Is it just normal parenting nerves or pregnancy anxiety? Dr Louise Wiseman explains the difference.
It is very normal to feel some anxiety during pregnancy and most expectant mothers have worries at some point. Pregnancy hormones naturally affect feelings, so it is vital to know how to calm pregnancy anxiety if it becomes a real problem, and when to ask for medical help.
Many women worry about how their anxious feelings may affect their unborn child and whether crying and stress will have an effect on the baby.
Dr Louise Wiseman explains what pregnancy anxiety is, what is normal and when to seek a doctor’s opinion. She explains the causes and the risk factors that may make a pregnancy more vulnerable to anxiety.
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By being aware of the symptoms, women can use stress relieving methods of self- care to help alleviate pregnancy worries to help them enjoy a happier pregnancy.
What is pregnancy anxiety?
Anxiety can happen to anyone at any stage of their life. It is a feeling of worry, unease, nervousness with recurring intrusive thoughts or concerns. It can be fleeting or persistent and it can lead a sufferer to avoid certain situations or feel very isolated.
More than ten per cent of pregnant women suffer specifically with pregnancy anxiety, also known as antenatal anxiety, at some point. In some it may be a new symptom, for others they may have had a pre-existing diagnosis of anxiety before pregnancy.
Symptoms of pregnancy anxiety
Pregnancy anxiety needs addressing when it becomes all-consuming and is affecting your daily life.
Symptoms of pregnancy anxiety may include the following:
- Difficulty concentrating or feeling mind goes blank
- Feeling irritable, snappy or restless
- Problems with sleeping
- Constant worrying
- Feeling anxious all the time (and not necessarily sure why)
- Feeling a sense of dread or on edge
- Heart palpitationsor feeling heart beating fast
- Muscles feeling tense especially around neck and shoulders
- Many women experience panic attacks
- Sweating, trembling or shaking
- Feeling of loss of control
- Shortness of breathor breathing faster than normal
What causes pregnancy anxiety?
There are many emotions associated with a pregnancy alongside the happiness and excitement of a new life.
There are completely new sensations, hormone changes and a growing bump to contend with. Most people are concerned as to whether their baby is healthy, whether they will cope with a newborn, what the delivery will be like, not to mention any financial or career worries or how the baby will fit in with an existing family and siblings.
Later in pregnancy, women may develop a fear of childbirth (called tokophobia). If any of these anxieties becomes more than just simple worries women can feel guilty about thinking this way at such a supposedly happy time.
The female hormones oestrogen and progesterone have strong effects on mood and the way we think.
The natural hormones of pregnancy allow the changes that are needed for the developing baby, placenta and enlarging womb. For about a third of women, the higher progesterone encourages a feeling of calm and reduces anxiety. However, around half of women in an American study reported increased anxiety or depression when pregnant.
The female hormones oestrogen and progesterone have strong effects on mood and the way we think as shown in both animal and human studies. Different women may respond differently to the new levels of hormones in pregnancy and the effect it has on the control centres for all hormones – the hypothalamic-pituitary-adrenal axis.
It is not surprising that large hormone changes can have strong effects. There may be a genetic component to the way the body reacts but a large amount of it may be related to external factors listed below.
Risk factors for pregnancy anxiety
There may be no obvious reason for anxiety during pregnancy, but any of the following factors may make anxiety more likely:
- Stressat home or at work
- Previous pregnancy lossor complication
- History of traumatic eventsor abuse
- Chronic medical conditions, including chronic pain
- Fertility problems prior to conception
- Medical or family history of depression, anxiety, mental illness
- Previous drug or alcohol abuse
- Diagnosed pregnancy complications e.g. where bed rest required
Chronic conditions that exist prior to pregnancy, like thyroid disease or known mental health problems, will be managed in the NHS in joint antenatal clinics with specialist Consultants working with the Obstetric antenatal team.
Risks of pregnancy anxiety to mother and baby
For all health professionals involved in a pregnancy, the priority is the health of mother and child during and after pregnancy. Prioritising mental health care and having good social support during pregnancy will also give the mother the best chance of feeling confidence with a newborn and bonding well with the child.
Animal studies have looked extensively at the link between antenatal ‘stress’ and behaviour in offspring but studies in humans have concentrated more on obstetric outcomes. Very severe life events in early pregnancy have been linked to development problems in the baby but this is less common.
Most consistently in studies, antenatal anxiety or stress has been linked with:
- Preterm labour (going into labour early)
- Low birth weight babies
This has been suggested to be partly due to high levels of stress steroid hormones passing from mother to child or, in late pregnancy, narrowing of the blood vessels that pass from mother to baby due to chronic stress. This could then in theory affect growth of the baby.
Tips for coping with pregnancy anxiety
Talk about your feelings to a family member, close friend or if worried see your doctor asap.
Look at ways to help balance stress hormones and relax during pregnancy
Pregnancy yoga, walking, your usual exercise that you are used to after checking with midwife or doctor.
3. Encourage mindfulness
Meditation, acupuncture or massage (both must be with an experienced practitioner well versed in pregnancy care), listening to music or calming podcasts, use of relaxation or mindfulness apps, journaling can all help focus and allay worries.
4. Prioritise sleep
If your commitments allow, nap when able. Have a good evening sleep hygiene routine.
5. Prioritise nutrition
Eating whole foods, reducing intake of overly processed foods with lots of refined sugar, plenty fresh produce can all help encourage a healthy gut microbiome and this has a strong positive effect on the release of feel good chemicals in the brain and will make mood improve.
6. Learn more about pregnancy
Gaining support from professionals or reading recognised books or attending antenatal classes can help you understand the changes in your body and be aware of what to expect with delivery to reduce any fears or phobias. Midwives and doctors are extremely experienced in looking after patients’ concerns and will never dismiss your worries without explanation.
7. Managing a panic attack
If you think you are suffering a panic attack, you should:
- Talk to a friend or family member or contact Samaritans
- Try calming breathing exercises
- Visit mind.org.ukto find support
- Use mindfulness or relaxation apps
- Get into good habits with nutrition and exercise and prioritising sleep will all help.
When to see a doctor for pregnancy anxiety
If any of these symptoms are affecting you every day and you feel that you cannot cope it is important that you seek medical help. Sorting it now will help to reduce the complications listed above and also the chance of postpartum depression, which can be more likely in those who have untreated anxiety in pregnancy. The doctor will also need to exclude other possible causes of anxiety symptoms such as thyroid issues.
Treatment for pregnancy anxiety
The doctor may refer you for specific therapy, e.g. CBT or psychology review or specialist psychiatric opinion. Any decision to use medication will be a careful one weighed up against any risks or side effects for you and the baby. Ensuring you feel supported socially in your pregnancy is also important.
It is a very individual decision to be made with your doctor tailored to you regarding medication for anxiety in pregnancy and all benefits and risks must be weighed up carefully. Many of the medicines used for anxiety are also antidepressant medications. Indeed, it might be unsafe to suddenly stop medication if you used it before pregnancy and it is keeping you well. It may be that if you were on medication before pregnancy this was altered or the dose changed for safety in pregnancy.
Some birth defects can be increased with certain medications given early in pregnancy but the risks are low and research is constantly evolving. Your doctor will counsel you thoroughly regarding this. Some studies have shown preterm birth may be more likely in those who have taken medication such as certain antidepressants but there may be other factors here such as smoking, obesity, depressed mood which may alter the results. There is a very rare disorder called pulmonary hypertension in newborns that restricts the lung flow at birth – this is thought to be increased by use of certain antidepressants in late pregnancy but still the risk is low.
The concern of untreated anxiety and its effects on the mother and future baby are vital and must be considered in any decision.
For most women a small amount of anxiety is completely normal with pregnancy alongside the excitement and anticipation, but if it is becoming a problem and you are not coping make sure you speak to your midwife or doctor asap as there is help out there.