Background: Addressing mental health of diabetic pregnant women is important as it might increase the chance of obstetric complications, preterm birth, and neonatal complications. Aim: The present study investigated the prevalence of anxiety and depression among pregnant women with diabetes and their predictors. Methods: A cross-sectional study was conducted in 2023. The sample comprised 350 pregnant women with diabetes (pre -pregnancy or gestational) referred to comprehensive health centers in Qazvin Province, Iran. Fertility and demographic characteristics, anxiety, depression, partner social support, self -efficacy, medication adherence, and fear of hypoglycemia were assessed. Results: Among the sample, 28.9 % had pre -pregnancy diabetes and 71.1 % had gestational diabetes. Anxiety and depression were reported by 74.9 % and 79.4 % of all participants (significantly higher among those with pre-existing diabetes compared to gestational diabetes). Self -efficacy (OR: 0.91 [95 % CI: 0.86; 0.96]) and spouse's social support (OR: 0.68 [95 % CI: 0.56; 0.82]) were significant predictors of abnormal anxiety. Fear of hypoglycemia (OR: 1.06 [95 % CI: 1.02; 1.09]), medication adherence (OR: 1.05 [95 % CI: 1.01; 1.09]), selfefficacy (OR: 0.86 [95 % CI: 0.82; 0.91]), partner social support (OR: 0.62 [95 % CI: 0.49; 0.78]), diabetes type (pregnancy vs. pre -pregnancy diabetes; OR: 0.26 [95 % CI: 0.09; 0.77]), perceived family economic status (fair vs. good; OR: 3.08 [95 % CI: 1.12; 8.49]), and diabetes treatment (insulin vs. diet; OR: 0.21 [95 % CI: 0.08; 0.55]) were significant predictors of abnormal depression. Conclusion: Diabetic pregnant women should be evaluated for anxiety and depression during their prenatal visit. Improving self -efficacy, increasing medication adherence, reducing the fear of hypoglycemia, and improving the spouse's social support might all be helpful in reducing anxiety and depression among pregnant women with diabetes. (c) 2024 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY -NCND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)