Managing Anxiety During Pregnancy

Pregnancy can be a time of joy and excitement. But with so many unknowns and big changes, it can also be a time of worry.

“It’s natural to have some anxiety during pregnancy,” says Dr. Lauren Osborne, a reproductive psychiatrist at NewYork-Presbyterian/Weill Cornell Medical Center. “Some anxiety can be good. It can cause you to be vigilant and do the things you need to do to take care of yourself to keep the pregnancy healthy. But if it impairs the way you function, then it becomes problematic.”

Dr. Osborne, who is also vice chair of clinical research in the Department of Obstetrics and Gynecology at Weill Cornell Medicine, says about 15% to 20% of pregnant people experience significant anxiety symptoms, with many more having some form of anxiety.

Dr. Osborne shared with Health Matters some facts about anxiety during pregnancy, including how to manage it, symptoms that people may miss, and when to reach out for help.

Many things can cause anxiety during pregnancy.

The list of what can potentially trigger anxiety during this life transition is long. Stressors may include everything from waiting for results of prenatal medical tests to financial concerns to the health of the baby. “You’re undergoing a seismic shift,” Dr. Osborne says. “So it’s natural to have anxiety about the changes in your life and about your role as a protector of this new being you’re bringing into the world.”

Another culprit is lack of sleep. While physical discomfort plays a role, worrying can exacerbate sleep issues. “If you are experiencing anxiety, you may find it harder to fall asleep at night because you’re anxious, you’re ruminating about things that are going around in your mind. And once you’re sleep-deprived, that can fuel anxiety,” Dr. Osborne says.

The pressure to follow the “rules” of pregnancy is a less often talked-about stressor — the barrage of do’s and don’ts, such as avoiding certain foods, the cat’s litter box, and saunas. “There’s a constant message of what you need to do and not do during your pregnancy,” says Dr. Osborne. “When we have a culture that’s filled with those kinds of messages, it makes people who are pregnant paralyzed with fear about what they might or might not be doing to harm their baby.”

Physical symptoms are often missed.

Many of the symptoms of anxiety that the body experiences — like shortness of breath, a feeling of a “pit” in one’s stomach, heart palpitations, sweating — are often mistaken for symptoms of pregnancy. In fact, those symptoms may actually be caused by anxiety.

“A lot of people may not even realize that they’re feeling anxious, and they chalk it up to pregnancy,” says Dr. Osborne. “That’s one of the reasons that we as a society under-recognize and under-diagnose anxiety in pregnancy — because a lot of people minimize it.”

Be sure to tell your OB-GYN about all physical changes you are feeling, Dr. Osborne adds.

When to reach out for help.

It may be hard to know when anxiety during pregnancy has reached a tipping point. One way to know is if your daily functioning is impaired, says Dr. Osborne. For example, if you are unable to do your work, your relationships become affected, you are constantly seeking reassurance from your doctor, or you have frequent worrisome thoughts about the well-being of yourself or your baby, then it’s important to tell your OB-GYN, who can refer you to a mental health professional.

“We know that anxiety during pregnancy is a leading risk factor for postpartum depression and anxiety,” says Dr. Osborne. “So it is really critical to get necessary treatment so you can get a handle on it.”

People who have a history of anxiety and depression have a greater chance of more pronounced anxiety during pregnancy, Dr. Osborne says, so make sure you tell your OB-GYN.

The bottom line is to ask your doctor about your treatment options. It’s important to have a plan in place if anxiety intensifies down the road.

Effective treatments are available for anxiety during pregnancy.

High levels of anxiety during pregnancy can affect not just the parent but the baby too. Anxiety is associated with preterm deliveries and low birth weight, and can affect the baby’s social-emotional development and the mother’s ability to bond with the infant, research suggests.

“We have a lot of data that say that women being depressed or anxious in pregnancy can have detrimental effects on themselves and on their future children,” Dr. Osborne says.

The good news is that treatments can help expectant mothers cope with their anxiety and feel better. This can include talk therapy with a mental health professional and medication.

If you are already on medication for anxiety or depression, don’t stop taking it without talking to your doctor, Dr. Osborne says. About 70% of those who have preexisting depression will have a relapse if they stop their medications during pregnancy, she adds. And changes in metabolism during pregnancy mean that you may need more rather than less medication.

“The risks of many medications are extremely minimal,” Dr. Osborne says. “I talk with my patients about the risk of taking the medication versus the risk of not treating your illness.”

Self-care eases anxiety.

Prenatal yoga, meditation, and deep breathing exercises all lessen anxiety. Creating a journal to write down – and cast away – your worrisome thoughts can help. Regular exercise may help to relieve stress, and mindfulness meditation apps can help you create moments of calm. Get extra sleep when you can to support your physical and mental health. If worry is keeping you awake, try listening to a mindfulness meditation or creating a soothing bedtime ritual such as a warm bath or a cup of herbal tea.

“Self-care rather than self-sacrifice is what we moms need to do for our babies,” says Dr. Osborne.

Lauren M. Osborne, M.D., is a reproductive psychiatrist at NewYork-Presbyterian/Weill Cornell Medical Center and serves as the vice chair of clinical research in the Department of Obstetrics and Gynecology at Weill Cornell Medicine. She recently launched the Perinatal Wellness Program, a pilot program to screen patients across pregnancy and after childbirth for mental health conditions and connect them to mental healthcare within the OB-GYN setting. Dr. Osborne is an expert on the diagnosis and treatment of mood and anxiety disorders during pregnancy, the postpartum, the premenstrual period, and perimenopause.