- Blaming Mom
- Anxiety During Pregnancy: How Does it Affect the Developing Fetal Brain?
- When Pregnancy Brings On Panic Attacks
- Help for Panic Attacks During Pregnancy
- Anxiety During Pregnancy: What’s Normal and What’s Not?
- What’s a normal amount of anxiety?
- More About Stress and Moods During Pregnancy
- Who’s most at risk?
- Why seek help?
- Anxiety medications during pregnancy
- Other anxiety treatments during pregnancy
- Pregnancy and Medication
- Anxiety & pregnancy
- Panic Disorder Increases the Risk of Adverse Birth Outcomes
- How can I prevent or manage anxiety in pregnancy?
- More information and support
- Anxiety Attacks During Pregnancy
- The Health of Anxiety Attacks
- What is an Anxiety Attack
- What Causes Anxiety Attacks in Pregnant Women?
- How to Prevent Future Anxiety Attacks
Van den Bergh says pregnant women should do all they can to reduce the stresses and anxiety in their lives, especially early in their pregnancies. While the findings could produce even more anxiety among women who worry that worrying will damage their unborn babies, the researcher says she hopes it will lead to the development of better strategies for dealing with stress during pregnancy.
Obstetrician and longtime fetal development researcher Peter Nathanielsz, MD, PhD, says placing the burden of reducing stress on the mother-to-be will not work. Nathanielsz’s well-publicized studies show that environmental exposures in the womb are associated with many health problems later in life including heart disease, diabetes, and obesity.
“I’ve been taken to task by people who say my research lays too much blame on the mom, but that is not it at all,” Nathanielsz says. “The womb is the first environment we experience, and we pass more biological milestones before we are born than we will ever pass again. We can leave it to the mother to deal with stress or we can rightly recognize that this is a societal problem that has to be addressed by all of us.”
Duke University obstetrics and psychiatry professor Diana Dell, MD, agrees that simply telling women to reduce the stress in their lives during pregnancy isn’t enough. Dell is a spokeswoman for the American College of Obstetrics and Gynecology.
“Women are already under enormous pressure to make perfect babies, so instead of blaming moms under stress we need to figure out how to best protect moms and babies from stress and anxiety,” she says.
Anxiety During Pregnancy: How Does it Affect the Developing Fetal Brain?
During fetal life, neurons proliferate, migrate and form connections, providing the structure of the developing brain. Neurons reach their final destinations by the 16th week of gestation, while branching and making appropriate connections occur even before that time (1). The brain continues to develop during the entire pregnancy, with most of the synapse formation in the developing brain happens during the third trimester (2).
During these complex neurodevelopmental events, the fetal brain is particularly vulnerable. Many factors may affect fetal brain development, including infectious agents, alcohol, various illicit drugs, medications, and environmental toxins, but there is accumulating evidence to indicate that exposure to psychiatric illness in the mother may also affect development of the fetal brain.
In animal models, the offspring of mothers who experience stress during pregnancy show changes in the morphology of the brain (3) and alteration in the regulation of the stress axis. In humans, high levels of anxiety during pregnancy have been associated with an increased risk of developing preeclampsia, premature birth and low birth weight. It has been demonstrated that low birth weight in premature infants has been associated with changes in brain morphology (4). In this population, it has been difficult to parse out the effects of maternal anxiety from the perinatal complications when assessing the brain morphology changes that are present in premature infants.
A recently published prospective study (5), recruited 557 pregnant women, none treated for any psychiatric disorder, and collected data on levels of anxiety at weeks 19, 25 and 31. A 10-item anxiety scale was used, which was developed specifically for pregnancy research (6, 7). So far, 52 offspring (between the ages of 6 and 9) have undergone brain scanning (MRI).
The researchers observed that anxiety during pregnancy had no effect on the global gray matter volume (estimate of the total neuronal body volume). However, high levels of anxiety at 19 weeks of pregnancy were correlated with the volume reductions in several regions of the brain, including the prefrontal, lateral temporal and premotor cortex, medial temporal lobe and cerebellum. High pregnancy anxiety at 25 and 31 weeks gestation was not significantly associated with local reductions in gray matter volume. There was no correlation between pregnancy anxiety and sociodemographic status or postpartum stress.
This is the first prospective study to show that pregnancy anxiety is related to specific changes in brain morphology. The regions most affected by high levels of anxiety are important for cognitive performance, social and emotional processing and auditory language processing. These findings are consistent with the body of literature which demonstrates that prenatal stress and associated anxiety may lead to delays in infant development, lower academic achievement, greater emotional reactivity and emotional/behavioral problems persisting through the adolescence (8-12).
While many women are understandably cautious about taking medications during pregnancy, this study, as well as others, indicated that anxiety during pregnancy is not a benign event. It is essential to address anxiety that emerges during pregnancy, and we must help to educate pregnant women about the long-term developmental risks of untreated anxiety.
Snezana Milanovic, MD
1. Sidman, R. L. & Rakic, P. (1973) Brain Res 62, 1-35.
2. Bourgeois, J. P. (1997) Acta Paediatr Suppl 422, 27-33.
3. Hayashi, A., Nagaoka, M., Yamada, K., Ichitani, Y., Miake, Y. & Okado, N. (1998) Int J Dev Neurosci 16, 209-16.
5. Buss, C., Davis, E. P., Muftuler, L. T., Head, K. & Sandman, C. A. Psychoneuroendocrinology 35, 141-53.
6. Rini, C. K., Dunkel-Schetter, C., Wadhwa, P. D. & Sandman, C. A. (1999) Health Psychol 18, 333-45.
7. Glynn, L. M., Schetter, C. D., Hobel, C. J. & Sandman, C. A. (2008) Health Psychol 27, 43-51.
8. Buitelaar, J. K., Huizink, A. C., Mulder, E. J., de Medina, P. G. & Visser, G. H. (2003) Neurobiol Aging 24 Suppl 1, S53-60; discussion S67-8.
9. Davis, E. P., Glynn, L. M., Schetter, C. D., Hobel, C., Chicz-Demet, A. & Sandman, C. A. (2007) J Am Acad Child Adolesc Psychiatry 46, 737-46.
10. O’Connor, T. G., Heron, J., Golding, J., Beveridge, M. & Glover, V. (2002) Br J Psychiatry 180, 502-8.
11. Van den Bergh, B. R., Mennes, M., Oosterlaan, J., Stevens, V., Stiers, P., Marcoen, A. & Lagae, L. (2005) Neurosci Biobehav Rev 29, 259-69.
12. Van den Bergh, B. R., Van Calster, B., Smits, T., Van Huffel, S. & Lagae, L. (2008) Neuropsychopharmacology 33, 536-45.
When Pregnancy Brings On Panic Attacks
Though many women might think of pregnancy as a magical time, it is not always nine months of bliss. Stress and anxiety may run high. And panic attacks during pregnancy are actually quite common. “Up to 10 percent of pregnant women struggle with panic attacks,” says Gina Hassan, PhD, a licensed psychologist in Berkeley, Calif., who specializes in perinatal health.
The symptoms of a panic attack during pregnancy are no different from a panic attack at any other time:
- Rapid heartbeat
- Chest pain
- Shaking or trembling
- Breathing difficulty
“People feel like they’re having a heart attack,” Hassan says. “Some women feel like they’re going to die.”
Women who have a history of panic attacks are more likely to experience panic attacks when they are pregnant. However, women who have never had a panic attack in their lives may find themselves experiencing them during pregnancy, Hassan says. On the other hand, some women who get panic attacks may find they subside when they are pregnant.
The diagnosis of a panic attack is based on a woman’s description of her symptoms. She may complain of being nauseated, having difficulty breathing, and feeling like she might die. She may go to the ER, where doctors may order tests. “To some degree, diagnosing a panic attack is ruling out other causes for these symptoms,” Hassan says.
Researchers believe panic attacks during pregnancy may be associated with a woman’s hormone levels. “It could be that the way their body responds to hormonal shifts is more dramatic,” Hassan says.
Research also shows that people may have a genetic predisposition to panic attacks — you’re more likely to experience panic attacks if a family member has had them. Stress or anxiety can bring on panic attacks, and some women find being pregnant and suddenly worrying about the health and well-being of their unborn child can trigger panic attacks, Hassan says.
Feeling the Stress of Pregnancy
Buffalo, N.Y.-based Jodi Hitchcock, a social worker who specializes in mood disorders, says that when she was pregnant with her third child, “crazy” thoughts would pop into her head, such as “Okay, now I’m going to have three kids under the age of 5. How do you have diapers for that many?” From there it would snowball: “It would go out of the normal,” she remembers, “and I’d start thinking, ‘What if one of them gets leukemia?’” Then she’d feel as though she was going to black out. “I’d be dizzy, sweating, feeling like I’m going to have a heart attack,” she recalls.
Like Jodi, Amy A. of Indiana doesn’t remember having panic attacks before or with either of her first two pregnancies. But when she was pregnant with her third child, she says, the panic attacks were constant. “I felt certain that I was going to die in childbirth. I was so certain that I wrote my husband a letter and gave it to his best friend so he could give it to my husband when I died,” she says. The panic attacks she was having lasted 15 to 30 minutes and were so bad they interfered with her ability to function.
Panic attacks during pregnancy can be a cause for concern because they can impact the fetus. “Blood flow to the fetus is reduced when their mothers are experiencing high anxiety, which can lead to low birth weight and premature labor,” Hassan says. Also, major panic attacks can affect the mother-child relationship and a mother’s ability to cope in the postpartum period.
Help for Panic Attacks During Pregnancy
What are the best treatments for panic attacks in a pregnant woman? In most cases, a combination of cognitive and behavioral therapies will help. Cognitive therapy can help people replace negative or frightening thoughts with more realistic, positive ones. Behavioral therapies, such as mindfulness exercises, also may help. Mindfulness teaches you to focus on what’s happening right now in the present, rather than worry about the future or dwell on the past. “It can help reduce stress during pregnancy,” Hassan says.
Amy says cognitive-behavioral therapy helped her to exert more control over her thoughts — it attempts to stop the anxiety before it escalates into a panic attack and to control anxiety in general.
Pregnant women who know what might trigger a panic attack — such as drinking coffee or stepping into an overheated room — should avoid those situations whenever possible.
Relaxation techniques, including deep breathing, can help calm someone who is having a panic attack. Amy says breathing is an important part of her therapy. Anti-anxiety medications can also be used, under the supervision of a physician. Medications may be necessary because women who have panic attacks during pregnancy are more likely to struggle with them postpartum, Hassan says.
Hitchcock, who has since had a fourth child, found that counseling and medication helped her deal with panic attacks. “Some women are afraid to admit that they are having panic attacks when they are pregnant,” says Hitchock, “but I can tell you just because you’re experiencing it during this time doesn’t mean it’s a permanent diagnosis or state of being.”
If you are pregnant and are having panic attacks or feel overwhelmed by stress, you should talk to your doctor and get appropriate treatment.
Anxiety During Pregnancy: What’s Normal and What’s Not?
Whether you’re a first-time parent or are adding to your family, struggled to get pregnant or got lucky without trying, nine months of pregnancy can raise all sorts of concerns. You may wonder: Why is the baby kicking so much…or so little? How will I bear the labor pains I’ve heard so much about? How can I be a good mother if I’ve got no clue what it’s like to care for an infant? These are all normal worries, since joining the first-time mama’s club means you’ll have plenty of questions only experience can answer. The reality is, nearly every woman — under that baby belly and “pregnancy glow” — is a bit anxious, worried or hesitant about some aspect of pregnancy, childbirth or parenting. But when should anxiety be a cause for concern? And how can it be treated during pregnancy? The answers are information that every expecting woman should hear.
What’s a normal amount of anxiety?
Anxiety is not only part of being pregnant; it’s part of being human! Everyone worries about their lives, and pregnancy can often amplify those worries. Some women are mostly worried about whether their babies are healthy (previous pregnancy losses or fertility problems can make this an especially overriding worry). Others might worry about whether they’ll be good parents, how their relationships with their partners will change, how siblings will react to a new baby, or the financial aspects of having a child (and even if you worry about all these things, that’s normal too).
But there’s a difference between normal worrying and all-consuming anxiety during pregnancy, also known as antenatal anxiety. It’s time to talk to a healthcare provider if you’re unable to concentrate on your day-to-day life; have trouble functioning at work or home; experience a frequent sense of panic, fear or restlessness; have obsessive thoughts; or don’t enjoy things that used to make you happy. Other signs of a more serious anxiety disorder can be physical, including heart palpitations and muscle tension. This level of anxiety isn’t normal or healthy — but treatment can help.
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Who’s most at risk?
Just about anyone can develop anxiety during pregnancy. In fact, a poll by the Anxiety and Depression Association of America found that 52 percent of pregnant women report increased anxiety or depression. That said, there are a few criteria that put you at higher risk for a severe anxiety disorder, which means that you should pay extra-close attention to how you’re feeling when you’re expecting:
- A previous diagnosis of an anxiety disorder
- Anxiety during a past pregnancy
- Previous pregnancy loss or fertility struggles
- Pregnancy with complications or bed rest (though practitioners rarely prescribe strict bed rest anymore, in part for this reason)
- Stress at home or work
All of these factors can contribute to a heightened risk of anxiety during pregnancy.
Why seek help?
Many women are under the mistaken impression that the best way to deal with anxiety is to just put up with it. But if your anxiety is severe and all-consuming, there are a few reasons it’s best to seek help. Although you might tell yourself “I’ll just feel better once the baby is here,” research has actually shown that women who have anxiety during pregnancy are more likely to have postpartum depression after baby is born. So although anxiety and depression don’t necessarily occur together, they are closely related — and by learning ways to control your anxiety before your new little one arrives, you’ll increase the odds that you’ll be able to enjoy those joyful first few months. Another reason to explore treatments: Long-term, severe anxiety during pregnancy can affect your baby’s development. Studies have shown that anxiety or depression during pregnancy can increase the odds of preterm birth and low birth weight, and even make it more likely a child will, down the road, have emotional or behavioral challenges.
Anxiety medications during pregnancy
Most drugs that treat anxiety fall into the same class of pharmaceuticals as antidepressants, which means some can be tricky to prescribe during pregnancy. While studies have shown no long-term effects of exposing babies to these drugs, many clinicians admit that could be because there are so few studies done on expecting women. The American College of Obstetrics and Gynecology cautions that prescribing these types of medications during pregnancy should always include a careful risk-benefit analysis.
If medications are necessary to ensure your well-being and/or your baby’s, your practitioner and a qualified therapist can work with you to decide which one offers the most benefits for the fewest risks (and how low a dose you can take and still get those benefits). If you’ve been on a medication for panic attacks, anxiety or depression pre-pregnancy, a change or adjustment of dose might be necessary, too.
Other anxiety treatments during pregnancy
While medication is one solution to anxiety disorders, it certainly isn’t the only one. In fact, therapy sessions with a psychologist, psychiatrist or counselor is always the first and best way to help pinpoint what’s causing your anxiety and develop a plan to help you ease your worries or learn relaxation techniques. The following anxiety-alleviating strategies can help, too:
- Catch more zzzs. Some research has found that lack of sleep could exacerbate anxiety, so aim for seven to eight hours a night whenever possible. Having trouble snoozing? Try these sleep-busting strategies. If problems persist, talk to your doctor about sleep aids: Many, including Unisom, Tylenol PM, Sominex and Nytol, are generally considered OK for occasional use during pregnancy.
- Eat whole, fresh foods. A growing amount of research has shown that what you eat can have a big effect on your mental health. Eating a well-balanced diet — nutrient-dense, whole and unprocessed foods (including fruits, vegetables, fish, nuts, dairy and whole grains) — instead of processed and fast foods is thought to support healthy bacteria in the gut, which in turn may help lessen anxiety.
- Stay active. Something as quick and easy as a 10-minute walk can decreases levels of tension. Research has found that people who get regular exercise are 25 percent less likely to develop anxiety or depression.
- Arm yourself with knowledge. Learning the ins and outs of pregnancy and parenting can go a long way in helping you feel prepared. So read up and consider taking a childbirth class.
- Build a support system. Spend time with experienced parents or friends who are also expecting. You can also join an online community to connect with others who are coping with the same feelings as you.
- Schedule time in your day to relax. Scientists have found that regular meditation and acupuncture have benefits for people with anxiety. Or try yoga, listen to music or get a massage from a professional or even just your partner.
Lastly, try to learn to remind yourself that you really will know what to do when your bundle of joy arrives. Even if you’ve never held a baby, instinct is on your side — and what your baby will really need more than anything is simply your love.
Pregnancy and Medication
Pregnant women with a history of anxiety or depression can face difficult and confusing choices about treating their symptoms with antidepressants and other medications.
Both anxiety disorders and depression are more likely to affect women than men, and women who are pregnant are not excluded. In fact, symptoms can develop or worsen during or after pregnancy, though in some cases women notice fewer symptoms while pregnant. Women can have an anxiety disorder and depression at the same time, too.
This is consistent with a 2009 ADAA online poll:
- 52% percent of women who have been pregnant reported increased anxiety or depression while pregnant.
- 32% reported a decrease in symptoms.
- 16% experienced no change.
The effectiveness and safety of treating these symptoms can also vary, and studies looking at these issues in pregnant women with mental health disorders are limited. Read on for an overview of what is known about treatment of anxiety and depression for pregnant women.
If you are pregnant or planning to start a family, it’s best to discuss these options and any concerns with your therapist, physician, and OB-GYN, who can work with you to develop or change your treatment plan. You may also consider a consultation with a psychiatrist who specializes in treating pregnant and postpartum women.
- Blog post: A Most Difficult Decision
- Related: To Medicate or Not Medicate
Safety of Medications
Any treatment plan has risks and benefits, and for pregnant women, the risks are of particular concern. Just as particular nutrients are passed to the fetus when food is eaten, so does some medication transfer from mother to unborn child.
A 2015 Centers for Disease Control (CDC) study found that some birth defects occur about two or three times more frequently in babies born to women who took the SSRI medications Paxil and Prozac early in pregnancy. Even with the increased risks for certain birth defects, the actual risk remains very low. And some similar drugs used to treat depression in pregnant women carry no such risks. Read the details here. (The CDC is working to improve the health of women and babies through Treating for Two: Safer Medication Use in Pregnancy.)
Studies have shown that antidepressant use is associated with preterm delivery, but a 2009 report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists advised that additional work is needed to determine whether taking antidepressants or other associated factors such as depressed mood, maternal obesity, or socioeconomic stress are more direct causes of preterm birth.
Use of selective serotonin reuptake inhibitors, or SSRIs, in the third trimester, however, has been associated with an increased risk for pulmonary hypertension in newborns, a rare disorder in which blood flow through the lungs is restricted But some studies indicate that this risk is still less than 1% if a mother uses SSRIs during the third trimester.
Taking SSRIs may pose an increased risk of birth defects. The FDA issues warnings to alert women of potential and new risks. It also strongly advises women to talk with their health care providers if they are undergoing treatment for depression to determine the most appropriate treatment option during pregnancy. Read the drug-safety announcement here.
One consequence of SSRI use during the third trimester of pregnancy, which has been confirmed in many studies, is a neonatal syndrome that may include irritability, poor feeding, sleep disturbance, and other symptoms. This syndrome usually lasts only a few days to a week.
Still, women should not assume it is safe to stop taking their anxiety or depression medication as soon as they find out they’re pregnant; doing so can lead to a relapse of symptoms, which may do greater harm to the child (and mother) than taking medication.
And more pregnant women are taking medication: The rate of antidepressant use at some point during pregnancy more than doubled between 1999 and 2003, to as many as 1 in 8.
Learn more about medication and treatment options, and always talk to your doctor about your concerns.
The American Psychiatric Association and the American College of Obstetricians and Gynecologists recommend the following:
- Women who plan to start a family and have mild depressive symptoms for six months or longer may be able to taper off medication. This may not be appropriate for women with a history of severe anxiety or depression, or who have bipolar disorder or a history of suicide attempts.
- Women who are pregnant, psychiatrically stable, and prefer to continue taking their medication may be able to do so after consulting with their therapist and OB-GYN.
- Women who are pregnant and have severe depression or anxiety should remain on medication, as they are at high risk for relapse.
In addition, women who are pregnant may benefit from therapy to replace or supplement medication. Therapy and other behavioral treatments can be effective in treating anxiety disorders and depression – before, during, and after pregnancy.
Remember to talk to your doctor before beginning or changing your treatment plan. An individualized approach to treating anxiety disorders and depression during pregnancy is usually best.
Updated July 2015
Anxiety & pregnancy
As many as thirty per cent of pregnant women will experience some level of anxiety. A smaller number of women will have more severe symptoms and will be diagnosed with an anxiety disorder.
Anxiety disorders are categorised according to their symptoms. These include:
- generalised anxiety disorder
- obsessive compulsive disorder (OCD)
- post-traumatic stress disorder (PTSD)
- panic disorder
- social phobia.
Most women have symptoms or a diagnosis of a particular disorder before they get pregnant. Some women will develop symptoms for the first time during pregnancy. Some symptoms will worsen with pregnancy.
Symptoms that are common to each disorder include:
- worry, stress or being on edge most of the time
- muscle tension and difficulty staying calm
- difficulty sleeping
- recurring worrying thoughts that will not go away
- panic attacks.
What causes anxiety?
You may be genetically predisposed to worry and anxiety or you may have been subject to a stressful event or both. When the anxiety is pregnancy-related it is likely that you have an anxious temperament and a general tendency to worry. Your anxiety will be focused on the baby’s health, fear of the birthing experience or concern about your weight gain and body shape.
Women who are victim/survivors of sexual assault may also have particular anxieties during pregnancy. For this group of women there is also likely to be anxiety in the lead up to the birth and further anxiety about being a parent. Women who have been sexually assaulted can find it very difficult to be touched. Medical check-ups can be very stressful, especially check-ups that involve the vagina. This group of women can also be very fearful of the birth process; they can suffer from muscle tension during the birth, which in turn can impact on their ability to manage the pain of labour.
Women who have different kinds of pre-existing anxiety disorders can find pregnancy challenging for any number of reasons. Pregnancy and the birth experience can put women into situations outside their comfort zones, which can induce anxiety. There are also symptoms that women may have in late pregnancy such as shortness of breath, dizziness, an increased heart rate and feeling hot and sweaty which can be mistaken for panic attacks or, in some instances, can lead to a panic attack. It is important to seek treatment early during pregnancy so that your experience of pregnancy and motherhood is positive rather than filled with dread, and also so that you can get quality antenatal and postnatal care for you and your baby.
Anxiety is effectively treated with psychological therapies. These include relaxation training, cognitive behavioural therapy, and mindfulness practice. Lifestyle modifications such as stress reduction and exercise are also helpful. Sometimes in more severe illnesses, medication may be needed, preferably in conjunction with psychological therapies.
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Panic Disorder Increases the Risk of Adverse Birth Outcomes
Anxiety often results in the activation of the sympathetic nervous system. This activation is commonly known as the “fight or flight response”; symptoms may include increased heart rate, shortness of breath, perspiration, chest pain, and nausea or diarrhea. Activation of the fight or flight response is also associated with the activation of numerous other responses in the body, including the production of various stress hormones, including cortisol.
Various studies suggest that stress or anxiety may be associated with adverse birth outcomes, such as preterm birth and small for gestational age infants. Little is known about the effect that specific anxiety disorders (versus “every day” stress or anxiety) may have on birth outcomes.
Approximately 30% of women experience some type of anxiety disorder during their lifetime; these disorders tend to cluster during the childbearing years. The lifetime prevalence rate for panic disorder is 2.7%; rates ranging between 1.3% and 2.5% have been documented in pregnant and postpartum women.
In a recent paper, Chen and colleagues sought to examine pregnancy outcomes among women with panic disorder, especially those women who experienced panic attacks during pregnancy. These researchers studied the medical records of 371 women who had a diagnosis of panic disorder in the two years prior to pregnancy. Outcomes were compared to a control group of 1585 women who delivered a baby around the same time but who did not have a diagnosis of panic disorder, any other psychiatric illness, or a chronic disease. Women were identified using the National Health Insurance Research Dataset and the Taiwanese birth certificate registry.
For the analyses, women with a diagnosis of panic disorder were separated into two groups: those who were treated in the emergency room for a panic attack during pregnancy and those who were not. Other variables that could impact birth outcomes (such as age of the mother, educational level of the parents, gender of the infant and socioeconomic status) were controlled for.
Results from the study indicated that mothers with panic disorder were 1.56 times more likely to deliver a infant who was small for gestational age than women without panic disorder; the odds of having a small for gestational age infant was slightly less (1.45 times) for women with panic disorder who were not treated for a panic attack in the emergency room during pregnancy. Among women with panic disorder, those women who were treated in the emergency room for a panic attack were 2.54 times more likely to experience preterm birth and 2.29 times more likely to have a small for gestational age infant than mothers with panic disorder who were not treated in the emergency room for a panic attack. No differences between the groups were detected for low birth weight, and analyses for preeclampsia were not conducted due to a small number of cases.
While this study suggests that women with panic disorder are at greater risk for certain adverse birth outcomes, including having a preterm delivery and an infant smaller for gestational age, there are some notable limitations. First, it is possible that some women experienced panic attacks and did not present to the emergency room for treatment, or that women who went to the emergency room for their panic attacks had more severe panic disorder than those who did not. In addition, Chen and colleagues were not able to control for the use of psychotropic medications during pregnancy, nor were they able to control other factors which may have affected birth outcomes, including nutritional habits or smoking. Lastly, only women with panic disorder listed as a primary diagnosis were included in the analyses, which may have resulted in the omission of some women with panic disorder.
In sum, this study contributes to our understanding of the association between panic disorder and adverse birth outcomes. The findings suggest that panic symptoms may affect birth outcomes and thus women should be screened for panic disorder during pregnancy. These women should review the data on the efficacy, safety and side effects of treatments (including psychotherapy, psychotropic medications, and lifestyle changes) for panic disorder with their health care providers.
Christina Psaros, Ph.D.
Chen Y, Herng-Ching L, Hsin-Chien L. Pregnancy outcomes among women with panic disorder – Do panic attacks during pregnancy matter? J Affect Disord (2009).
Bandelow B et al. Panic disorder during pregnancy and the postpartum period. European Psychiatry (2006) 21: 495-500.
Bánhidy et al. Association between maternal panic disorders and pregnancy complications and delivery outcomes. European Journal of Obstetrics, Gynecology, and Reproductive Biology (2006) 124: 47-52.
“Late in my pregnancy I feel so panicky all the time, my heart feels like it is always racing and I can’t even take deep breaths. I’m so scared to have another panic attack, I barely want to leave the house.” – Susan
“I know it’s not rational but since I’ve become pregnant I keep having this constant sense of dread. Like something terrible is going to happen to my husband, and I will be left alone and pregnant. I text him several times a day to reassure myself he’s okay, but it doesn’t make me feel better for very long. I just hate being alone now.” – Anjali
What is Anxiety?
Anxiety is a natural, adaptive response we experience when we feel unsafe or threatened. We can experience many kinds of “threats” to the safety of ourselves and/or our loved ones. Sometimes we are anxious about something specific (e.g., waiting for the results of a diagnostic test). Some threats feel more vague, like a general sense that something bad will happen. We may also experience anxiety to a threat we are imagining in our heads, like picturing a loved one getting into an accident.
We can experience anxiety in these areas:
- In our bodies (increased heart rate, sore stomach, tight chest and throat, shallow breathing, loss of appetite, difficulty falling or staying asleep, etc.)
- In our mind (racing thoughts about the future; imagining the worst-case scenario; ruminating; worrying and obsessing, etc.)
- In our actions or behaviours (avoiding certain situations, activities, places, or people; over-controlling; asking others for constant reassurance; checking things repeatedly; being extra careful and vigilant of danger, etc.)
Other possible signs of anxiety during pregnancy:
- loss of appetite
- difficulty sleeping
- muscle tension (grinding teeth, neck and shoulder pain, back pain, muscle twitching)
- difficulty concentrating and focusing
How common is anxiety during pregnancy?
Anxiety is very common during pregnancy, and by some measures even more common than depression. Factors that could increase the chances of experiencing high anxiety during pregnancy include:
- history of high anxiety and/or depression
- perfectionism (believing you should not make any mistakes and do everything just right)
- history of miscarriage(s)
- high-risk pregnancy
- major life stressors (such as marital or financial problems)
Find out more about treatment and support for mental health.
How can I prevent or manage anxiety in pregnancy?
- Talk to someone you trust, such as your partner, family or a friend about how you are feeling.
- Try not to feel guilty or embarrassed. These feelings are not your fault.
- Look after yourself – try some of our top tips for looking after your emotional wellbeing.
- Avoid caffeine
- Eat well
- Avoid smoking and drinking alcohol. This can harm you and your baby.
- Try learning about simple relaxation techniques and practise them regularly.
You could also try a self-help book
The Royal College of Psychiatrists recommends these:
- Overcoming Anxiety by Helen Kennerley
- Overcoming Anxiety, Stress and Panic: A Five Areas Approach by Chris Williams
- Feel the Fear and Do It Anyway by Susan Jeffers
- Overcoming Panic and Agoraphobia by Derrick Silove and Vijaya Manicavasagar
- Panic Attacks: What They Are, Why They Happen and What You Can Do About Them by Christine Ingram
- An Introduction to Coping with Phobias by Brenda Hogan
Make a wellbeing plan
Our online Wellbeing Plan is a tool that helps you start thinking about how you feel and what support you might need in your pregnancy and after the birth.
You can use it to help you talk to your partner, family, friends or midwife about how you are feeling.
More information and support
Anxiety Attacks During Pregnancy
Pregnancy may represent something genuinely happy and exciting, but pregnancy itself can be very stressful. Your body goes through considerable hormonal changes. You feel aches and pains you never felt before. You have to worry about your own health, worry about the health of the fetus, and worry about how you’re going to live your life once you bring a baby into this world.
Pregnancy may also increase your risk of developing anxiety attacks, and when you’re pregnant these attacks can be an incredible challenge. This article explores the relationship between pregnancy and panic attacks and suggests possible treatment options.
The Health of Anxiety Attacks
Any time you experience some of the stresses of an anxiety attack, it’s never a bad idea to visit a doctor just in case. Pregnancy does have many complications, and it can often be hard to tell the difference between an anxiety attack and something more serious.
What is an Anxiety Attack
Anxiety attacks are extremely stressful events – especially for pregnant women. Often referred to as “panic attacks,” anxiety attacks are moments of intense anxiety that manifest in physical symptoms. During an anxiety attack, you’re likely to experience:
- Rapid heartbeat.
- Lightheadedness or feeling faint.
- Chest pains.
- Leg and muscle weakness or tingling.
- Trouble thinking.
- Shortness of breath.
These are the same symptoms that anyone with an anxiety attack experiences, regardless of pregnancy. What tends to cause more problems is the feeling of doom. During an anxiety attack (which usually peaks about 10 minutes in), there is often this incredibly intense feeling of doom, usually about your health. That’s why so many of those with anxiety attacks end up visiting a doctor.
When you are pregnant, your concerns about the health of the child can increase the effects of your anxiety attack dramatically, because now you’re worrying about the health of two, not just your own.
That’s why anxiety attacks represent such a serious issue for those that are pregnant. That level of anxiety can be devastating and make your quality of life worse, and since doctors recommend trying to be as stress-free as possible when you’re with child, controlling your anxiety attacks becomes very important.
What Causes Anxiety Attacks in Pregnant Women?
Every person is different. What makes pregnancy unique is that there are several different issues that may occur when you go through pregnancy that may bring on anxiety attacks:
- You may have anxiety attacks as a result of hormonal changes during pregnancy.
- You may have anxiety attacks as a result of the stress and worries of pregnancy.
- You may have already suffered from anxiety attacks and they become worse during pregnancy.
- You may simply be at an age when developing anxiety attacks is more common.
Some doctors have found that those that normally have anxiety attacks actually stop having anxiety attacks while pregnant, only to find that they come back once the child is born. It’s amazing the way pregnancy can affect the mind and body both in physical and mental ways.
So claiming a cause and effect with pregnancy and anxiety attacks is not that simple, and certainly cannot be done through the Internet. But there are plenty of possible causes of anxiety attacks related to your pregnancy.
How to Prevent Future Anxiety Attacks
When anxiety attacks are caused by hormonal changes, controlling them is possible but a bit more difficult. You cannot and should not stop these hormonal changes from happening, and that means that when your brain creates these panic attacks as a result of your hormones, it’s going to continue to do so until your hormones return to normal.
But that doesn’t mean that you need to live with anxiety attacks throughout your pregnancy. There are several important things to note:
- Preventing Recurrence Post-Pregnancy It’s important to realize that some people that develop anxiety attacks never lose them, even when they are the result of pregnancy hormonal changes. That is because the fear of an anxiety attack and the experience of an anxiety attack can be severe enough that you increase your risk for triggering them in the future. Dealing with anxiety attacks should always be a priority.
- Reducing Severity There are strategies that reduce the severity of an anxiety attack even if they do not cure it altogether. The less severe your anxiety attacks, the less they’ll affect the quality of your life and the comfort of your pregnancy, and in some cases they may be easier to control.
- Stress Control Even though anxiety attacks may feel as though they come from nowhere and that your hormonal issues may be solely to blame, the truth is that stress does play a role in triggering your anxiety attacks. Control your stress and anxiety, and your likelihood of experiencing an attack is reduced.
Also, the vast majority of anxiety attacks can be controlled even when they have a physical cause. It often takes a bit longer to control them because it involves recognizing and understanding emotions and experiences that are not entirely related to mental health, but they can still be controlled nonetheless without the use of medication.
That last point is key. Unfortunately, mental health medications are thoroughly unadvised for those who are pregnant. While this may limit your options for treating your mental health, it should be noted that most anxiety medications act as more of a crutch than they do an actual treatment. They may be valuable as a short-term solution, but most stop working in the long term, have many side effects, and can take away your ability to cope with stress further.
That’s why you’ll need to take advantage of medication-free options. There are several relaxation exercises that may be beneficial. If you have the room available, you may also want to create a relaxation room – a room dedicated to nothing but your own mental health. It should be a room that is:
- Free of any clutter.
- Free of any technology.
- Free of any photos or bright lights.
It should be a room that is as quiet as possible that you can go into and experience nothing but a relaxing, quiet experience. This can be beneficial not only for dealing with your own stresses, but also for handling being a parent.
Finally, there is never a wrong time to consider broader anxiety-reduction strategies. These include therapy and lifestyle changes that you are able to adopt for the future. Even though pregnancy may play a role in these attacks, the lessons you learn and the help you receive may create some life-long change.