This presentation will explore the use of insulin pumps in pregnancy, focussing on practical applications as well as research-based outcomes. Insulin pump therapy (IPT) is now established as a safe and beneficial way of insulin delivery during pregnancy. It can be particularly helpful in managing the changes in glucose metabolism that occur across pregnancy, especially in the setting of morning sickness, the onset of insulin resistance during mid-pregnancy and during the peripartum period. Optimising blood glucose levels with IPT requires a motivated patient and the support of a highly skilled and supportive multi-disciplinary team. It specifically requires knowledge about basic and advanced pump functions, siting cannulas, adjusting insulin settings to accommodate changing requirements and the ability to problem solve with blood glucose data at a highly sophisticated level. Evidence suggests that glycaemic control with pumps is not inferior to subcutaneous multi-dose insulin (MDI) regimens in pregnancy. High quality research comparing IPT with MDI regimens with respect to maternal and fetal outcomes is still emerging. However, recent research has demonstrated the benefits of continuous glucose monitoring in pregnancy for improving neonatal outcomes with both IPT and MDI. Insulin pump and related technologies are continuing to progress, with closed loop insulin delivery evolving as a promising option for pregnancy.