The prevalence of diabetes in pregnancy has continued to increase, both as obesity drives up the rate of glucose intolerance itself and as improvements in diabetes and infertility treatments allow more women with diabetes to become and remain pregnant into the third trimester. With this increase has come a concomitant increase in the number of pregnant women using insulin to control their blood glucose in pregnancy. This review seeks to identify advantages and disadvantages of insulin pump use in pregnancy, as compared to a more traditional multiple daily injection (MDI) insulin regimen. Insulin pumps have not yet been shown to offer superior glucose control compared to MDI insulin, and thus many healthcare practitioners and health insurance companies are hesitant to adopt such a practice; however, insulin pumps often facilitate ease of usage of insulin and promote postpartum insulin use when indicated. Although only a small percentage of pregnant women with diabetes in the United States currently use insulin pumps, we believe that insulin pumps may represent a superior mode of insulin delivery for many women with diabetes in pregnancy.