Conflicting evidence for continuous glucose monitoring in gestational diabetes: current challenges and the imperative for individual participant data meta-analysis

The incidence of gestational diabetes mellitus (GDM) is rising along with rates of obesity and type 2 diabetes. GDM is associated with an increased risk of various short- and long-term complications for both mother and child, including type 2 diabetes. Managing GDM requires a multidisciplinary approach that includes dietary guidance, promoting regular physical activity, and performing self-monitoring of blood glucose (SMBG). Continuous glucose monitoring (CGM) has transformed pregnancy care in women with type 1 diabetes and is increasingly being proposed as a strategy to improve glycaemic management in GDM. By capturing postprandial glucose excursions, glycaemic variability, and time in range, CGM provides a more detailed picture of glycaemia and has raised expectations of improved metabolic control and pregnancy outcomes. Despite these theoretical advantages, evidence for CGM in GDM remains conflicting. More recently, several large randomized controlled trials (RCT’s) show conflicting data: some studies show modest improvements in glycaemic measures, whereas others report no clear benefit for key maternal or neonatal outcomes, leaving the clinical value and cost-effectiveness of CGM unclear. A major limitation is the absence of validated CGM-based glycaemic targets specific to GDM, and current guidelines offer little direction beyond conventional SMBG guidelines. Future research should prioritize adequately powered large RCT’s representing a broad population, and, importantly, individual participant data meta-analyses to reconcile inconsistent findings, identify subgroups most likely to benefit, establish pregnancy-specific CGM thresholds, and evaluate the impact on both obstetric outcomes and long-term postpartum metabolic risk. This ongoing debate underscores the need to critically appraise the role of CGM in GDM, summarize results from completed RCT’s and meta-analyses, recognize key methodological and clinical evidence gaps, and outline the steps required for CGM to become fully integrated into standard GDM care.