Gestational diabetes mellitus (GDM) is associated with adverse maternal and neonatal outcomes. Glycaemic monitoring is essential in managing GDM, traditionally through self-monitoring of blood glucose (SMBG). Continuous glucose monitoring (CGM) has emerged as a potential alternative, offering real-time glucose trends and reduced reliance on patient adherence. This study aims to systematically evaluate the comparative effectiveness of CGM and SMBG in GDM pregnancies, focusing on glycaemic control and clinical outcomes.

We conducted a systematic review and meta-analysis of studies published from January 1, 1980, to December 31, 2024, in PubMed, Embase, Scopus, Cochrane Library, and Web of Science. Eligible studies included randomised controlled trials and observational studies comparing CGM with SMBG in pregnant women with GDM. Studies involving pre-existing type 1 or type 2 diabetes, non-human subjects, non-English publications, and conference abstracts, case reports, or reviews, were excluded. Two reviewers independently screened articles, extracted data, and assessed the quality using the Jadad scale and Newcastle-Ottawa Scale. Primary outcomes included glycaemic control measures; secondary outcomes included maternal and neonatal outcomes. Pooled odds ratios (OR) or mean differences (MD) with corresponding 95% confidence intervals (CI) were calculated. Statistical heterogeneity was assessed using Cochran’s Q-test and quantified using the I² statistic. All p-values were two-sided, with statistical significance set at p < 0.05. This study is registered with PROSPERO (Registration No: CRD420251084931).

We included 14 studies in the meta-analysis (n=1,383; 714 CGM, 800 SMBG) comprising 9 RCTs and 5 observational studies. Risk of bias was low to moderate. Compared with pregnant women using SBMG, those who used CGM for GDM management had significantly improved glycaemic control, with a lower MAGE value (MD –0.46 mmol/L, 9% CI –0.79 to –0.12), a lower fasting glucose level (MD –0.41 mmol/L, 95% CI –0.71 to –0.11), and a higher insulin initiation (OR 1.63, 95% CI 1.11 to 2.39). CGM also reduced risk of caesarean delivery (OR 0.71, 95% CI 0.55 to 0.91), pre-eclampsia (OR 0.27, 95% CI 0.11 to 0.66), and LGA (OR 0.58, 95% CI 0.40 to 0.84).

Our study suggests that CGM offers superior glycaemic control compared to SMBG in GDM pregnancies, with potential benefits for maternal and neonatal outcomes. These findings highlight the relevance of CGM in clinical practice and the need for further trials to inform its routine use in antenatal care.