Listening to women: experiences of using closed-loop in type 1 diabetes pregnancy

Introduction: Recent high-profile calls have emphasized that women’s experiences should be considered in maternity care provisioning. We explored women’s experiences of using closed-loop during type 1 diabetes pregnancy to inform decision-making about antenatal rollout and guidance and support given to future users.
Methods: We interviewed 23 closed-loop participants in the Automated insulin Delivery Amongst Pregnant women with T1D (AiDAPT) trial following randomization to closed-loop and ~20 weeks later. Data were analysed thematically.
Results: Women described how closed-loop lessened the physical and mental demands of diabetes management, enabling them to feel more normal and sleep better. By virtue of spending increased time-in-range, women also worried less about risks to their baby and being judged negatively by healthcare professionals. Most noted that intensive input and support during early pregnancy had been crucial to adjusting to, and developing confidence in, the technology. Women emphasised that attaining pregnancy glucose targets still required ongoing effort from themselves and the healthcare team. Women described needing education to help them determine when, and how, to intervene and when to allow closed-loop to operate without interference. All women reported more enjoyable pregnancy experiences as a result of using closed-loop; some also noted being able to remain longer in paid employment.
Conclusions: Study findings endorse closed-loop use in type 1 diabetes pregnancy by highlighting how the technology can facilitate positive pregnancy experiences. To realise fully the benefits of closed-loop, pregnant women would benefit from initial, intensive oversight and support together with closed-loop specific education and training.