Continuous glucose monitoring (CGM) has emerged as an important tool for managing gestational diabetes mellitus (GDM), offering real-time glucose data and the potential for improved glycemic control. Unlike traditional self-monitoring of blood glucose (SMBG), which provides intermittent readings, CGM captures continuous glucose fluctuations, including postprandial and nocturnal changes, which are critical in GDM management.
Objective:
This systematic review aimed to assess the effectiveness of CGM compared with SMBG in managing glycemic control in women with GDM, focusing on key glycemic metrics such as time in range (TIR) and glycemic variability (GV), and exploring their associations with maternal and neonatal outcomes.
Methods:
A comprehensive search of PubMed and Google Scholar was conducted, adhering to PRISMA guidelines. Studies included randomized controlled trials, observational studies, and prospective cohort studies comparing CGM and SMBG, with 35 studies ultimately reviewed.
Results:
Compared with SMBG, CGM demonstrated significant improvements in maintaining TIR and reducing GV, which correlated with favorable maternal and neonatal outcomes, including lower rates of large-for-gestational-age (LGA) infants, preterm birth, and NICU (neonatal intensive care unit) admissions. Furthermore, CGM detected more hyperglycemic and hypoglycemic events, particularly nocturnal fluctuations. However, the studies also highlighted the need for standardized metrics to optimize CGM use in GDM management.
Conclusion:
Continuous glucose monitoring offers substantial advantages over SMBG for managing GDM by providing continuous, real-time glucose data, enabling timely treatment adjustments. These findings support the integration of CGM into clinical practice to improve maternal and neonatal outcomes in GDM. Further research is needed to establish standardized CGM metrics specific to GDM management.
ElSayedNAMcCoyRGAleppoG, et al. American Diabetes Association Professional Practice Committee. 7. Diabetes technology: standards of care in diabetes—2025. Diabetes Care. 2025;48(suppl 1):S146-S166.
2.
ChawlaMSabooBJhaS, et al. Consensus and recommendations on continuous glucose monitoring. J Diabetol. 2019;10(1):4-14.
3.
YooJHKimJH. The benefits of continuous glucose monitoring in pregnancy. Endocrinol Metab (Seoul). 2023;38(5):472-481.
4.
SongYZhaiXBaiYLiuCZhangL. Progress and indication for use of continuous glucose monitoring in patients with diabetes in pregnancy: a review. Front Endocrinol (Lausanne). 2023;14:1218602.
5.
WyckoffJABrownFM. Time in range in pregnancy: is there a role?Diabetes Spectr. 2021;34(2):119-132.
6.
DunnTCAjjanRABergenstalRMXuY. Is it time to move beyond TIR to TITR? Real-world data from over 20,000 users of continuous glucose monitoring in patients with type 1 and type 2 diabetes. Diabetes Technol Ther. 2024;26(3):203-210.
7.
American Diabetes Association Professional Practice C. 15. Management of diabetes in pregnancy: standards of care in diabetes-2024. Diabetes Care. 2024;47(suppl 1):S282-S294.
8.
AfandiBHassaneinMRoubiSNagelkerkeN. The value of continuous glucose monitoring and self-monitoring of blood glucose in patients with gestational diabetes mellitus during Ramadan fasting. Diabetes Res Clin Pract. 2019;151:260-264.
9.
BaghelANigamAGuptaN. Glycemic variability and its correlation with large for gestation-age babies in gestational diabetic pregnancies. J Assoc Physicians India. 2023;71(12):32-35.
10.
BastobbeSHeimannYSchleußnerEGrotenTWeschenfelderF. Using flash glucose monitoring in pregnancies in routine care of patients with gestational diabetes mellitus: a pilot study. Acta Diabetol. 2023;60(5):697-704.
11.
ChenRYogevYBen-HaroushAJovanovicLHodMPhillipM. Continuous glucose monitoring for the evaluation and improved control of gestational diabetes mellitus. J Matern Fetal Neonatal Med. 2003;14(4):256-260.
12.
CrowtherCASamuelDHughesR, et al. Tighter or less tight glycaemic targets for women with gestational diabetes mellitus for reducing maternal and perinatal morbidity: a stepped-wedge, cluster-randomised trial. PLoS Med. 2022;19(9):e1004087.
13.
CyprykKPertyńska-MarczewskaMSzymczakWWilcyńskiJLewińskiA. Evaluation of metabolic control in women with gestational diabetes mellitus by the continuous glucose monitoring system: a pilot study. Endocr Pract. 2006;12(3):245-250.
14.
DalfraMGSartoreGDi CianniG, et al. Glucose variability in diabetic pregnancy. Diabetes Technol Ther. 2011;13(8):853-859.
15.
Di FilippoDAhmadzaiMChangMHY, et al. Continuous glucose monitoring for the diagnosis of gestational diabetes mellitus: a pilot study. J Diabetes Res. 2022;2022:5142918.
16.
Di FilippoDHenryABellC, et al. A new continuous glucose monitor for the diagnosis of gestational diabetes mellitus: a pilot study. BMC Pregnancy Childbirth. 2023;23(1):186.
17.
DurnwaldCBeckRWLiZ, et al. Continuous glucose monitoring profiles in pregnancies with and without gestational diabetes mellitus. Diabetes Care. 2024;47(8):1333-1341.
18.
Fishel BartalMAshby CornthwaiteJGhafirD, et al. Continuous glucose monitoring in individuals undergoing gestational diabetes screening. Am J Obstet Gynecol. 2023;229(4):441e1-441e14.
19.
GaborovaMDonicovaVBacovaI, et al. Glycaemic variability and risk factors of pregnant women with and without gestational diabetes mellitus measured by continuous glucose monitoring. Int J Environ Res Public Health. 2021;18(7):3402.
20.
GuptaYSinghCGoyalA, et al. Continuous glucose monitoring system profile of women diagnosed as gestational diabetes mellitus by International association of diabetes and pregnancy study groups criteria and labeled as normoglycemic by alternate criteria in early pregnancy. J Diabetes Investig. 2022;13(10):1753-1760.
21.
KestiläKKEkbladUURönnemaaT. Continuous glucose monitoring versus self-monitoring of blood glucose in the treatment of gestational diabetes mellitus. Diabetes Res Clin Pract. 2007;77(2):174-179.
22.
LaiMWengJYangJ, et al. Effect of continuous glucose monitoring compared with self-monitoring of blood glucose in gestational diabetes patients with HbA1c<6%: a randomized controlled trial. Front Endocrinol (Lausanne). 2023;14:1174239.
23.
LaneASMlynarczykMAde VecianaMGreenLMBarakiDIAbuhamadAZ. Real-time continuous glucose monitoring in gestational diabetes: a randomized controlled trial. Am J Perinatol. 2019;36(9):891-897.
24.
LawGRAlnajiAAlrefaiiL, et al. Suboptimal nocturnal glucose control is associated with large for gestational age in treated gestational diabetes mellitus. Diabetes Care. 2019;42(5):810-815.
25.
LiangXFuYLuS, et al. Continuous glucose monitoring-derived glycemic metrics and adverse pregnancy outcomes among women with gestational diabetes: a prospective cohort study. Lancet Reg Health West Pac. 2023;39:100823.
26.
LiangGLaiMWangY, et al. Decreased complexity of glucose time series index associated with adverse pregnancy outcomes in gestational diabetes mellitus. Diabetes Obes Metab. 2024;26(9):3587-3596.
27.
MajewskaAStanirowskiPJTaturJ, et al. Flash glucose monitoring in gestational diabetes mellitus (FLAMINGO): a randomised controlled trial. Acta Diabetol. 2023;60(9):1171-1177.
28.
Márquez-PardoRTorres-BareaICórdoba-DoñaJA, et al. Continuous glucose monitoring and glycemic patterns in pregnant women with gestational diabetes mellitus. Diabetes Technol Ther. 2020;22(4):271-277.
29.
MazzeRYogevYLangerO. Measuring glucose exposure and variability using continuous glucose monitoring in normal and abnormal glucose metabolism in pregnancy. J Matern Fetal Neonatal Med. 2012;25(7):1171-1175.
30.
O’MalleyGArumugamDOgyaaduS, et al. Pilot study for use of intermittently scanned continuous glucose monitoring in women with gestational diabetes. J Diabetes Sci Technol. 2023;17(1):259-261.
31.
PandeyATejerao NaikBUdayRChannabasappaS. Time-in-range with insulin versus metformin in gestational diabetes mellitus using continuous glucose monitoring: a randomized control study at a tertiary care centre in South India. Cureus. 2024;16(6):e61849.
32.
ParamasivamSSChinnaKSinghAKK, et al. Continuous glucose monitoring results in lower HbA(1c) in Malaysian women with insulin-treated gestational diabetes: a randomized controlled trial. Diabet Med. 2018;35(8):1118-1129.
33.
QuahPLTanLKLekN, et al. Continuous glucose monitoring feedback in the subsequent development of gestational diabetes: a pilot, randomized, controlled trial in pregnant women. Am J Perinatol. 2024;41(S01):e3374-e3382.
34.
RademakerDvan der WelAWTvan EekelenR, et al. Continuous glucose monitoring metrics and pregnancy outcomes in insulin-treated diabetes: a post-hoc analysis of the GlucoMOMS trial. Diabetes Obes Metab. 2023;25(12):3798-3806.
35.
ScifresCMMead-HarveyCNadeauH, et al. Intensive glycemic control in gestational diabetes mellitus: a randomized controlled clinical feasibility trial. Am J Obstet Gynecol MFM. 2019;1(4):100050.
36.
ScottEMBilousRWKautzky-WillerA. Accuracy, user acceptability, and safety evaluation for the freestyle libre flash glucose monitoring system when used by pregnant women with diabetes. Diabetes Technol Ther. 2018;20(3):180-188.
37.
ShenSYŽurauskienėJWeiDM, et al. Identification of maternal continuous glucose monitoring metrics related to newborn birth weight in pregnant women with gestational diabetes. Endocrine. 2021;74(2):290-299.
38.
TartaglioneLdi StasioESiricoA, et al. Continuous glucose monitoring in women with normal OGTT in pregnancy. J Diabetes Res. 2021;2021:9987646.
39.
VoormolenDNDeVriesJHSansonRME, et al. Continuous glucose monitoring during diabetic pregnancy (GlucoMOMS): a multicentre randomized controlled trial. Diabetes Obes Metab. 2018;20(8):1894-1902.
40.
WeiQSunZYangYYuHDingHWangS. Effect of a CGMS and SMBG on maternal and neonatal outcomes in gestational diabetes mellitus: a randomized controlled trial. Sci Rep. 2016;6:19920.
41.
YuFLvLLiangZ, et al. Continuous glucose monitoring effects on maternal glycemic control and pregnancy outcomes in patients with gestational diabetes mellitus: a prospective cohort study. J Clin Endocrinol Metab. 2014;99(12):4674-4682.
42.
ZaharievaDPTengJHOngML, et al. Continuous glucose monitoring versus self-monitoring of blood glucose to assess glycemia in gestational diabetes. Diabetes Technol Ther. 2020;22(11):822-827.
43.
LimBSYYangQChoolaniM, et al. Utilizing continuous glucose monitoring for early detection of gestational diabetes mellitus and pregnancy outcomes in an Asian population. Diabetes Care. 2024;47(11):1916-1921.
44.
GuptaYSinghCGoyalA, et al. Continuous glucose monitoring system profile of women stratified using different levels of glycated hemoglobin (HbA1c) in early pregnancy: a cross-sectional study. Adv Ther. 2023;40(3):951-960.
45.
ReavenPDNewellMRivasSZhouXNormanGJZhouJJ. Initiation of continuous glucose monitoring is linked to improved glycemic control and fewer clinical events in type 1 and type 2 diabetes in the veterans health administration. Diabetes Care. 2023;46(4):854-863.
46.
WeiJChenJWeiX, et al. Frontiers Long-term remission of type 2 diabetes after very-low-calorie restriction and related predictors. Front Endocrinol. 2022;13:968239.
47.
CapponGVettorettiMSparacinoGFacchinettiA. Continuous glucose monitoring sensors for diabetes management: a review of technologies and applications. Diabetes Metab J. 2019;43(4):383-397.
48.
BhavadhariniBMahalakshmiMMAnjanaRM, et al. Prevalence of gestational diabetes mellitus in urban and rural Tamil Nadu using IADPSG and WHO 1999 criteria (WINGS 6). Clin Diabetes Endocrinol. 2016;2:8.
49.
SeshiahVBalajiVBalajiMSPaneerselvamAKapurA. Pregnancy and diabetes scenario around the world: India. Int J Gynaecol Obstet. 2009;104(suppl 1):S35-S38.
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