The main benefit is that the use in pregnancy is safe and then can help women to get similar or better glucose control and similar or better clinical outcomes. And on top of this, the effort from the woman is less to achieve these outcomes. My name is Rosa Corcoy, I am a clinical endocrinologist working at Hospital de la Santa Creu i Sant Pau in Barcelona. I am the Director of the Diabetes Unit, and one of my main interests is diabetes and pregnancy. The role of technology in the treatment of women with diabetes and pregnancy is an important one, and it will be an even more important one. Right now the use of CGM is standard of care, and the use of closed-loop insulin delivery is on its way to also become the standard-of-care. The literature on this topic is producing an important number of papers, and really important are the trials on this topic, the CRISTAL trial and the AiDAPT trial. And at the same time there are a good number of papers reflecting daily practice and real-life practice. And that's also important to understand how to best adapt the technology to the women in our practice. If we focus on the published trials, the AiDAPT trial and the CRISTAL trial, the main benefit is that the use in pregnancy is safe, and then can help women to get similar or better glucose control and similar or better clinical outcomes. And on top of this, the effort from the woman is less to achieve these outcomes. The best time to implement hybrid closed-loop in pregnancy is, as anything related to pregnancy, to maternal complication of diabetes, to other maternal health issues, the best point is before pregnancy. First, because you'll be in a peace of mind to do any changes even if they are not difficult ones. And second, because pregnancy starts from day one, and it's important to get as tight a glucose control as possible from the very first weeks to decrease the risk of miscarriages, of congenital malformations, and also for placental health. If this is not the case and the woman gets pregnant and the glucose regulation is not okay, then the point is to begin it as early as possible during pregnancy, so that the benefit is for the longer time and in general, unless there are additional circumstances, it's not needed to get a hospital admission to do the change from a different system, either multiple daily injections or pump, to a hybrid closed-loop. Closed-loop insulin delivery can be safely used during labour, delivery and the postpartum. It helps achieving the tight regulation and again with less effort from the side of the woman, in this case, and also for the healthcare providers in the delivery room. And it's not being done in every place, but it's going to be probably again the standard in several months or years. 60 As to the women that should get the system, the first important group are the women that are already using the system before pregnancy. The normal thing is to continue it, because if they had difficulty in regulating their diabetes before pregnancy, this will also be the case after they get pregnant. And for women not using the system who should be offered them? I think that there are different conditions. First, the women that are not achieving the goals for pre-pregnancy or pregnancy. And second, the women that are achieving them, but with a high mental burden. Even if you have the opportunity to offer the system to every pregnant woman with type 1 diabetes, I think that at this point those women that are well regulated without the system and without an important mental burden, probably they do not need it. During pregnancy you have to be prepared to do any type of adaptations, both without a closed-loop and with it, to change the ratios, the settings. Depending on the system, you will adapt different things: the duration of insulin, the glucose target. And you should do it continuously, not frequently, proactively, or with a reactive short time. Both from the part of the healthcare practitioner and also from the woman itself. It's common to say that closed-loop systems need of assistive techniques, because they are very good but not good enough. They need to be helped, not just announcing the meals, but also doing some boluses at some times to decrease the rate of the basal, to increase it, sometimes for meal boluses using fake carbs or just going to the manual mode to have the intended meal bolus that you need. So you have to be prepared to do lots of things, either if continuing with the same system or even changing it. Hybrid closed-loop in itself is a really important advancement in the management of type 1 diabetes in general. Of course, this goes also to pregnancy, but pregnancy is a very challenging situation. It's a stress situation for the body and also for the technology that we are using to treat diabetes. It's not uncommon that we bring the technology to some limits that were not considered when thinking about the general diabetes population. For example, in those important trials AiDAPT and CRISTAL, even though the system has proved its value, its safety, some improved outcomes, but the outcomes overall in the intervention arm are not normal, are not as superimposable to what healthy women would have. So it's a great advancement, but more improvements are needed.