Advancing Metabolic Monitoring: Continuous Glucose Monitoring Across the Prenatal–Postnatal Spectrum of Dysglycemia

Background: Continuous glucose monitoring (CGM), through high-frequency real-time glucose profiling, offers a more complete characterization of glucose patterns compared to traditional diagnostic tools, particularly fasting glucose and the oral glucose tolerance test (OGTT), relevant to maternal–fetal health, postpartum risk, and pediatric metabolic regulation.

Objectives: This review compares the diagnostic performance of CGM versus OGTT and fasting glucose in high-risk pregnancies; evaluates CGM for early detection and prediction of dysglycemia in children and adolescents; and examines associations between CGM-derived glycemic stability, IGF-1 activity, and growth outcomes in pediatric dysglycemia.

Methods: We reviewed randomized trials, prospective cohorts, and observational pediatric studies (2009–2025) evaluating CGM in high-risk pregnancies, postpartum women, and pediatric groups—including obesity, prediabetes, autoantibody-positive relatives, cystic fibrosis, Prader–Willi syndrome, and β-thalassemia major. Due to heterogeneity in design and outcomes, findings were synthesized narratively.

Results: Across pregnancy, CGM consistently identified glycemic disturbances not captured by OGTT, including postprandial and nocturnal hyperglycemia and elevated variability. CGM-guided care improved maternal time-in-range, reduced time-above-range, and was associated with lower rates of large-for-gestational-age infants, neonatal hypoglycemia, and NICU admission. Postpartum, CGM demonstrated substantially higher follow-up adherence than OGTT and reliably detected persistent dysglycemia.
In pediatrics, CGM identified presymptomatic dysglycemia 12–24 months earlier than OGTT in children with type 1 diabetes autoimmunity and improved prediction of short-term progression to stage 3 diabetes. Among adolescents with obesity or prediabetes, CGM revealed frequent postprandial hyperglycemia despite normal fasting glucose or OGTT, indicating significant hidden dysglycemia. CGM also detected early glucose instability in cystic fibrosis, Prader–Willi syndrome, and β-thalassemia major, outperforming OGTT in sensitivity.
In youth with type 1 diabetes, CGM use produced robust clinical benefits, including 0.4–0.6% reductions in HbA1c, 10–12% increases in time-in-range, fewer severe hypoglycemia events, improved IGF-1 concentrations, and stabilization or improvement of height SDS, suggesting an important link between daily glucose stability and growth physiology.

Conclusions: CGM offers a more sensitive and physiologically meaningful assessment of dysglycemia than OGTT across the maternal–child continuum, supporting its integration into high-risk pregnancy care, postpartum surveillance, and pediatric metabolic evaluation.