Background: Sexual satisfaction is important for maintaining pregnant women’s self-esteem and interpersonal relationships, and serves as a major indicator of health. Affecting a woman's sexual issues will indirectly affect her quality of life. The present study aimed to examine the factors related to sexual satisfaction in women with gestational diabetes in the third trimester. Method: This cross-sectional descriptive-analytic study was conducted in 2019 on 120 women with gestational diabetes visiting the clinics affiliated with Mazandaran University of Medical Sciences. Multistage random cluster sampling was performed, and the sample was selected in a non-probability and convenience manner. The data collection instruments included a demographic and midwifery-related information questionnaire, Hudson’s Index of Sexual Satisfaction, the Female Sexual Function Index, ENRICH Marital Satisfaction Scale (short version), the Female Sexual Distress Scale, The World Health Organization Quality of Life questionnaire, the Parental Distress Questionnaire, and the Depression, Anxiety, and Stress Scale. Data were analyzed in SPSS 23 by using descriptive statistics, chi-squared test, t-test, ANOVA, Pearson’s correlation coefficient, Kruskal-Wallis test, Mann-Whitney U test, and Spearman correlation coefficient. Results: Results showed that about 50% of women with gestational diabetes had low and moderate sexual satisfaction. In women with gestational diabetes, sexual satisfaction was positively correlated with sexual function (β = 0.215, p = 0.02) and marital satisfaction (β = 0.298, p = 0.003), and negatively correlated with depression (β = -0.269, p = 0.05). Conclusion: Half of the women with gestational diabetes had low and moderate sexual satisfaction. Marital satisfaction, sexual function, and depression significantly predicted sexual satisfaction in women with gestational diabetes. Examination of sexual function, marital satisfaction, and depression must be part of the routine evaluation for women with gestational diabetes. To increase the sexual satisfaction of these women, it is essential to offer interventions for reducing depression and improving sexual function, marital satisfaction and, thus, their quality of life. Keywords: Sexual satisfaction, gestational diabetes, pregnancy