Anxiety in pregnancy complicated by gestational and pre-gestational diabetes: a systematic review and meta-analysis.
4 affiliations
- 1Department of Obstetrics and Gynaecology Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
- 2Division of Maternal Newborn Nursing and Midwifery, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. [email protected].
- 3Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
- 4College of Nursing, Columbia University, New York City, USA.
Abstract
Background
Gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (pre-GDM) affect approximately 20% of pregnancies worldwide, requiring intensive management, alongside pregnancy-related concerns and broader psychosocial factors, all of which may contribute to increased psychological distress. While anxiety is associated with adverse maternal and child outcomes, evidence in women with diabetes during pregnancy remains fragmented. This systematic review and meta-analysis examined anxiety in pregnant and postpartum women with GDM and pre-GDM.Methods
This study searched MEDLINE, Scopus, Embase, EBSCO, Cochrane Library, ClinicalTrials.gov, and WHO ICTRP from inception to April 2025. Observational studies reporting anxiety outcomes in pregnant or postpartum women with GDM or pre-GDM were included. Two reviewers independently screened articles, extracted data, and assessed quality using the JBI Critical Appraisal Checklists. Random-effects meta-analyses were performed, with subgroup analyses by region and measurement instrument. Meta-regression explored heterogeneity sources. The study followed PRISMA 2020 and was prospectively registered in PROSPERO (CRD420251063824).Results
Thirty-four studies (n = 994,189; 38,584 GDM; 156 pre-GDM; 955,449 healthy controls) were included. Women with GDM had higher odds of antenatal anxiety than healthy controls (OR = 1.69, 95% CI: 1.20-2.37) and higher mean anxiety scores (SMD = 0.21, 95% CI: 0.07-0.34). Among eight single-arm studies reporting the prevalence of screen-positive antenatal anxiety in women with GDM, all conducted in Asia, the pooled prevalence was 36% (95% CI: 22-50%); however, this estimate should be interpreted very cautiously because of extreme heterogeneity (I² = 98.7%), with individual study estimates ranging from 12 to 61%. Subgroup analyses indicated stronger antenatal anxiety associations in Asian studies (SMD = 0.41, 95% CI: 0.27-0.55). Postpartum anxiety did not differ significantly between women with GDM and healthy controls (RR = 0.99, 95% CI: 0.93-1.05). Evidence regarding pre-GDM was limited and should be considered preliminary.Conclusions
A high burden of antenatal anxiety was observed among women with GDM, particularly in Asian populations, although precise prevalence estimates remain uncertain due to extreme heterogeneity. Postpartum anxiety appeared comparable to that of healthy women. Evidence regarding pre-GDM was based on only two studies and remains insufficient to draw conclusions. Findings suggest that targeted assessment and increased clinical vigilance may be appropriate in higher-risk subgroups; however, further prospective studies are needed before routine screening can be recommended.
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BibTeX
@article{limruangrong2026anxiety,
title = {{Anxiety in pregnancy complicated by gestational and pre-gestational diabetes: a systematic review and meta-analysis.}},
author = {Piyanun Limruangrong and Uraiwan Ukhawounam and Prapaporn Pornsuriyasak and Alicia K Matthews},
journal = {BMC pregnancy and childbirth},
year = {2026},
month = jul,
doi = {10.1186/s12884-026-09705-x},
url = {https://europepmc.org/article/MED/42907780},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Anxiety in pregnancy complicated by gestational and pre-gestational diabetes: a systematic review and meta-analysis.
AU - Piyanun Limruangrong
AU - Uraiwan Ukhawounam
AU - Prapaporn Pornsuriyasak
AU - Alicia K Matthews
PY - 2026
DA - 2026/07/01
JO - BMC pregnancy and childbirth
DO - 10.1186/s12884-026-09705-x
UR - https://europepmc.org/article/MED/42907780
AB - Background Gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (pre-GDM) affect approximately 20% of pregnancies worldwide, requiring intensive management, alongside pregnancy-related concerns and broader psychosocial factors, all of which may contribute to increased psychological distress. While anxiety is associated with adverse maternal and child outcomes, evidence in women with diabetes during pregnancy remains fragmented. This systematic review and meta-analysis examined anxiety in pregnant and postpartum women with GDM and pre-GDM.Methods This study searched MEDLINE, Scopus, Embase, EBSCO, Cochrane Library, ClinicalTrials.gov, and WHO ICTRP from inception to April 2025. Observational studies reporting anxiety outcomes in pregnant or postpartum women with GDM or pre-GDM were included. Two reviewers independently screened articles, extracted data, and assessed quality using the JBI Critical Appraisal Checklists. Random-effects meta-analyses were performed, with subgroup analyses by region and measurement instrument. Meta-regression explored heterogeneity sources. The study followed PRISMA 2020 and was prospectively registered in PROSPERO (CRD420251063824).Results Thirty-four studies (n = 994,189; 38,584 GDM; 156 pre-GDM; 955,449 healthy controls) were included. Women with GDM had higher odds of antenatal anxiety than healthy controls (OR = 1.69, 95% CI: 1.20-2.37) and higher mean anxiety scores (SMD = 0.21, 95% CI: 0.07-0.34). Among eight single-arm studies reporting the prevalence of screen-positive antenatal anxiety in women with GDM, all conducted in Asia, the pooled prevalence was 36% (95% CI: 22-50%); however, this estimate should be interpreted very cautiously because of extreme heterogeneity (I² = 98.7%), with individual study estimates ranging from 12 to 61%. Subgroup analyses indicated stronger antenatal anxiety associations in Asian studies (SMD = 0.41, 95% CI: 0.27-0.55). Postpartum anxiety did not differ significantly between women with GDM and healthy controls (RR = 0.99, 95% CI: 0.93-1.05). Evidence regarding pre-GDM was limited and should be considered preliminary.Conclusions A high burden of antenatal anxiety was observed among women with GDM, particularly in Asian populations, although precise prevalence estimates remain uncertain due to extreme heterogeneity. Postpartum anxiety appeared comparable to that of healthy women. Evidence regarding pre-GDM was based on only two studies and remains insufficient to draw conclusions. Findings suggest that targeted assessment and increased clinical vigilance may be appropriate in higher-risk subgroups; however, further prospective studies are needed before routine screening can be recommended.
SN - 1471-2393
ER -