual percent change (AAPC) in diabetes technology use over time. Unadjusted and adjusted log-linear Poisson regression models were developed to assess the associations between the outcomes of CGM and insulin pump use and demographic and clinical predictors. Associations were reported as adjusted risk ratios (ARR) with 95% confidence intervals (CI).

Results

Among 9,201 pregnancies with T1D, CGM use increased from 2.3% in 2009 to 13.7% in 2020 (AAPC: 13.9%; 95% CI: 11.7–17.1), while insulin pump use remained unchanged from 10.9% in 2009 to 11.8% in 2020 (AAPC: −2.4%; 95% CI: −4.4 to 0.4). Medicaid insurance and obesity were associated with a lower likelihood of CGM use and insulin pump use, while a high obstetric comorbidity index score was associated with a higher likelihood of insulin pump use (ARR: 1.26; 95% CI: 1.05–1.51).

Conclusion

From 2009 to 2020, CGM use among pregnant individuals with T1D increased, while insulin pump use remained unchanged. Use varied by patient demographic and clinical factors, most notable for lower likelihood of CGM use and insulin pump use with Medicaid insurance. Although CGM use increased over time, overall CGM use remained lower than expected despite the known benefits of CGM use in improving neonatal outcomes in pregnancies complicated by T1D.

Key Points

  • CGM use in pregnant individuals with T1D increased from 2.3 to 13.7%, but pump use was stable.

  • Medicaid and obesity were associated with lower CGM and pump use in pregnant individuals with T1D.

  • Low CGM use in pregnant T1D individuals highlights barriers and the need for equitable access.

Keywords

continuous glucose monitors - insulin pumps - pregnancy - type 1 diabetes

Supplementary Material



Publication History

Received: 12 December 2024

Accepted: 02 June 2025

Accepted Manuscript online:
03 June 2025

Article published online:
24 June 2025

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