Anxiety Disorder vs. Stress During Pregnancy

Pregnancy

Jun 27

Anxiety is a broad term, which in the general population is often synonymous with worry and stress. In this article, we will separate out two situations: When a woman is feeling stress during pregnancy and having general worries and when a woman is struggling with an anxiety disorder.

Pregnancy is an anxiety-provoking time whether you are a new mom or having your third child. Many women ask me:

Is worrying impacting the development of my baby?
Are my anxiety levels are normal?
How do I manage my worries and stress during pregnancy?

Stress During Pregnancy

Stress is defined as a threat to usual balance. When you are feeling stressed – because something outside of your usual life balance is taking place, and pregnancy is a prime example – your biology changes. The way that you respond to stress depends on a number of factors, and these include things like how much social support you have and how experienced you are with different coping skills.

The biology behind stress includes various hormones such as cortisol and other chemicals in the body (See: Hormones in Pregnancy). Studies have looked at the ways chronic stress and elevated stress hormones affect pregnancy, finding an association with worse outcomes for delivery and for the baby. These are described later in this article.

Common Worries during Pregnancy

The anxieties women often have in pregnancy include:

Fear of childbirth
Fear of having a child with handicap or having something wrong with the baby
Concern about one’s changing appearance
Worry about being a good parent

It is valuable to note that some studies have concluded that pregnancy related anxiety is different than other types of general anxiety, with different rates of occurrence and different biological explanations. This may mean that our usual ways of diagnosing anxiety conditions cannot as successfully be applied in pregnancy and therefore women with pregnancy anxiety are being missed or misdiagnosed. Because anxiety and stress can have a dramatic impact on pregnancy and infant outcomes, it is important for pregnant women to become aware of this in order to be able to explore treatment options (covered in separate article posts).

When anxiety reaches a level of severity where it is impacting functioning, whether that means performance at work, interpersonal relationships, or your ability to care for yourself, it might be considered more than anxiety – it may be an anxiety disorder.

Anxiety disorders are more common in women compared to men, and the average age for the onset of an anxiety illness in a woman corresponds with the usual reproductive times. An anxiety disorder, to which a woman might have vulnerability due to genetics or biology, can often be triggered by stress. And pregnancy is a stressful time.

How Common Are Anxiety Disorders in Pregnancy?

Researchers have studied anxiety in pregnancy, but the numbers when making estimates of prevalence of anxiety disorders vary widely. Overall, the prevalence of any anxiety disorder during pregnancy ranges from just under 5% all the way to almost 40%. The most common condition is Generalized Anxiety Disorder. Other clinically significant conditions included panic disorder, phobias including social phobia, obsessive-compulsive disorder, and post-traumatic stress disorder.

It is also quite possible to have more than one type of anxiety condition or to have an anxiety condition combined with a depressive disorder or another mental health issue. Several studies also find that anxiety is highest in the first and third trimester, compared to the second. For more specific information about each of the aforementioned conditions, see separate articles in this section.

Do Anxiety Disorders Change in Pregnancy? Do They Improve or Worsen?

The answer to this question depends on the study you choose to review. Unfortunately, the literature on this also varies widely, with some studies noting symptoms improve in pregnancy while more suggest that symptoms actually worsen, and several actually find that there is no change. A number of elements can increase your risk of symptoms, however. These include low social supports, low self-esteem, and a high risk pregnancy. Previous history of an anxiety condition also increases the risk of pregnancy-related anxiety.

Anxiety and Stress and the Impact on Pregnancy Outcomes

Anxiety disorders, acute severe stress, and chronic stress during pregnancy can impact delivery outcomes and the postpartum period, including:

Increased risk of postpartum depression and postpartum anxiety
Preterm delivery
Prolonged labor
Lower birth weight babies
Smaller head circumference (a predictor of cognitive development)
Pre-eclampsia
Longer hospital stays after delivery
Infant functioning/temperament (more fussy, crying, and lower scores on tests of neurodevelopment)
Future anxiety and other mental illness in childhood and beyond

Anxiety during pregnancy can also influence the type of pregnancy women experience. Because of the strong link between mind and body, anxiety can impact the physical aspects of pregnancy. For example, heightened anxiety in the first trimester leads to more reports of nausea and vomiting. Anxiety can also lead to the development of unhealthy coping behaviors such as use of alcohol, tobacco, or extreme over-eating.

Treatment for Anxiety and Increased Stress in Pregnancy

Before beginning to treatment pregnancy-related anxiety, it is important to make sure that the symptoms of anxiety are not due to a different underlying medical ailment. For example, thyroid dysfunction, not uncommon in pregnancy, can lead to similar symptoms as an anxiety disorder, with elevated heart rate and anxious thoughts. Similarly, other conditions such as anemia or pre-eclampsia can present with symptoms similar to anxiety disorders. Therefore, it is essential to speak with your obstetrician about these symptoms and receive appropriate medical evaluation.

A wide variety of treatment options have been researched to improve anxiety in pregnancy. These include more traditional forms of psychotherapy, such as cognitive-behavioral therapy, one of the best studied non-medication treatment options for anxiety disorders. The options also include music, which has been shown to decrease levels of stress hormone cortisol, relaxation techniques, which have been shown to improve fetal heart rates, sleep management, reduction of caffeine, and medications. To learn more about these and other various treatment options, see articles in the section Treatments.

It is important to keep in mind that every woman is different and treatment should be individualized.

Selected References:
Goodman, J.H., Chenausky, K.L., Freeman, M.P. “Anxiety disorders during pregnancy: A systematic review.” Journal of Clinical Psychiatry: 75:10 (2014).
Huizink, A.C., Mulder, E.J.H., Robles de Medina, P.G., Visser, G.H.A., Buitelaar, J.K. “Is pregnancy anxiety a distinctive syndrome?” Early Human Development: 79 (2004): 81-91.

Anna Glezer, M.D.

Dr. Glezer began her training at Harvard and then transitioned to the University of California, San Francisco, where she has been a practicing physician, teacher, mentor, and is an associate professor. She is board certified in adult and forensic psychiatry, a member of the American Psychiatric Association, and the immediate past President of the Northern California Psychiatric Society.

She has worked with hundreds of women going through the emotional challenges of conception, pregnancy, loss, and postpartum. She has been interviewed for, and her written work has appeared on multiple leading sites, including Huffington Post, Fit Pregnancy, Health Line, Help Guide, and more. She has presented at local and national conferences and published in academic journals. Several years ago, she established the annual Bay Area Maternal Mental Health Conference and launched the educational website Mind Body Pregnancy, aimed to inform women, their partners, and their providers about mental health and emotional issues common in the reproductive years.

She began her private practice to help women throughout the Bay Area access reproductive mental health services and is really passionate about helping as many women as possible.