A systematic review and meta-analysis of the effects of continuous glucose monitoring compared to self-monitoring of blood glucose on glycemic control and maternal and infant outcomes in women with gestational diabetes mellitus

Abstract

Abstract Background Continuous glucose monitoring (CGM) compared to self-blood glucose monitoring (SMBG) has been a controversial topic regarding glycemic control in pregnant women with gestational diabetes mellitus (GDM), as well as maternal and infant outcomes. The aim of this study was to assess and compare the effectiveness of CGM and SMBG in managing glycemic control and perinatal outcomes among homebound pregnant women with GDM. Methods A comprehensive search was conducted across five databases—PubMed, Web of Science, Medline, Embase, and the Cochrane Library—commencing on July 15, 2024. We included four randomized controlled trials (RCTs) that compared CGM with SMBG in patients with GDM. The primary outcomes assessed were gestational weight gain (GWG), glycated hemoglobin(HbA1c), and the number of people treated with hypoglycemic drugs. Participants were excluded if they had received any glucose-lowering medication prior to enrollment. A meta-analysis of interventions on the basis of at least two studies with 95% confidence intervals and an assessment of heterogeneity via the I² statistic were performed. Results The results of the study showed that CGM was significantly associated with a decrease in the number of women with excessive GWG and an increase in the number of GWG-appropriate (RR = 0.57; 95% CI: 0.41, 0.80; I² = 0.0%; P = 0.001), (RR = 1.55; 95% CI: 1.19, 2.03; I² = 0.0%; P = 0.001). However, GWG-insufficiency was not significantly different (RR = 1.03; 95% CI: 0.47, 2.26; I² = 0.0%; P = 0.948). Real-time continuous glucose monitoring (rt-CGM) may offer superior effectiveness in glycemic control management compared with SMBG (SMD=-0.70; 95%CI=-1.07, -0.34; P = 0.000; I 2 = 0.0%), whereas retrospective continuous glucose monitoring (r-CGM) demonstrates greater effectiveness in reducing infant birth weight (SMD=-0.30; 95%CI=-0.54, -0.06; P = 0.018; I 2 = 8.6%). No significant differences were observed in the other perinatal outcomes. Conclusion CGM may be more effective than SMBG in preventing excessive weight gain and maintaining appropriate gestational weight in women with GDM. Moreover, rt-CGM appears to offer superior glycemic control compared with SMBG. r-CGM may be more effective in reducing neonatal birth weight. Trial registration The PROSPERO registration number is CRD42024571538.