How to Manage Anxiety During Pregnancy

Between hormonal changes, societal pressures, negative past experiences some have experienced in previous pregnancies, and other stressors, it’s understandable that your anxiety levels may be high. Anxiety, which is a feeling of concern, worry, or nervousness, according to the American College of Obstetricians and Gynecologists, is one of the ways the body responds to stress.

But you don’t have to be in a constant state of anxiety for nine months (and beyond). There are many steps you can take to manage and ease feelings of anxiety—actions that can be beneficial for both you and your baby.

“Normal” Anxiety vs. Anxiety Disorder

To some degree, feelings of anxiety during pregnancy are normal. But in some cases, anxiety can become difficult to handle on your own. So, how do you know if what you’re feeling is run-of-the-mill anxiety or at a level that needs to be addressed by a mental health professional?

“The best way of telling the difference is [by asking yourself] to what degree is that anxiety affecting your functioning,” explains Lauren M. Osborne, M.D., board-certified psychiatrist, director of the Johns Hopkins Center for Women’s Reproductive Mental Health, and associate professor of psychiatry and behavioral sciences at Johns Hopkins Medicine, in Baltimore. “If you worry about a few things, and you're able to put those worries out of your mind and go about your day, that's normal anxiety.”

Anything beyond that may be a sign of an anxiety disorder—for example, if the worry or fear is constant and overwhelming. Some people may experience debilitating panic attacks, avoid leaving their home, or feel like they’re always on high alert, looking out for danger. They may have physical symptoms like trouble sleeping, stomach pain or nausea, rapid heartbeat, or headaches.

In an anxiety disorder, the anxiety can become “so overwhelming that it’s affecting you at work, it leads to severe levels of sleep loss, it impacts your social life, or you’re having frequent panic attacks,” says Veerle Bergink, M.D., a professor of psychiatry and director of the Mount Sinai Women’s Mental Health Center, in New York City.

Ask yourself if anxiety is impairing your day-to-day ability to function. If it is, it’s likely an anxiety disorder, Osborne says. She recommends calling your doctor to discuss what you’re experiencing so you can be evaluated and potentially treated.

The Effects of Anxiety on Pregnancy

Addressing this mental health issue is important, because if elevated enough, the effects of anxiety on pregnancy can be serious for both you and your baby.

For someone who’s pregnant, anxiety can lead to:

• Increased nausea and vomiting. Many expectant parents experience morning sickness, and while certain factors are known to make it worse—like an empty stomach or strong odors—stress and anxiety may also play a role. “[Those] who are anxious in pregnancy have increased rates of physical symptoms like nausea and vomiting,” explains Osborne. It can become cyclical, as research suggests that increased nausea and vomiting can worsen feelings of anxiety, too.
• Harmful health behaviors. Studies suggest that anxiety during pregnancy may be linked with an increased risk of harmful health behaviors—like smoking, drinking alcohol, and poor nutrition.
• Increased risk of postpartum mood disorders. Research also suggests that anxiety during pregnancy is a significant predictor of postpartum depression and anxiety. You may be particularly vulnerable to a mood disorder after giving birth.
• Unnecessary checkups. For some people, anxiety can make them constantly worried about something going wrong with the pregnancy, causing them to make extra calls to the doctor when everything is just fine. “They're more apt to seek reassurance and have unnecessary doctor appointments,” Osborne says. This may not seem like a big deal, but it can cause extra stress, take up quite a bit of time, and be costly, too.

Anxiety during pregnancy may also affect a baby’s:

• Risk of preterm birth. Stress and anxiety during pregnancy may increase the risk of preterm birth, according to several studies, including one published in BMC Pregnancy and Childbirth in 2016. When a baby is born too early, they are at higher risk for certain health problems and developmental delays.
• Temperament. Research suggests that anxiety during pregnancy may go on to affect a baby’s temperament. “[Anxious parents] have higher stress hormones themselves, and a higher amount of that stress hormone gets across the placenta to the baby,” Osborne says. “What that means is that the baby is born with more stress reactivity, so is more likely to have a fussy temperament as an infant.”
• Physical development. Some research suggests that a mother’s anxiety during pregnancy may affect a baby’s length and weight at birth.
• Mental, emotional, cognitive, and behavioral development. High levels of anxiety during pregnancy may increase the risk of developing mental disorders, emotional problems, concentration and hyperactivity issues, and cognitive development impairment in childhood, according to a review of scientific articles published in the journal Mater Sociomed.
• Risk of certain health conditions. In that same review, it was noted that researchers have also linked maternal anxiety to an increased risk of illnesses in the child, such as shortness of breath and asthma, rashes, heart issues, and endocrine issues.

Also, if a pregnant person is coping with anxiety by engaging in harmful health habits like using substances, that can have an indirect impact on the baby, adds Osborne.

That said, a typical amount of anxiety won’t be harmful to your baby, emphasizes Bergink. “Stress is part of life; everyone has stress—but if it's really long-lasting, then it's not good for the baby.”

6 Ways to Manage Anxiety During Pregnancy

If you’re experiencing anxiety during pregnancy, the most important step to take, both for your own health as well as your baby’s, is to tell your doctor. “A mental health checkup should be as normal as a physical health checkup,” emphasizes Bergink.

1. Seek Treatment

Your doctor can screen you to determine if you’re dealing with an anxiety disorder. Depending on their severity, your doctor may recommend treatment options to help you manage your feelings of anxiety. This could include psychotherapy, cognitive behavioral therapy (CBT), or medication that’s safe to take during pregnancy.

For more information about prenatal anxiety and a list of providers who can help, check out the website for Postpartum Support International (PSI). You can also call 800-944-4773 (800-944-4PPD).

2. Talk It Out

Opening up to someone you trust about what you’re going through may help you feel less alone. “Rally the troops in terms of partners, sisters, cousins—anybody who can help you through it,” Osborne says.

Join a support group to connect with others who understand what you’re going through—you can even connect with others in the pregnancy community. And if that isn’t helping, don’t be afraid to seek professional help.

3. Stay Active

Research suggests that exercising during pregnancy can help reduce the risk of prenatal anxiety. “There's good evidence for prenatal yoga in helping with perinatal mood anxiety disorders,” Osborne says. Talk to your doctor before starting an exercise program if you’re at risk of pregnancy complications or preterm labor.

4. Prioritize Sleep

Prenatal anxiety may make it more difficult to get a good night’s sleep, and too little sleep can contribute to low mood. Plus, not getting enough sleep is linked to an increased risk of other pregnancy complications like gestational diabetes or preeclampsia (high blood pressure), and may lead to a longer labor or increase your risk of a cesarean section.

Take steps to improve the quality of your sleep by going to bed and waking up at the same time each day; keeping your bedroom cool, dark, and free of electronics; and using oversize pillows to help keep you in a comfortable position while you’re in bed.

5. Practice Relaxation Techniques

Relaxation techniques may help lower levels of stress and anxiety during pregnancy. Consider options like:

• Prenatal massage
• Acupuncture
• Breathing exercises
• Meditation
• Music therapy
• Guided imagery

6. Set Aside a Designated “Worry Time”

If you find yourself worrying quite a bit throughout the day, you might find it helpful to schedule 30 minutes each day as “worry time.” When you feel anxiety creep up throughout the day, tell yourself you’ll get to those thoughts later. When it’s time, write down your concerns in a notebook and try to brainstorm potential solutions. This can help turn worry time into something productive.

Don’t Be Afraid to Ask for Help

Although it’s possible to manage anxiety during pregnancy, it can be difficult to do it on your own. If you continue to experience symptoms of prenatal anxiety, reach out to a mental health professional for help.

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