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Perinatal Anxiety: Anxiety During Pregnancy & Baby’s First Year

Perinatal Anxiety: Anxiety During Pregnancy & Baby’s First Year

Perinatal anxiety is common but highly treatable with therapy, medication, mindfulness, or other approaches. 

Written By
Haley Tardy

Haley Tardy

July 1, 2022

You just found out you’re going to be a parent. Whether it’s the first, second, or even fifth time. You were trying for six months or got lucky. You’ve experienced loss or went through three rounds of IVF. Pregnancy always comes with a slew of concerns and questions, and while this is often thought to be a happy time, that isn’t always the case — and that’s okay.

Anxiety after the birth of a baby is a topic that is becoming more normalized, but did you know that many people also experience anxiety during pregnancy?

Termed perinatal anxiety, feelings of sadness, anger, worry, or fear during pregnancy, or the first year after the birth of your baby, are not something you should overlook.

What is Perinatal Anxiety?

Perinatal Mood and Anxiety Disorders—also known as PMADs—are one of the top complications of pregnancy and childbirth. Not only this, but it is estimated that 15% to 21% of pregnant and postpartum women experience PMADs.

So, what exactly is perinatal anxiety and how does it differ from other anxiety disorders that can happen during, and after, pregnancy? Here’s a quick breakdown:

  • Prenatal or Antenatal Anxiety — anxiety that occurs during pregnancy.
  • Perinatal Anxiety — anxiety that happens during pregnancy and up to one year postpartum.
  • Baby Blues — short-term (two weeks or less) feelings of anxiety, etc. before or after birth.
  • Postnatal Anxiety — anxiety that happens in the first year after birth.

The Research on Anxiety and Pregnancy

While perinatal anxiety is less studied than PMADs like postpartum depression, there is plenty of research that suggests it can negatively affect both mom and baby.

According to a 2015 study, high levels of stress and anxiety during pregnancy increased the risk for preterm birth, low birthweight, earlier gestational age, and a smaller head circumference.

Not only this, but anxiety during pregnancy may lead to prolonged crying in infants, higher risk of illness, increased mental disorders, emotional problems, lack of concentration, hyperactivity and impaired cognitive development of children.

Research also tells us that women suffering from mental health disorders are less likely to seek treatment due to the stigma associated with their diagnosis. Of the women who experience symptoms of perinatal anxiety, less than 50% will seek help — even fewer will go on to receive effective treatment.

We can change that.

Symptoms of Perinatal Anxiety

Before we hop in here, we want to preface this section by saying that some level of anxiety and fear during pregnancy is normal. This is a huge moment in your life and everything around you is changing in a short amount of time. Being scared of the uncertain is both expected and very common (not just in pregnancy but in life in general). When anxiety becomes overwhelming and interferes with your day-to-day life, that is when you should seek help.

The following symptoms, as well as others, could be a sign that you have a form of perinatal mood or anxiety disorder.

Physical Symptoms of Perinatal Anxiety:

  • Breathing Rapidly (Hyperventilating)
  • Difficulty Sleeping or Restlessness
  • Increased Heart Rate
  • Nausea or Stomach Upsets
  • Sweating
  • Trembling or Shaking
  • Tension or Muscle Aches

Mental Symptoms of Perinatal Anxiety:

  • Difficulty Focusing
  • Feeling On-edge
  • Frequent Anger or Irritability
  • Frequent Worry or Fear
  • Frequent Sense of Panic
  • Intrusive Thoughts
  • Ruminating

Risk Factors and Causes of Perinatal Anxiety

There are several theories as to why we experience anxiety in pregnancy — from the increase of hormones circulating in our body to traumatic experiences or external stressors.

While there is no one universally agreed upon theory, there may be some people more prone to experiencing an anxiety disorder. If any of the following resonate with you, be sure to discuss it with your doctor, or someone you feel safe with, if you have concerns.

  • Excess Stress
  • Exposure to Racism
  • Family or Personal History of Anxiety
  • Lack of Support
  • Previous Pregnancy Loss
  • Personal History of Drug or Alcohol Misuse
  • Thyroid or Other Medical Conditions
  • Trauma (Previous or Current)

How Long Does Perinatal Anxiety Last?

Everyone is different, so how long a person might experience PMADs will vary. While some women experience anxiety for several weeks, others may feel its effects for months, or even years. The good news is that perinatal anxiety is very treatable with diagnosis.

How is Perinatal Anxiety Different from Depression?

The primary difference between anxiety and depression (whether in pregnancy or in general) is the symptoms. A person who is experiencing depression may have some of the same symptoms we discussed above, but they will also experience a prolonged feeling of sadness, worthlessness, or loss of interest in things they used to enjoy.

Unfortunately, anxiety and depression often go hand-in-hand. About 60% of people with anxiety also show symptoms of depression, and vice versa. Also, each condition can make symptoms of the other get worse or last longer.

How Do I Get a Proper Diagnosis of Perinatal Anxiety?

Perinatal anxiety is still a relatively new concept that is less understood than postpartum anxiety or depression. In addition to this, many women will choose to suffer from perinatal anxiety because they feel guilt or shame around the experience. For those who do recognize the symptoms, there is fear of being seen as a bad mom or stigma attached to mental health issues.

While there is still much to learn about the condition, only a trained healthcare or mental health professional will be able to assess whether you have a perinatal mood and anxiety disorder. Here are a few tips to help get you the treatment you deserve:

  1. Advocate for what you need. The first step happens with you — while it can be difficult or scary to talk about how we feel, it is the only way to begin.
  2. Talk to someone you trust about how you are feeling. Whether it’s your OB/GYN, primary care provider, therapist, or a friend. While a friend cannot offer a medical diagnosis, they can join you during an appointment or provide moral support.
  3. Ask your doctor or provider if they have treated perinatal anxiety before and what treatment methods they prefer. Is medication right for you? Is a medication and therapy combination better? Do you want to avoid certain medications during pregnancy? How do they assess perinatal anxiety and how does it differ from depression? Do you need a blood panel to rule out underlying conditions? Ask any and all questions you have — don’t leave anything off the table.
  4. Be sure that any screenings or assessments you take are specific to the perinatal period and not just for generalized depression or anxiety. The most commonly used scale is the Edinburgh Postnatal Depression Scale (EPDS).
  5. Research PMADs on your own, but only use fact-checked, scientific sources. Because the condition is still being studied, it’s easy for misinformation to be cited as fact.

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Coping With Perinatal Anxiety

Perinatal anxiety can affect any pregnant person or new parent. It does not matter how old you are, your income, race, ethnicity, or education. If you think you may be suffering from PMADs, or perinatal anxiety specifically, there are ways to overcome it.

Practice Mindfulness & Meditation

There is a mounting body of evidence in support of meditation that shows the myriad benefits it has for you. Meditation reduces stress and anxiety, increases mindfulness and awareness, and helps you fall asleep and stay asleep longer.

Study after study supports the use of meditation as a stress-reducer, with one 2021 randomized controlled trial finding that a mindfulness program reduced stress in women who have had multiple miscarriages.

Mindfulness techniques were also shown to be effective for improving both the mental health and relationships of women who experienced infertility or were going through reproductive treatment.

So no matter what’s causing your anxiety, meditation may help.

Cognitive Behavioral Therapy (CBT) or Talk Therapy

Cognitive behavioral therapy works by asking a patient to change their thinking patterns. By recognizing problems, reevaluating them, and reframing or finding coping skills, you and your therapist are able to develop a treatment strategy unique to your needs. It has been proven that CBT is effective in improving anxiety and related symptoms among women with anxiety disorders in the perinatal period.

If you haven’t worked with a therapist before, now is a great time to start, and let us assure you that nobody is judging — definitely not your therapist.

Can’t find affordable therapists in your area? Consider a virtual or app-based appointment. Resources like BetterHelp and TalkSpace are a good start.

Prescription Medication

If other methods of treatment don’t seem to be working, your doctor may suggest medication or a combination of treatment with medication.

The most frequently cited concern when it comes to medication is how will this affect me, my baby, or breastfeeding? Thankfully, medical science has made major leaps and bounds over the last few decades, and many SSRIs and SNRIs are considered safe and effective for anxiety during pregnancy.

As always though, talk with your doctor if you have questions about medication types, length of use, side effects for you or baby, or just want more information.

Self-Care & Lifestyle Changes

You cannot self-care your way out of depression and anxiety — this has to be said. However, increasing some self-care practices like sleeping enough, eating whole, nutrient-dense foods, and staying hydrated are effective ways to support your mind and body. Here’s a few self-care practices you can start today:

  • Journal When You Feel Anxious
  • Limit Processed and Fast Foods in Your Diet
  • Make Time for Hobbies
  • Schedule Time to Relax
  • Spend Time with Friends and Family
  • Spend Time Outdoors

If You’re Experiencing Perinatal Anxiety—You Are Not Alone

According to estimates, as many as 1 in 5 women will experience anxiety during their pregnancy. While some anxiety is normal during this time, it should not last longer than two weeks or interfere with your daily life, work routine, or relationships.

While there is no one cause of anxiety, some people may be more prone to the experience. Some of the risk factors for perinatal anxiety include history of anxiety, past or current trauma, experience with racism, or having lost a pregnancy in the past.

If you are noticing any mental or physical symptoms of anxiety, such as panic attacks, feeling on-edge, difficulty focusing, or others, then you should call your doctor as soon as possible. Keep in mind, symptoms may appear all of the sudden, or come on more gradually.

Perinatal Mood and Anxiety Disorders—PMADs—are common, but highly treatable. Therapy, medication, mindfulness, or other approaches exist, but many women will not seek treatment for fear of negative perception.

One way we can end the stigma around perinatal anxiety is to talk about it more. That is why Expectful created Shared Stories — unfiltered, unscripted, and finally, understood. Honest storytelling from hopeful, expecting, and new moms. Find support through your journey, always judgment free.

Haley Tardy
Haley Tardy