Aims <p>This study aims to evaluate the impact of continuous glucose monitoring (CGM) on pregnancy outcomes in women with pregestational diabetes mellitus (PGDM).</p> Methods <p>A retrospective cohort study was conducted on 387 pregnant women with PGDM at Virgen del Rocío University Hospital in Seville, spanning from 2016 to 2022. The patients were categorized into two groups: 212 women who used continuous glucose monitoring (CGM) and 175 women who self-monitoring of blood glucose (SMBG). The study evaluated maternal characteristics, pregnancy complications, delivery methods, neonatal outcomes, and congenital anomalies.</p> Results <p>The CGM group exhibited lower weight gain during pregnancy (9.6&#xa0;kg vs. 10.0&#xa0;kg, <i>p</i> = 0.02) and required fewer prenatal visits (7 vs. 8, <i>p</i> = 0.01). The rate of cesarean sections was significantly lower in the CGM group (53.1% vs. 58.2%, <i>p</i> = 0.03), and the incidence of macrosomia was reduced (12.9% vs. 22.2%, <i>p</i> = 0.04). There were no significant differences in congenital anomalies, intrauterine fetal deaths, or neonatal deaths between the groups.</p> Conclusions <p>CGM in pregnant women with PGDM is associated with better pregnancy outcomes, including reduced cesarean section rates and lower incidence of macrosomia. These findings support the wider implementation of CGM for improved maternal and fetal health in PGDM pregnancies.</p>