Redefining Blood Glucose Screening in Pregnancy: From Gestational Diabetes to a Gestational Dysglycemia Spectrum—A Systematic Review and Translational Case Proposal

A bstract Aim: To examine whether current evidence supports a continuum-based interpretation of pregnancy-related blood glucose dysregulation, moving beyond the conventional threshold-defined framework of gestational diabetes mellitus. Materials and Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting recommendations. Electronic searches of PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library were performed for studies published between January 2008 and February 2026. Eligible studies addressed blood glucose screening in pregnancy, continuous glucose monitoring, metabolic or placental biomarkers, and maternal or fetal outcomes. Titles, abstracts, and full texts were screened sequentially, with data extracted and synthesized through structured qualitative analysis. Results: Forty studies met the inclusion criteria. Across observational cohorts, randomized investigations, and biomarker-focused analyses, maternal glycemia demonstrated graded associations with adverse pregnancy and offspring outcomes, rather than clear diagnostic inflection points. Continuous glucose monitoring revealed temporal patterns—subtle variability, nocturnal elevations, and postprandial excursions—that were often not reflected in standard oral glucose tolerance testing. At the same time, biomarker and placental studies suggested that metabolic perturbations may emerge earlier in gestation, before the clinical recognition of gestational diabetes. Conclusion: Taken together, the evidence points toward a more fluid metabolic landscape in pregnancy than current binary classifications imply. Gestational dysglycemia appears to evolve along a continuum shaped by maternal physiology, placental signaling, and dynamic glucose behavior. Framing dysglycemia in this way may open the door to earlier risk identification and more individualized screening strategies, although practical implementation will require further validation.