General information of pregnant women
Eighteen women were included in this study. Their general characteristics are shown in Table 1. Our research team screened potential participants through the specialized electronic medical record system at the obstetrics outpatient clinic. A total of 21 pregnant women with GDM met the inclusion criteria and were invited to participate in the study. Among these, 18 women agreed to participate, while 3 women declined due to a lack of interest and privacy concerns. The consent rate was 85.71% (18 out of 21 eligible women).
Themes
Theme 1: Impact of illness on sleep
Impact of psychological changes on sleep after the diagnosis of GDM
Pregnant women demonstrated different levels of ascribed importance, cognition, and acceptance after receiving a GDM diagnosis, accompanied by the emergence of various emotions. Our study found that a positive mood promotes sleep and improves sleep quality, while anxiety and other negative emotions act as barriers to sleep. And the ability to regulate negative emotions is a key factor in maintaining good sleep. According to one participant, “The day I was first diagnosed, I was so anxious that I couldn’t sleep and kept thinking about it.” (P18) Another woman recounted: “My blood sugar was also a little bit high with my first child, and when I was diagnosed during pregnancy with my second child, I felt as if it was nothing, I just went with the flow, and I did not have trouble sleeping at night because of the diagnosis.” (P11) One participant shared: “I also get anxious when my blood sugar is unstable. I looked for some ways to control sugar on the Internet, and now I do not worry, and the quality of my sleep is a little bit better after I understood it.” (P09).
Impact of blood glucose fluctuation on sleep
Based on the experiences shared by participants in this study, blood sugar instability in some pregnant women can lead to negative emotions before going to bed, which can also change their physical state and affect the quality of sleep. As one woman put it, “When my blood sugar is higher, I feel that my whole body is more constrained; I feel as if my whole being is very bulky and heavy. When I try to sleep, I experience some difficulty breathing, which makes it hard to fall asleep.” (P15).
Theme 2: Impact of physiological and psychological changes in pregnancy on sleep
Impact of physiological changes in pregnancy on sleep
The study participants believed that the anatomical, physiological, and pathological changes they experienced during pregnancy could affect their sleep patterns and even cause varying degrees of sleep disorders, including insomnia and sleep disruption. Among these changes, frequent urination due to the enlarged belly in the third trimester, the need to change sleeping positions multiple times during the night, and pubic bone pain were identified as significant factors hindering sleep. One participant’s experience illustrates this point: “My belly is bigger, and sleeping is not so comfortable. I roll over, I urinate more frequently at night, and I feel that maybe my sleep is not as good as it used to be.” (P11) Reflecting on her experience, one interviewee said, “I recently have been experiencing pubic bone pain at this stage, and having to roll over constantly makes me sleep poorly.” (P04).
Effects of psychological changes in pregnancy on sleep
Participants in this study reported that anxiety about postnatal life, childcare, body changes, etc., tends to occur in the third trimester of pregnancy due to the proximity of labor, which can significantly impede sleep. The emotional impact was evident in one participant’s words: “It’s just that I’m going to give birth soon, and now I have a little bit of that prenatal anxiety, and I sleep intermittently because I’m afraid of it.” (P16) Another participant highlighted her perspective: “The reason I was having trouble falling asleep earlier was because of my fear of life after giving birth.” (P18).
Theme 3: Impact of different daily behaviors and environment on sleep
Daily habits
According to the participants’ accounts in this study, bad habits such as waking up to use electronic devices before or in the middle of sleep, staying up late to play mahjong, having too many late-night snacks before going to bed, taking too long a lunch break, drinking milk tea, and eating fast food may impair sleep quality of pregnant women with GDM. Conversely, they noted that activities like fitness exercises or walking and other sports, listening to music before going to bed, soaking the feet, wearing a steam eye mask, drinking hot milk, and providing psychological suggestions can promote better sleep health. In the words of one respondent, “I sleep too much during my lunch break in the daytime, and I get too caught up watching TV dramas before bedtime (playing with my cell phone), so I cannot sleep at night.” (P14) One participant explained: “I walk for an hour after eating and I feel that I sleep better when I am tired from walking.” (P15) One interviewee mentioned: “I usually listen to some meditation music before bed … Then, after soaking my feet and using a steam-eye mask, I feel much better.” (P18).
Work
The pregnant women interviewed believed that work had a significant impact on sleep, particularly when work was not completed or when they worked late. These factors often led to a poor emotional state and reduced sleep quality, whereas engaging in more time-consuming tasks during the day or working from home could enhance sleep quality. One participant’s response revealed her coping mechanism: “If I don’t do something on any day, then it might be on my mind, and I keep thinking about how to explain the plan. So, I usually complete my work on the same day, which makes me feel more at ease before going to bed.” (P08) Another individual expressed: “When I’m more tired from work, I do sleep quite well.” (P06).
Dream changes
Participants in this study described how the frequency of dreams and the occurrence of nightmares could make patients with GDM wake up frequently at night. They were unable to fall asleep quickly after waking up, and this could even affect their mood and quality of life the following day. One woman’s experience was particularly telling: “If you have some nightmares …… you wake up suddenly, and you feel like you cannot fall asleep again.” (P13) A respondent noted: “ In late pregnancy, I often have nightmares,so I will wake up scared. Then, I comfort myself and go back to sleep.” (P18).
Environmental changes
As reported by participants in this study, changes in environmental factors, such as excessively high temperatures, high humidity, and bright lighting, can significantly disrupt sleep in pregnant women with GDM. Conversely, they found that a comfortable temperature, moderate humidity, dim lighting, and a quiet environment promoted better sleep. A participant elaborated: “I cannot sleep well if the humidity is too high on days with a southerly wind.” (P16) One woman’s account captured the environmental challenges::“I’m sensitive to light and sound, so I need blackout curtains……. because that way I fall asleep a bit faster.” (P18).
Theme 4: Impact of family support on sleep
Husband support
Pregnant women indicated that having a husband with them before bedtime can promote sleep, but if the husband has a habit of staying up late, waking up early for work, snoring, or arguing with them, it can become a barrier to sleep. One participant reflected: “It is all about my husband accompanying me to go for a walk together, and if he has the time, I go; if not, I stay by myself in the house lying on my bed, unable to sleep. Sometimes, when I argue with my husband, I get angry and end up playing on my phone until I fall asleep.” (P16).
Child support
Participants in this study mentioned that while having children nearby could improve their sleep, concerns about their children’s schooling or health, such as catching a cold at night, often negatively impacted sleep quality. Reflecting on her experience, one participant noted,“My child has just started first grade, which is also a very new stage for him, and it makes me worry so much that I can’t sleep well… But, every time I sleep with my son, I am very happy and can sleep more soundly.” (P14) As one participant described it: “Now that it is winter, I am afraid that my older childwill be cold. Occasionally, I will wake up to cover him with a quilt. My sleep is not so deep, it is a bit shallower.” (P12).
Theme 5: Demand for specialized medical services
Healthcare professionals’attention and guidance
According to the participants’ feedback in this study, healthcare professionals often pay little attention to and provide limited education on sleep-related issues for women with GDM. One participant explained: “The doctor’s advice is mainly about controlling blood glucose and exercising, but sleep is rarely mentioned.” (P15) In her own words,“I usually tell the doctor that my blood sugar is a bit high, and he advises me to control it, but he doesn’t mention how to pay attention to sleep.” (P16).
Inadequate allocation of medical resources
Pregnant women with GDM should have access to comprehensive healthcare services to ensure safe delivery. When labor was imminent, the limited availability of hospital beds and the fear of not having a bed negatively affected participants’ sleep quality. One participant described: “But I am more worried now before I go to bed because I often see people saying that there are no beds in the hospital, and I get more scared.” (P16) Pregnant women also mentioned that the hospital had a limited number of daily registration slots, and they needed to secure these in advance every morning, which led to worsened sleep quality and a poor mental state the next day. One participant recounted her experience: “I often had to get up at 7 a.m. to book the hospital’s appointment during that period. I wake up very early, feeling dizzy the next morning as if my whole body has been beaten.” (P18).
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