Diabetes and Poor Sleep Quality Drive Pregnancy Anxiety

Recent clinical research is uncovering a complex issue facing expectant mothers, where the risk of type 2 diabetes and poor sleep quality are driving a significant surge in pregnancy-related anxiety. A landmark study published in BMC Pregnancy and Childbirth reveals that metabolic health indicators are now inseparable from psychological well-being, with nearly 80% of pregnant women experiencing some form of anxiety related to their pregnancy.¹

“Pregnancy-related anxiety is a common psychological problem during pregnancy. Studies have shown that approximately 10% of pregnant women are affected by generalized anxiety disorder,” the study authors said. “Pregnancy-related anxiety has been associated with adverse pregnancy outcomes such as premature birth and low birth weight and may also be linked to cognitive and behavioral difficulties in offspring, as well as long-term mental health problems.”

For pharmacists on the front lines of maternal care, these findings underscore a critical need to move beyond simple glycemic monitoring toward a more holistic, biopsychosocial approach to patient management.

The study, which utilized the Finnish Diabetes Risk Score (FINDRISC) to assess pre-pregnancy metabolic status, found a direct positive correlation between high diabetes risk scores and elevated anxiety levels. Intriguingly, researchers identified sleep quality as a primary mediator in this relationship, suggesting that metabolic dysregulation may first disrupt sleep architecture, which then depletes a woman’s emotional regulation capacity. This biological cascade is often fueled by the activation of the hypothalamus-pituitary-adrenal axis, where chronic stress leads to increased cortisol secretion. High cortisol levels not only interfere with insulin sensitivity but also create a feedback loop that further aggravates psychological burdens.

Pharmacists must also recognize that not all diabetic pregnancies carry the same psychological weight. Data from the Social Determinants of Health Research Center indicates that women with pre-existing diabetes face significantly higher rates of anxiety and depression—reaching as high as 84.2%—compared to those diagnosed with gestational diabetes. This disparity likely stems from the long-term management requirements and the increased probability of fetal and maternal complications associated with pre-existing conditions. The fear of neonatal hypoglycemia and birth defects remains a pervasive stressor that pharmacists are uniquely positioned to address through education and reassurance.^2,3

One of the most actionable findings for the pharmacy profession is the strong link between medication adherence and mental health. Abnormal depression in pregnant women with diabetes is significantly predicted by lower medication adherence and a profound fear of hypoglycemia. When patients struggle with the extra demands of pregnancy—such as the need to frequently adjust insulin doses that may double or triple as the due date approaches—their psychological resilience often wavers. Pharmacists can intervene by identifying patients with low self-efficacy and providing targeted counseling on insulin management and hypoglycemia prevention, which has been shown to reduce the incidence of borderline and abnormal anxiety.^2,3

The risk profile for these patients is further influenced by demographic factors, with advanced age, late gestational stage, and a history of adverse pregnancy outcomes serving as primary predictors for heightened anxiety. Older expectant mothers often report greater concern regarding their own safety and fetal health, although those in the third trimester frequently experience a "fear of the unknown" regarding delivery. Furthermore, the financial strain of managing a diabetic pregnancy can be substantial, and perceived fair-to-poor economic status is a known predictor of depression in this population.¹

“The results of this study indicate that anxiety is prevalent among pregnant women, which is consistent with the findings of previous studies,” the study authors said. “Future research should conduct longitudinal tracking while controlling for specific confounding factors during pregnancy to clarify the temporal sequence and mechanism path between diabetes risk, sleep quality, and anxiety.”

To support these high-risk patients, clinical guidelines suggest that a multidisciplinary approach is essential. Management often involves a transition to insulin and medical nutrition therapy to reach strict blood glucose targets, such as a fasting level between 70 and 95 mg/dL. Beyond pharmacotherapy, pharmacists should encourage non-pharmacological interventions that improve the mediating factor of sleep, such as moderate-intensity physical activity like brisk walking or prenatal yoga, provided these are cleared by the patient's obstetrician. By recognizing that pregnancy-related anxiety is an underestimated and underdiagnosed condition, pharmacists can play a pivotal role in bridging the gap between metabolic control and maternal mental health.^1,3

READ MORE: Diabetes Resource Center

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REFERENCES

1. Liu S, Wang J, Ma C, Liu T. A study on the correlation among sleep quality in pregnant women, type 2 diabetes risk scores based on FINDRISC, and pregnancy-related anxiety. BMC Pregnancy Childbirth. Published online April 6, 2026. doi:10.1186/s12884-026-09038-9

2. Reza Salimi H, Griffiths MD, Alimoradi Z. Prevalence of anxiety and depression among pregnant women with diabetes and their predictors. Diabet Epidemiol Manag. June 2024, 100198. doi:https://doi.org/10.1016/j.deman.2024.100198

3. National Institutes of Health. Pregnancy if You Have Diabetes. September 2024. Accessed April 7, 2026. https://www.niddk.nih.gov/health-information/diabetes/diabetes-pregnancy