The effect of continuous glucose monitoring on neonatal outcomes in pregnant women with diabetes.

OBJECTIVE

To evaluate the effects of continuous glucose monitoring (CGM) compared with standard self-monitoring of blood glucose (SMBG) on neonatal perinatal outcomes among pregnant women with diabetes.

METHODS

A systematic search of PubMed, Embase, Scopus, Cochrane library was conducted from database inception through February 5th, 2026. Randomized controlled trials (RCTs) enrolling pregnant women with confirmed diabetes that compared CGM with conventional SMBG were included. Primary outcomes included large for gestational age (LGA), small for gestational age (SGA), neonatal hypoglycemia, neonatal hyperbilirubinemia, and admission to the neonatal intensive care unit (NICU). Random-effects meta-analyses were performed to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs).

RESULTS

Seventeen RCTs comprising 2,349 women with diabetes were included, with 1,234 participants allocated to CGM and 1,115 to SMBG. CGM use was associated with a significantly lower risk of NICU admission compared with SMBG (RR 0.75, 95% CI 0.59 to 0.97, P = 0.03, I2 = 0%). CGM demonstrated a nonsignificant trend toward reduced incidence of LGA (RR 0.81, 95% CI 0.65 to 1.01, P = 0.06, I2 = 31%) and neonatal hypoglycemia (RR 0.85, 95% CI 0.70 to 1.03, P = 0.10, I2 = 0%). However, CGM was associated with an increased risk of SGA (RR 1.44, 95% CI 1.01 to 2.04, P = 0.04, I2 = 0%). No significant difference was observed in the risk of neonatal hyperbilirubinemia between groups (RR 0.81, 95% CI 0.65 to 1.01, P = 0.64, I2 = 0%). Between-study heterogeneity was low to moderate across outcomes.

CONCLUSION

Among women with diabetes, CGM is associated with a significant reduction in NICU admissions. CGM may reduce the risk of LGA and neonatal hypoglycemia, although the beneficial effects did not reach statistical significance. The observed increase in SGA highlights the need for careful glycemic target optimization when using CGM in GDM. Further large, high-quality RCTs are warranted to define optimal CGM-guided glucose targets that balance fetal overgrowth and growth restriction.