Sleep, chronotype, and psychosocial well-being in gestational diabetes mellitus: An integrated behavioral and psychosocial evaluation

Gestational diabetes mellitus (GDM) is associated with adverse metabolic and obstetric outcomes, yet its impact on behavioral, psychosocial, and chronobiological factors remains inadequately characterized. This prospective cohort study aimed to evaluate sleep quality, chronotype, daytime sleepiness, fatigue, perceived social support, and depressive symptoms in women with GDM using the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Morningness-Eveningness Questionnaire (MEQ), Multidimensional Scale of Perceived Social Support (MSPSS), and Edinburgh Postpartum Depression Scale (EPDS). A total of 618 pregnant women (273 with GDM and 345 normoglycemic controls) were enrolled. Women with GDM exhibited significantly poorer sleep quality (p < 0.001), heightened fatigue severity (p < 0.001), and excessive daytime sleepiness (p < 0.001), lower perceived social support (p < 0.001) compared to controls. Evening chronotype was higher in the GDM group (p < 0.001), whereas controls were predominantly morning types. Although EPDS scores were elevated in GDM (p < 0.001), rates of clinically significant depression (EPDS ≥ 13) did not differ. Neonates of GDM mothers had higher birth weights (p < 0.001) and greater NICU admission rates (p < 0.001). In conclusion, GDM is associated with poorer sleep quality, greater fatigue, higher daytime sleepiness, evening chronotype, and reduced perceived social support, alongside adverse neonatal outcomes.