Associations of mind–body integrative care with sleep, metabolic profiles, and pregnancy outcomes in women with gestational diabetes mellitus: A prospective cohort study

Sleep and emotional disturbances are common among women with gestational diabetes mellitus (GDM) and are associated with poor glycemic control and adverse pregnancy outcomes (APOs). Mind-body approaches have been proposed as supportive strategies to improve psychological and metabolic health; however, longitudinal evidence during pregnancy remains limited. In this prospective controlled cohort study, 200 women with GDM were enrolled at 24 to 28 gestational weeks. Participants were classified into a mind-body integrative care group (routine prenatal care supplemented with structured mindfulness, relaxation, and sleep management components) or a routine-care group (routine prenatal care alone), according to the care pathway received under routine clinical practice. Outcomes were assessed at baseline, after 8 weeks, and at delivery. Sleep quality (Pittsburgh Sleep Quality Index), anxiety (7-item Generalized Anxiety Disorder Scale), depression (9-item Patient Health Questionnaire), and metabolic indicators (glycated hemoglobin [HbA1c], homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein) were measured. Multivariable logistic regression, Cox proportional hazards models, and counterfactual-based parallel mediation analyses were applied. After 8 weeks, exposure to mind-body integrative care was associated with lower odds of sleep disturbance (odds ratio = 0.61, 95% confidence interval = 0.38-0.98, P = .041) and more favorable metabolic profiles, including lower HbA1c, homeostasis model assessment of insulin resistance, and high-sensitivity C-reactive protein levels. The overall incidence of APOs was lower in the mind-body integrative care group than in the routine-care group (28.0% vs 42.0%, P = .038), corresponding to a directionally consistent reduction in APO risk in Cox analysis (hazard ratio ≈ 0.70). Mediation analyses suggested that changes in sleep quality (ΔPittsburgh Sleep Quality Index) and glycemic control (ΔHbA1c) represented the primary indirect pathways, jointly accounting for approximately 67% of the observed association. Exposure to mind-body integrative care was associated with better sleep quality, more favorable metabolic profiles, and a lower incidence of APOs among women with GDM. The observed psychological-metabolic mediation pattern supports the potential relevance of integrative, nonpharmacological approaches in prenatal care while underscoring the need for further randomized studies to establish causality.