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Professor Eleanor Scott, one of the UK's leading experts in pregnancy and diabetes, provides the evidence-based roadmap that cuts through the noise. 

Full Show notes: https://theglucoseneverlies.com/pregnancy-t1d/

This episode covers the complete journey: pre-conception planning (why HbA1c <48 mmol/mol and 70% time in pregnancy range matters), the chaos of first trimester insulin sensitivity and hypos, the dramatic insulin resistance of trimesters two and three (where insulin needs can increase 3-5× baseline), and the instant drop in insulin requirements after delivery.

Professor Scott explains why the pregnancy glucose target is tighter (3.5-7.8 mmol/L / 63-140 mg/dL) — babies are extremely sensitive to raised glucose, which increases risks of miscarriage, congenital malformations, preterm delivery, and large babies requiring neonatal intensive care. She also offers reassurance: if pregnancy is unplanned or glucose control isn't optimal at conception, early intervention still makes a substantial difference. Absolute risk of complications remains around 10% even with high HbA1c at conception — not inevitable.

The technology discussion is critical: CGM is non-negotiable  But not all hybrid closed-loop systems are equal. CamAPS FX is the only system with robust RCT evidence (ADAPT trial) showing improved time in range, reduced gestational weight gain, smaller babies, and less maternal burden. It was developed specifically for pregnancy with adaptive algorithms and a personal glucose target as low as 4.4 mmol/L. The Medtronic 780G has a CE mark for pregnancy but didn't improve time in range in trials. Other systems aren't studied or indicated for pregnancy.

Practical strategies include pre-bolusing 15-20 minutes, choosing mixed meals over high-GI foods, walking after eating, moderate carbohydrate intake (30-40%), and building routine to help algorithms (and your brain) adapt to rapid changes.

For show notes, resources, and full transcript: https://theglucoseneverlies.com/pregnancy-t1d/

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