11 Minutes

Pregnancy is a transformative period for any woman that often brings a blend of happiness, concern, and anticipation. While the thought of bringing a new life into the world can be exhilarating, it also triggers a spectrum of emotions, anxiety being one of the most common ones.

Anxiety during pregnancy is known to commonly affect expecting mothers, with negative implications for both mother and baby if left unmanaged. Fortunately, the management of prenatal and antenatal anxiety is possible with the widespread availability of professional and self-help resources.

Several factors, including psychological, physiological, and environmental stressors, can lead to anxiety during pregnancy. [1]

Hormonal Fluctuations

Pregnancy triggers multiple hormonal changes, especially in terms of progesterone and estrogen. These hormonal shifts impact the neurotransmitter activity in the brain to heighten anxiety.

Health Concerns

It is natural to develop concerns about the development and health of the fetus. In some women; however, these concerns, like thoughts of miscarriage, congenital anomalies, and preterm birth, may become so severe that they trigger anxiety.

Major Life Changes

Anticipation about the impending transition to motherhood and the associated changes in lifestyle and identity can overwhelm a woman, inducing severe anxiety.

Physical Discomforts

Pregnancy can bring a host of physical symptoms, such as back pain, fatigue, body weight fluctuations, and nausea which contribute to anxiety and stress.

Family/Personal History

Pregnant women with a personal or family history of mental health disorders, including anxiety disorders, are at a higher risk of acquiring them during pregnancy.

Anxiety during pregnancy may manifest in different ways, affecting both the physical and mental well-being of the mother. [2] Some common symptoms to look out for include the following:

  • Increased emotional sensitivity and irritability
  • Persistent, uncontrollable worry about childbirth, pregnancy, and responsibilities as a future parent
  • Inability to relax
  • A sense of impending doom
  • Difficulty falling or maintaining sleep, often secondary to physical discomfort or racing thoughts
  • Physical tensions, such as headaches, muscle tension, etc.
  • Chronic fatigue that does not respond to rest
  • Avoiding certain situations and activities that may potentially trigger anxiety
  • Having repetitive thoughts or behaviors with the intention of reducing anxiety

Remember that the symptoms of anxiety during pregnancy can vary from one woman to another in terms of nature and severity.

Experiencing anxiety during pregnancy can lead to far-stretched effects that not only influence the mother but also affect the well-being and development of the baby. [3] Following are some possible risks to keep in mind:

Fetal Risks

Maternal anxiety can affect the developing fetus in the following ways:

  • Fetal development: Maternal anxiety may put the growing fetus at risk of having low birth weight, developmental issues, and preterm birth.
  • Neurodevelopmental impact: High levels of stress in mothers can lead to impaired neural development in the fetus. This impairment may lead to long-term neurodevelopmental issues in the child.

Maternal Risks

Heightened anxiety levels can put a pregnant mother at risk of the following:

  • Mental health issues: Persistently elevated anxiety levels may push a pregnant mother to develop other mental health issues, like depression.
  • Physical health issues: Chronic anxiety can lead to physical health issues, such as sleep disturbances and high blood pressure. These issues can complicate pregnancy in the coming stages, putting both maternal and fetal health at risk.

Timely diagnosis and management are essential to manage anxiety during pregnancy. [4] Following are some methods to identify and assess anxiety in expectant women:

Screening Tools

Experts may use the following to screen for anxiety in pregnant women:

  • Clinical interviews: These in-depth interviews conducted by trained healthcare providers help them understand a patient’s current symptoms and mental health history.
  • Questionnaires: Tools such as the State-Trait Inventory (STAI) and Generalized Anxiety Disorder-7 (GAD-7) can help experts quantify anxiety.

Risk Assessment

Anxiety risk assessment in pregnant women may involve the following:

  • Detailed history: This involves assessing a woman’s personal and family history, particularly given mental health disorders.
  • Psychosocial factors: This involves evaluating the effects of economic, social, and relational factors on a pregnant woman’s anxiety levels.

Plenty of psychological and pharmacological techniques can support pregnant women fight anxiety and keep it under control.

Psychological Strategies

The following psychological interventions can help with anxiety early pregnancy symptom management: [5]

  • Cognitive Behavioral Therapy (CBT): Pregnancy can be a difficult time, particularly for women struggling with anxiety. Fortunately, psychological interventions can serve as a safe and effective starting point to manage symptoms. This type of talking therapy helps pregnant women identify and replace negative behaviors and thought patterns with positive ones. All CBT sessions take place under the supervision of a professional who helps pregnant women recognize and get over distorted thinking while acquiring healthier ways of thinking. The technique is highly proven, and multiple studies confirm its benefits in reducing pregnancy anxiety symptoms.
  • Mindfulness-Based Stress Reduction: Also known as MBSR, this mindfulness-based strategy combines yoga and mindfulness meditation to manage anxiety stress. With techniques like gentle yoga, mindful breathing, and body scans, pregnant women can improve their mood, reduce stress, and boost overall well-being.

Pharmacological Interventions

The following two types of pharmacological interventions are indicated in pregnancy with caution and care. [6]

  • Selective Serotonin Reuptake Inhibitors (SSRIs): This drug class includes medications like fluoxetine, sertraline, and citalopram, commonly used to manage anxiety and depression. These medications are considered safe during most pregnancies. However, it is essential to discuss the risks and benefits with a doctor before commencing treatment. An honest review of individual circumstances, including how severe the anxiety is and how likely it is to affect the mother and baby, must be performed to understand if these medications are the right choice.
  • Benzodiazepines: These medications are not as common as SSRIs and are usually prescribed as a short-term solution to severe anxiety. However, remember that benzodiazepines have a high addiction potential and can bring certain risks for the baby. Hence, they must be used only in severe circumstances under close medical supervision.

In addition to pharmacological and behavioral interventions, the following holistic approaches are often considered beneficial when used as an adjunct:

Acupuncture

This traditional Chinese technique involves the insertion of thin needles in certain body parts. Several studies have confirmed acupuncture as a potent anti-anxiety technique as it balances the body’s energy flow and promotes relaxation. However, caution is advised to choose a practitioner with experience in handling pregnant women. [7]

Massage Therapy

Prenatal massage therapy promotes relaxation and reduces anxiety. A trained massage therapist can deliver the treatment safely and effectively while alleviating physical discomfort and stress. Additionally, regular massages can also improve the overall mood and boost sleep.

Aromatherapy

Aromatherapy involves using essential oils to relax and rejuvenate the body. The technique relies on powerful essential oils, such as chamomile and lavender, which are particularly famous for their relaxing properties. These oils can be added to massage oils, warm baths, or diffusers to enjoy the calming benefits. It is imperative to contact a doctor regarding the safety of aromatherapy and the choice of essential oils, as some may not be safe to use during pregnancy.

In addition to seeking professional help, many self-help tips and remedies are available to manage anxiety while pregnant. Some of these tips include the following:

Talk about your anxiety

Feeling anxious during pregnancy is natural. Sharing this anxiety with someone, such as a partner, a close family member, or a best friend, is essential to seeking support. Moreover, sharing your feelings can keep them from hijacking your mind and consuming your everyday life. If there is no trusted support system available, consider talking to a therapist.

Find a release

Find activities that lower your anxiety and stress. For instance, exercise can be a great way to channel out anxiety while triggering the release of endorphins to control pain and improve mood. Other activities for anxiety management include the following:

  • Running
  • Walking
  • Yoga

Remember to choose an activity based on your tolerance level and after consulting with a doctor to determine its safety in individual cases. If you do not like a particular activity, choose any that you prefer with a goal to get the body moving. Research confirms that an aerobic activity session lasting as little as five minutes can reap positive benefits.

Practice time management and organization

Being organized and effective in time management can help reduce anxiety and stress. Experts recommend creating a daily schedule to complete everyday tasks with adequate time for relaxation, rest and self-care. Similarly, planning ahead for the baby, such as buying essentials and setting up the nursery, can also help avoid last-minute meltdowns.

Set realistic goals

Ensure that you set realistic goals during pregnancy while acknowledging that you may be unable to do everything as you did before pregnancy. Practice self-compassion and be kind to yourself. Prioritize essential tasks while giving yourself to rest and ask for support when needed.

Spend time reading and researching

Some women find reading and researching about pregnancy and childbirth relaxing and calming. Reliable information, such as books written by trusted authors and websites affiliated with national and international health organizations, can be a source of accurate information. This knowledge can reduce prenatal anxiety by giving mothers a clearer understanding of what’s happening in their bodies and what to expect in the coming months.

Avoid information overload

While it is essential to stay informed, avoiding information overload is also important. Constantly reading up about negative pregnancy reviews or possible pregnancy complications can build up stress and anxiety. Hence, experts advise limiting the information intake and choosing reliable sources to avoid false stories.

Get plenty of rest

Sleep is essential for recovery and support, especially for pregnant. It can not only help them carry on with their everyday tasks more efficiently but also lower their anxiety symptoms. If you are experiencing sleep-related issues, consider improving your sleep hygiene.

Maintain a daily journal

Pregnancy can be overwhelming for anyone, with millions of thoughts racing the mind every day. Journaling can help women let go of these thoughts without any fear of judgment, which helps lower their mental burden and stress. Writing down daily thoughts can also help women prioritize their worries, identify anxiety triggers, and manage them more effectively.

Join a prenatal education class

Prenatal education classes can be a good source of anxiety management. These classes deliver valuable and practical information about pregnancy, delivery, and newborn care while demystifying the process and reducing fear. Knowing what to expect in the upcoming days, weeks, and months can address many concerns and make women confident about handling different situations. Once this happens, the anxiety about what is going to happen next goes down.

The following professional resources and support are available for women struggling with anxiety while pregnant:

Consultation With a Psychiatrist

Women with several levels of anxiety must consult a psychiatrist for better evaluation and assessments. Psychiatrists are also trained to provide specialized care through prescription medications and intensive therapy sessions as indicated. They can also liaise with the obstetricians of their patients to design an anxiety management plan safe for the mother and baby.

Online Resources

Many online resources and mobile applications are currently available to support women fighting anxiety during pregnancy. For instance, many applications offer breathing exercises, guided meditation, and mental health tracking that may prove useful as self-help measures. Additionally, many online forms and communities are available to support expecting mothers and help them establish a sense of connection.

Emergency Resources

In case of severe anxiety that provokes thoughts of self-harm or harm to others, seeking emergency help is crucial. Expecting mothers struggling with anxiety must; therefore, familiarize themselves with the emergency resources available locally, such as crisis centers, hotlines, and emergency room services.

Partners and families are crucial in supporting pregnant people during anxious times. The following two types of support can be expected from family members and spouses:

Practical Support

This type of support may involve:

  • Helping with daily tasks: Dividing daily responsibilities and helping with tasks around the house can decrease the emotional and physical burden on the pregnant woman and alleviate stress and anxiety.
  • Preparing for parenthood: Family members can engage in various preparatory activities with pregnant mothers to manage their anxiety. Some examples include setting up the nursery, attending prenatal classes, etc.

Emotional Support

Emotional support for anxious pregnant women involves the following:

  • Positive reinforcement: Partners and family members can offer encouragement and positive reinforcement to help pregnant women build resilience and confidence.
  • Active listening: Sometimes, providing emotional reassurance or a listening ear can significantly reduce ongoing anxiety.

Experiencing anxiety during pregnancy can be a challenging experience as it drastically impacts the well-being of the mother and the baby. Awareness of its causes, manifestations, and effects is essential to acquire effective management strategies. Prenatal anxiety management typically requires combined input from partners, families, healthcare physicians, and the society at large to support women during this highly vulnerable time. Additionally, pregnant women must also be encouraged to engage in self-care activities to alleviate anxiety and a more positive pregnancy experience.

Shariatpanahi M, Faramarzi M, Barat S, Farghadani A, Shirafkan H. Prevalence and risk factors of prenatal anxiety disorders: A cross-sectional study. Health Sci Rep. 2023 Aug 21;6(8):e1491. doi: 10.1002/hsr2.1491. PMID: 37614287; PMCID: PMC10442528.

Shahhosseini Z, Pourasghar M, Khalilian A, Salehi F. A Review of the Effects of Anxiety During Pregnancy on Children’s Health. Mater Sociomed. 2015 Jun;27(3):200-2. doi: 10.5455/msm.2015.27.200-202. Epub 2015 Jun 8. PMID: 26236168; PMCID: PMC4499279.

Nakić Radoš S, Tadinac M, Herman R. Anxiety During Pregnancy and Postpartum: Course, Predictors and Comorbidity with Postpartum Depression. Acta Clin Croat. 2018 Mar;57(1):39-51. doi: 10.20471/acc.2017.56.04.05. PMID: 30256010; PMCID: PMC6400346.

Misri S, Abizadeh J, Sanders S, Swift E. Perinatal Generalized Anxiety Disorder: Assessment and Treatment. J Womens Health (Larchmt). 2015 Sep;24(9):762-70. doi: 10.1089/jwh.2014.5150. Epub 2015 Jun 30. PMID: 26125602; PMCID: PMC4589308.

Clinkscales N, Golds L, Berlouis K, MacBeth A. The effectiveness of psychological interventions for anxiety in the perinatal period: A systematic review and meta-analysis. Psychol Psychother. 2023 Jun;96(2):296-327. doi: 10.1111/papt.12441. Epub 2022 Dec 11. PMID: 36504355.

Rubinchik SM, Kablinger AS, Gardner JS. Medications for panic disorder and generalized anxiety disorder during pregnancy. Prim Care Companion J Clin Psychiatry. 2005;7(3):100-5. doi: 10.4088/pcc.v07n0304. PMID: 16027764; PMCID: PMC1163270.

da Costa N, Silva Martins E, Pinheiro AKB, Soares PRAL, de Souza Aquino P, Castro RCMB. Acupuncture for perceived stress in pregnant women: an intervention study. Rev Esc Enferm USP. 2022 May 30;56:e20210233. doi: 10.1590/1980-220X-REEUSP-2021-0233en. PMID: 35639350; PMCID: PMC10081585.

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