How to cope with anxiety during pregnancy

It's very normal to feel more anxious than usual during pregnancy. Worry and fear are natural responses to big changes, including expecting a child. Whether this is your first baby or you're adding to your family, your life is about to change dramatically in ways you can't control.

An anxiety disorder during pregnancy, however, can interfere with your ability to live your day-to-day life. Especially during this time, it can be difficult to distinguish between normal worry and persistent anxiety. If anxiety and fear start to feel like the norm rather than the exception, it may be time to get help. Talk to your provider so you can start treatment. 

What causes anxiety during pregnancy?

Anxiety is a very common mental health problem, especially for women. It's hard to pinpoint exactly how common anxiety disorders are in pregnancy, but research suggests that up to one in five women experience an anxiety disorder during or after pregnancy.

While a number of factors can contribute to developing an anxiety disorder (see below), pregnancy and postpartum are a particularly vulnerable time.

Certain things may worsen anxiety during pregnancy, including:

• Hormonal changes during pregnancy, which can impact your moods and make you more vulnerable to worry
• Difficulty sleeping – a common pregnancy problem that can make anxiety symptoms worse
• Previously experiencing pregnancy loss or a traumatic delivery, which can increase the risk for post-traumatic stress disorder (PTSD, a type of anxiety disorder)
• Previously experiencing other types of trauma, which might be triggered by hormonal, physical, and social changes during pregnancy and postpartum
• Being diagnosed with a pregnancy complication, such as gestational diabetes or preeclampsia
• Concerns about big issues such as your baby's health and your own, your changing body, being able to breastfeed, managing your finances, or your ability to be a good parent
• Rarely, other health conditions such as hyperthyroidism, heart disease, or respiratory illness, which can cause or worsen anxiety symptoms

Pregnancy anxiety symptoms

• Constant feelings of worry, tension, or doom
• Feeling on edge
• Chest or stomach pains
• Dizziness
• Chronic headaches
• Nausea
• An intermittently rapid heartbeat
• Trouble falling or staying asleep
• Panic attacks: An acute feeling of intense fear accompanied by physical symptoms such as a racing heart, faster breathing, sweating, shaking, or nausea
• Teeth grinding

Anxiety often coincides with other mental health issues, like depression. It's also not unusual to experience obsessive-compulsive disorder (OCD) for the first time in pregnancy, which involves having the same unwanted and intrusive thoughts or urges over and over again and engaging in repetitive actions or mental rituals. Symptoms of these conditions can worsen after your baby's born.

Risk factors for anxiety in pregnancy

While there's no way to predict who will experience pregnancy anxiety or develop an anxiety disorder, a few factors may increase your risk, including:

• A personal history of anxiety or depression
• A family history of anxiety disorders
• A previous pregnancy loss
• Experiencing stressful events during pregnancy such as health challenges, losing a job, or relationship problems with your partner
• A baby with health problems
• Childhood trauma

Will having anxiety during pregnancy affect my baby?

Studies show that persistent anxiety during pregnancy could lead to future health and developmental issues for your baby. But there are good treatments for anxiety, and effectively treating anxiety during pregnancy can help avoid bad outcomes.

Studies have linked a mother's untreated anxiety during pregnancy to prematurity, low birth weight, and fetal growth restriction in babies. Some research suggests that pregnancy anxiety may also increase a child's future risk of mental disorders, emotional problems, hyperactivity, and impaired cognitive development.

In moms, untreated anxiety while pregnant may make nausea and vomiting worse. Anxiety may also make it more difficult to care for yourself and your little one and to bond with your baby once they're born. Rather than going away after birth, untreated pregnancy anxiety increases the risk of postpartum anxiety and postpartum OCD.

Treatment options for pregnancy anxiety

Treatment for pregnancy anxiety varies, but usually involves talk therapy and/or medication.

Important: If at any point you feel that you can't cope or have thoughts of harming yourself, immediately call your healthcare provider, 911, or 988 (the 988 Suicide & Crisis Lifeline). Or, use the Crisis Text Line (text HOME to 741741).

Talk therapy for anxiety

Sometimes just talking to someone can help you feel better. Your provider can refer you to a psychologist, counselor, or psychiatrist.

It's hard to discuss your deepest fears, especially if you worry what others may think. But try to be as honest as possible with your therapist about how you're feeling.

Your provider may suggest a type of talk therapy known as cognitive behavior therapy (CBT). Research suggests CBT is effective at treating anxiety disorders, because it teaches you new ways of thinking, reacting, and behaving in stressful situations.

With CBT, you and your therapist will discuss your thoughts, emotions, and reactions to hypothetical or real situations. Your therapist will point out any unhelpful patterns of thinking or behavior and work with you to recognize them and respond in a different way.

Medication for anxiety

It's important to be cautious when taking medicine during pregnancy, and to talk to your provider before taking any medication or supplement.

Some anti-anxiety medications are considered safe during pregnancy. And treating anxiety effectively during pregnancy is a priority. Your doctor can help you weigh risks and benefits and guide you to good options.

If you're on medication already, don't stop taking it without talking to your provider first. Stopping medication suddenly can lead to a relapse or cause side effects.

There are two main types of medications used to treat anxiety during pregnancy:

• Selective serotonin reuptake inhibitors (SSRIs) are also prescribed to treat depression. Commonly prescribed SSRIs for anxiety include fluoxetine, sertraline, citalopram, and paroxetine.
• Benzodiazepines are prescribed to manage severe anxiety or panic attacks. They're used with caution during pregnancy, because these medicines have been associated with an increased risk of preterm birth and low birth weight. Taken close to delivery, they may cause withdrawal symptoms, difficulty breathing, and feeding problems in newborns.

If your doctor recommends any anxiety medications, they'll keep a close eye on your progress throughout pregnancy.

While several herbal remedies are touted to help with anxiety symptoms, it's best to avoid them during pregnancy unless they're specifically recommended by your provider. There's very little research on their safety, especially during pregnancy.

And just because herbal remedies are "natural" doesn't mean they're necessarily harmless: Some can be dangerous during pregnancy. Also, supplements aren't as closely regulated as medication, or approved by the Food & Drug Administration (FDA), which means they may not contain the ingredients or the amount of ingredients listed on the label.

How can I can cope with anxiety in pregnancy?

Constant pregnancy anxiety can be exhausting. In addition to getting treatment from a mental healthcare provider, try these self-care strategies:

Take care of yourself. Being kind to yourself goes a long way in helping to relieve anxiety during pregnancy. Try to rest or take breaks during the day. Use affirmations to soothe your mind. And try to identify and avoid perfectionism or setting expectations too high for yourself or your family.

Try relaxation techniques. Research suggests mindfulness practices may help reduce worries about labor and reduce the risk of postpartum depression. Meditation, acupuncture, and prenatal massage can help you relax and reduce feelings of anxiety.

Connect with others. Tell someone you trust how you feel. You could talk to your partner, call a sympathetic friend, or chat with other expecting moms in the BabyCenter Community. Don't hesitate to ask loved ones for help with chores or other responsibilities.

Focus on sleep. Pregnancy may keep you from sleeping well, but sleep is critical for your physical health and mental well-being. Prioritize rest, and find strategies that help you to sleep better, like a calming bedtime routine or a comfy pregnancy pillow.

Get moving. Regular exercise prompts the brain to release hormones that may alleviate feelings of anxiety and depression. It also gives you an outlet to take your mind off of worries. While exercise is generally considered very safe and healthy during pregnancy, be sure to get your provider's approval before starting any new routine.

Aim for a healthy diet. Eating nutritious foods can boost your mental and physical health. Try to follow a balanced diet with plenty of fruits, vegetables, and foods rich in omega-3s, like fish. Eat protein with meals to keep your blood sugar levels stable. Include complex carbohydrates, like whole grains and beans, which are thought to increase serotonin levels in the brain and increase feelings of calmness.

Learn and prepare. Anxiety can be triggered by feeling like you don't have things under control. So set aside an amount of time per week – even if it's just an hour – to read up on pregnancy, take an online class, set up the nursery, or do anything else that helps you feel more prepared for the changes ahead.