Anxiety Disorders and Pregnancy

What is perinatal distress?

Perinatal distress is a general terminology used to describe several conditions and symptoms that women may experience before, during, and after birth which includes:

  • depression
  • anxiety 
  • stress 

Perinatal distress may also include issues associated with pregnancy complications such as pregnancy loss, premature births, miscarriages, stillbirths, terminations, and infants born with disabilities or other issues.

What is anxiety?

The term anxiety disorder represents a family of mental disorders associated with fear and anxiety. Both mental states — anxiety and fear — are thought to be important evolutionary mechanisms that enhanced chances of survival in a once-primitive world. In today’s presumably safer world, anxiety and fear still serve a purpose but when these feelings linger or are experienced with intensity, quality of life suffers.

Anxiety that reaches the point of a disorder is the obsessive worrying about real or imagined events expected in the future. An unhealthy fear, or phobia, creates difficulty when facing challenges of everyday living. When these symptoms are present at the same time, anxiety disorder is diagnosed. The disorder can take form as panic attacks, separation anxiety, situational anxiety (fear of leaving home, for example), post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). People suffering from depression, bipolar disorder, eating disorders, and substance abuse are often diagnosed with anxiety disorders, too. Caffeine, alcohol, recreational drugs, and some prescription medications can heighten one’s sense of anxiety when a disorder is present.

Screen to see if your anxiety is normal or not.

How is anxiety diagnosed?

Medical history is an important diagnostic tool for anxiety disorders. Symptoms often begin in childhood and the disorder frequently runs in families. Certain traumatic life events trigger anxiety disorders, too, as is the case with PTSD and combat soldiers, rape victims, and survivors of a natural disaster.

When an anxiety disorder is suspected, clinical screening questionnaires often confirm the diagnosis or identify the need for further testing.

What causes anxiety?

When a parent has an anxiety disorder, his/her children are six times more likely to develop similar disorders than children whose parents don’t have any form of the disorder. Children who experience traumatic childhoods, regardless of parental diagnosis, are more prone to develop anxiety disorders due, perhaps, to a heightened sensitivity to threats or danger.

In adulthood, extreme stress can trigger a diagnosis. Violent or traumatic events are often associated with PTSD but financial, employment, and marital strife can trigger anxiety disorders. The stress of chronic illness can lead to anxiety disorders; the condition is closely associated with age-related dementias.

How can anxiety be treated before and during pregnancy?

There are many safe treatments for anxiety that do not involve medications and which can reduce anxiety during pregnancy and help you feel better. Anti-anxiety medication as initial treatments is often not recommended during pregnancy if there are other safer options. If you are on medications, you should not stop them unless you have talked to your doctor and explored options. The gold standard of research, the Cochrane Library, concluded that mind-body interventions including yoga and autogenic training might benefit women's anxiety during pregnancy. 

  • Practice mindfulness. Research shows that mindfulness training instead of medications may reduce anxiety such as worries about getting pregnant, pregnancy, and labor, and it may even prevent postpartum depression.
  • Yoga, massage, meditation, and acupuncture. Finding relaxation techniques that work for you may take some experimentation — PLUS their benefits will continue even after the baby arrives.
  • Cognitive behavior therapy (CBT) demonstrates promise and focuses on challenging maladaptive thoughts, emotions, and actions, and it uses anxiety management strategies such as diaphragmatic breathing (adapted to pregnancy).
  • Regular physical activity: In general, it is safe to engage in physical activity during pregnancy. However, if you are at risk for preterm labor or have pregnancy complications, consult with your doctor first.
  • Ensure adequate sleep: Whether it’s a calming bedtime routine, pregnancy pillow, or a few nights in a bed away from your snoring partner, now is the time to learn what works for your sleep.
  • Journaling. Writing about your worries may help you brainstorm potential solutions, and it allows you to reflect on your concerns.
  • Schedule worry time. We often worry because we do not want to forget something. Setting aside 30 minutes toward the end of the day provides you with a time to worry productively, but it frees you from holding onto your worries the rest of the day (practice reminding yourself "I’ll get to these thoughts later").

How can anxiety disorders affect pregnancy?

Some anti-anxiety drugs may not be safe during pregnancy and nursing and you should discuss with your doctor whether the medication is safe or not when TTC and during pregnancy. Women taking these drugs before pregnancy are urged to discuss their medication regimen with their Ob-Gyn before conception or at the first signs of pregnancy. Do not stop any medication you need without first discussing it with your doctor. Alternative options or dosage adjustments may be needed for the safest pregnancy possible. When anti-anxiety medications are prescribed during pregnancy, it is important to notify one’s prenatal medical team of these and all new prescriptions.

How prevalent is anxiety?

Estimates indicate 4.5% of the global population suffers from an anxiety disorder, with females being twice as likely as men (5.2% and 2.8%, respectively) to develop it. Approximately 29% of the US population is expected to experience an anxiety disorder at some time in life.

Except for substance abuse, anxiety disorder is the most common psychiatric condition in the US population. Anxiety disorders account for more workplace disabilities than any other cause.

Read More:
Perinatal Distress in Women in Low- and Middle-Income Countries: Allostatic Load as a Framework to Examine the Effect of Perinatal Distress on Preterm Birth and Infant Health
Pregnancy Depression
Mood Swings and Emotional Changes During Pregnancy
How to Manage Bipolar Disorder During Pregnancy

What is Anxiety Disorder? National Institute of Mental Health. National Institutes of Health. n.d. Web. 6 Oct. 2014.
Anxiety Disorders. American Psychiatric Association. American Psychiatric Association. n.d. Web. 6 Oct. 2014.