Anxiety During Pregnancy: Who, What, When, Where and Why?

When a pregnancy is wanted and planned, the assumption is that a woman will feel happy, even elated, during this time of expectation. However, many women go through a roller coaster of emotions during pregnancy including feelings of anxiety and depression. In fact, around 10% to 20% of women report experiencing anxiety or depression during a pregnancy.

What Are Common Sources of Anxiety During Pregnancy?

Anxiety may come from many sources, including concern for the baby, the experience of childbirth, hospital and healthcare experiences, or worry about being a good parent – or all of these.  These concerns may be especially difficult to manage for women facing additional stressors like financial strain, barriers to high quality and consistent prenatal care, discrimination, and many other conditions.

Too much anxiety in pregnancy is not good for the health of women or their babies. Anxiety has been shown to predict earlier births including preterm births (at less than 37 weeks) with complications for infants and extra burden for new parents.

It turns out that worrying about a pregnancy is a particularly good predictor of preterm birth. This is concerning because the earlier a baby is born, the greater the risk for serious and long-term health problems including respiratory, neurological, and developmental problems. Not all women have complications due to anxiety but it is a clear risk factor similar to medical risk factors.

Who Experiences the Most Anxiety?

Understandably, women who have experienced complications in a previous pregnancy or birth often worry more during later pregnancies. For example, women whose current pregnancy has medical risks such as hypertension, gestational diabetes, past infertility, or a history of miscarriages worry more during pregnancy. And, women who have a history of anxiety, both those with a tendency to worry or with symptoms of an anxiety disorder are more likely to be anxious about their pregnancies.

Situations such as an unplanned pregnancy or lacking support from the baby’s father can increase stress and anxiety, even in women who are not usually anxious. No matter the origin, elevated and prolonged anxiety during pregnancy can increase health risks for both mothers and babies, even beyond the effects of medical conditions and other common risk factors.

When Do Anxiety Symptoms Typically Start?

Worries among women vary over the course of pregnancy, with early pregnancy more likely to involve concerns about losing the baby and late pregnancy involving worries about the impending labor and delivery.  For some women, anxiety can take away from the positive aspects of being pregnant and as noted cause complications for their pregnancy and infant.

So, what can be done? Fortunately, there is increasing evaluation of anxiety and depression in pregnancy in clinics and women can also talk to their health care provider about it. There are many effective treatments for anxiety in adults that also work well during pregnancy. Treatments range in cost, duration and whether a licensed provider is needed to deliver them.

What Can Be Done to Help Manage Anxiety?

While some amount of worry in pregnancy is absolutely normal, worry that feels uncontrollable, is accompanied by physical symptoms like restlessness, tension, or a racing heart, and is bothersome or creating problems at work or at home can and should be treated. There are a few different ways of addressing anxiety.

Therapy

For women interested in therapy, there are several options. The most well-supported treatment is cognitive behavioral therapy, which teaches people skills to identify patterns in their anxiety, manage anxious thinking, and reduce avoidance that may be getting in the way of living a meaningful life.

Mindfulness Treatments

Mindfulness based treatments also work well. Rather than dwelling on an uncertain future or an unchangeable past—both of which can heighten anxiety—mindfulness encourages awareness and non-judgmental acceptance of present-moment experiences.

Self-guided and Online Resources

Both cognitive behavioral therapy and mindfulness treatments can be done individually or in a group setting with other expectant parents. Increasingly, therapy is offered online and in-person which makes it easier to access.

For people who may not be able to commit to weekly sessions at a set time, there are also prenatal mental health coaching platforms that provide telehealth sessions with a coach and supplemental coping skills practices. Finally, there are fully self-guided resources including self-help workbooks and mental health apps that work well for people motivated to practice therapeutic techniques on their own.

If you or someone you know is anxious in pregnancy for an extended time, seek resources from a healthcare provider, mental health professional, or trusted support network like the National Maternal Mental Health Hotline (1-833-TLC-MAMA) and the Postpartum Support International (1-800-944-4773).

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