Comparing efficacy in glycaemic control and pregnancy outcomes between continuous glucose monitoring and self-monitoring of blood glucose in pregnancies complicated by gestational diabetes mellitus: a systematic review and meta-analysis.

Continuous glucose monitoring (CGM) may offer advantages over self-monitored blood glucose (SMBG) in gestational diabetes mellitus (GDM)-complicated pregnancies, but evidence remains inconsistent. We conducted a systematic review and meta-analysis of randomised controlled trials and observational studies published between January 1980 and April 2026 in PubMed, Embase, Scopus, Cochrane Library, and Web of Science, comparing CGM with SMBG in GDM pregnancies. The review was preregistered with PROSPERO (CRD420251084931). Primary outcomes were glycaemic control measures; secondary outcomes included maternal and neonatal events. Risk of bias was assessed using the Jadad scale and Newcastle-Ottawa Scale. Pooled risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Twenty-one studies involving 5,650 pregnant women were included, with low-to-moderate bias risks. Compared with SMBG, CGM significantly lower mean blood glucose (MD -0.24 mmol/L; 95% CI: -0.41, -0.06), coefficient-of-variation (-0.78%; -1.50, -0.06), mean amplitude of glycaemic excursions (-0.22 mmol/L; -0.43, -0.02), and time-above-range > 7.8 mmol/L (-2.19%, -3.78, -0.60). CGM was also associated with an 21% increase in medication use and an 8-35% reduction in adverse maternal and neonatal outcomes, including caesarean delivery, macrosomia, neonatal hypoglycaemia, and hyperbilirubinemia. These findings suggest CGM improves glycaemic control in GDM and reduces maternal and neonatal complications.