Prevalence and correlates of anxiety, depression, and sleep disturbances among mid-pregnant women in Northwestern China

Antenatal mental disorders are closely associated with adverse maternal and infant outcomes. Most existing studies focus on postpartum depression or eastern Chinese populations, while mid-pregnancy mental health data in Northwest China remain scarce, and confounding bias from symptomatic overlap of anxiety, depression and sleep disturbances has not been fully addressed. As a critical window for maternal adaptation and fetal development, this study aimed to investigate the prevalence and correlates of anxiety, depression and sleep disturbances among mid-pregnant women in Northwest China, and their associations with inflammatory markers. A cross-sectional study was conducted on 881 singleton pregnant women (14–27 weeks’ gestation) consecutively recruited from a tertiary hospital in Ningxia, China. Sociodemographic and obstetric data were collected via face-to-face interviews. Validated Chinese versions of the Pregnancy-related Anxiety Scale (PAQ), Edinburgh Postnatal Depression Scale (EPDS) and Pittsburgh Sleep Quality Index (PSQI) were used for assessment. Serum C-reactive protein (CRP) and serum amyloid A (SAA) were measured. Two logistic regression models were built for each outcome: Model 1 (full covariates) and Model 2 (excluding comorbid mental symptoms to reduce overlapping bias). The prevalence of anxiety, depression and sleep disturbances was 31.57%, 33.26% and 31.44%, respectively. In Model 1, accidental pregnancy, comorbid depression and pregnancy-specific adverse life events were associated with higher anxiety odds (all p < 0.01); age ≥ 35 years and no fetal gender preference were protective for depression (both p < 0.05). Severe nausea/vomiting and elevated CRP were associated with higher sleep disturbance odds ( p < 0.001 and p = 0.04). Model 2 further identified severe nausea/vomiting as an independent risk factor for anxiety ( p = 0.04) and adverse life events for sleep disturbance ( p = 0.02). SAA showed a non-monotonic association with sleep disturbances ( p = 0.04). Mid-pregnant women in Northwest China have a high burden of mental symptoms. Somatic factors and adverse life events show independent associations after controlling for symptomatic confounding, and inflammatory markers correlate with sleep disturbances. Longitudinal whole-pregnancy studies are warranted to verify gestational dynamic changes. Routine screening and targeted interventions should be integrated into antenatal care.