The relationship between gestational diabetes mellitus and mental disorders in pregnancy: a systematic review

Background Gestational diabetes mellitus and mental disorders may co-exist during pregnancy. Mental disorders may be present prior to pregnancy or emerge during the gestational period, and both conditions have been independently associated with adverse maternal and neonatal outcomes. However, the extent and nature of their interrelationship remain unclear, particularly in observational research. Therefore, this review aimed to address the following questions: whether and how the two conditions are related, what support mechanisms are available to patients, and how the link between gestational diabetes mellitus varies across different mental disorders. Methods A systematic review of seven databases (PubMed, Embase, Medline, CINAHL, Scopus, PsycINFO, and Web of Science) was conducted to identify observational studies published between January 2019 and October 2024 that examined gestational diabetes mellitus and mental disorders in pregnancy. The protocol was published in PROSPERO (CRD42024608711). The quality of the included studies was assessed using the National Institute of Health (NIH) tool for observational studies. Findings were categorised into the following themes: the interconnection between gestational diabetes mellitus and mental disorders; support strategies for gestational diabetes mellitus and mental disorders; the link between gestational diabetes mellitus and the variability of mental disorders; and factors associated with maternal and neonatal outcomes. Results Eleven studies met the inclusion criteria. Findings indicate an association between gestational diabetes mellitus and various mental disorders, particularly depression and anxiety; however, the directionality of this association remains uncertain. Socioeconomic status, ethnicity, and trauma history emerged as potential modifiers. Non-pharmacological interventions were preferred for both conditions, though pharmacological treatments were sometimes necessary. Conclusions There is growing evidence of a complex interaction between gestational diabetes mellitus and mental disorders during pregnancy, though causality remains unconfirmed. Clinicians also should prioritise lifestyle-based interventions, monitor pharmacotherapy risks, and provide integrated care for affected patients. Further longitudinal studies are needed to elucidate the directionality and mechanisms underpinning this association. Clinical trial number Not applicable.