Background <p>Gestational diabetes mellitus (GDM) is associated with adverse maternal and neonatal outcomes. Continuous glucose monitoring (CGM) enables real-time glucose assessment and may improve glycemic control; however, its clinical benefit in GDM remains uncertain.</p> Objective <p>To evaluate the impact of continuous glucose monitoring (CGM) on maternal and fetal outcomes in women with gestational diabetes mellitus (GDM), compared to standard of care (SOC) glucose monitoring.</p> Methods <p>A prospective cohort of 100 pregnant women with GDM was divided into CGM and SOC groups. Outcomes assessed included maternal glycemic control, cesarean delivery rates, and neonatal outcomes such as preterm birth, small for gestational age (SGA), and neonatal intensive care unit (NICU) admission. Multivariate analyses were performed to adjust for confounders.</p> Results <p>No significant differences were noted in clinicodemographic characteristics, except for higher overweight/obesity prevalence in the CGM group (96% vs. 84%,&#xa0;<i>p</i> = 0.046). The CGM group had fewer cesarean deliveries (44% vs. 68%, <i>p</i> = 0.016) and lower postpartum smoking rates (0% vs. 8%, <i>p</i> = 0.041). Exploratory analyses showed small differences in TIMI score (<i>p</i> = 0.044) and postpartum renal dysfunction (<i>p</i> = 0.065), although the study was not powered to evaluate these outcomes. Fetal outcomes, including birth weight and NICU admissions, showed non-significant positive trends. Multivariate analysis revealed no significant association between CGM and improved composite fetal outcomes (aOR 1.748, 95% CI 0.452–6.749, <i>p</i> = 0.418).</p> Conclusion <p>Although CGM did not significantly reduce adverse fetal outcomes, it showed potential benefits in maternal health behaviors and glycemic control. Larger studies are needed to confirm its role in optimizing maternal and neonatal outcomes.</p>