Preexisting diabetes in pregnancy is associated with increased risk for adverse perinatal and neonatal outcomes. It is critical to reduce these risks by achieving well-controlled blood glucose levels without increasing maternal hypoglycemia. However, maintaining tight glycemic control is challenging in the setting of rapid metabolic, physiologic, and anatomic changes throughout gestation. The development and rapid improvement of continuous glucose monitoring technology has allowed significant progress toward hybrid closed-loop (HCL) insulin delivery systems, but there are current limitations for using HCL technology in pregnancy. The speakers, Sarit Polsky, MD, MPH and Amy Valent, DO, MCR, discuss these challenges and more.