Antenatal anxiety is a perinatal mental health problem that can develop in women with a history of or existing anxiety issues or no history at all. The development of antenatal anxiety in a woman with no pre-existing condition has no established cause; it may be hormonal changes in pregnancy, the way the brain changes in pregnancy, external factors (e.g., a lack of social support), or nothing that can be identified. There is strong evidence that a mother’s mental health in pregnancy impacts outcomes for both her and her baby and can result in complications like premature labour, low birth weight, and neurodevelopmental problems. Pregnancy anxiety can also result in poor postnatal bonding. Awareness and early reporting of symptoms are important so that a mother can get appropriate care as soon as possible.

Isn’t every pregnant woman worried? How do I know my anxiety symptoms are a mental health problem?

It is true that every pregnant woman worries from time to time. As a general rule, symptoms that indicate a real problem are those that persist or make it difficult to engage in regular activities, especially those you need to keep doing to maintain the health of your pregnancy. These might include eating poorly or neglecting to eat, not sleeping properly, failure to quit smoking and drinking, failure to attend antenatal appointments or communicate with your healthcare team, failure to engage in regular exercise, and so on.

What does antenatal anxiety feel like?

There are a broad range of ways anxiety can manifest itself, and some are more severe than others.

Symptoms can include but are not limited to:
A rapid heartbeat
Constantly catastrophising (imagining things going wrong)
Constant worrying
Constantly feeling “on edge” or irritable
Abdominal pain or gastrointestinal problems (these can be early signs of labour and should always be reported)
Pain or tension in your muscles or chest
A desire to self-harm (this should be reported immediately)
Shaking
Sleeplessness
Tension headaches
Tooth grinding (bruxism) or other compulsive stress-related activities, such as pulling at your hair and eyelashes

It is very important to report these symptoms, both because anxiety needs diagnosis and treatment and because they can be indicative of other problems that impact you and your baby.

What are some breathing exercises for anxiety in pregnancy?

Breathing exercises you learn for coping with labour and birth can also be useful in managing anxiety. Examples can include box breathing (breath in for, hold for, and exhale for a count of four), Lamaze breathing, Bradley Method breathing, or breathing you may pick up as part of a hypnobirthing or calm birth course.

Can I take anxiety medication during pregnancy?

Medication can be a useful part of anxiety management, but you should not take anything in pregnancy without talking to a doctor, even if you have taken it safely before or it does not require a prescription. You do not have to take anything you do not want to, and your doctor will typically only prescribe anxiety medication if he or she feels that the benefits of taking it outweigh the risks. You can also pursue alternative means of managing anxiety, such as breathing techniques, talking therapies, meditation, and lifestyle changes such as eating better and abstaining from caffeine.

Is social anxiety in pregnancy the same as the mental health condition antenatal anxiety?

Social anxiety can be a symptom of antenatal anxiety or a generalised anxiety disorder. It may be useful to you or your healthcare team to note what you feel the strongest causes of any social anxiety to be. For example, is it physical changes? Your previous pregnancy experiences? A desire to stay close to home? Concerns about pregnancy generally? Articulating as much as possible about your social anxiety to your healthcare team will ensure you get the best possible care.

Are panic attacks in pregnancy the same as the mental health condition antenatal anxiety?

Panic attacks are a recognised symptom of antenatal anxiety and should be reported to your doctor or midwife, but you don’t need to have them to be diagnosed with antenatal anxiety. Panic attacks manifest differently in different people. Symptoms can include, but are not limited to:

Feeling you are unable to breathe
Feeling convinced that something terrible is going to happen
Feeling faint
Feeling you are unsafe
Hyperventilation (this can distress your baby and should be reported)
Suicidal thoughts (always report this immediately)
Sweating and shaking

All of these symptoms can also be indicative of other problems and should be assessed by a healthcare professional as soon as possible.

How do I distinguish between antenatal anxiety and depression?

Anxiety and depression can coexist in pregnancy, but they are treated differently, so it’s important that you report potential symptoms of both. Read more about antenatal depression.

How can I stop an anxiety attack immediately?

A mental health professional is your best source of advice on tailoring your response to anxiety attacks to your particular circumstances. Always explain to anyone looking after you that you are pregnant. Here is some general advice on dealing with an anxiety attack.

If you feel you can speak, alert those closest to you to what is happening.
Pause what you are doing and try to find a seat or somewhere peaceful to wait for the attack to subside.
Engage in intentional, mindful deep breathing. If you suffer from anxiety-prompted asthma, taking your reliever inhaler (typically Salbutamol) may be useful, but try not to use it excessively, as this can result in lightheadedness. You should never rely on your inhaler to cope with anxiety, only with asthmatic symptoms.
You can try the 5-5-5 method or the 3-3-3 method to reduce anxiety fast.
The 5-5-5 method is a sympol breathing exercise that involves inhaling, holding your breath, and exhaling, each for a count of five.
The 3-3-3 method is sensorial and aimed at keeping you present and aware of the safety of your surroundings, as well as distracting you. Identify three things you see, three things you hear, and three things you can feel (in a tangible rather than emotional way, e.g., how warm your scarf is).
Call your doctor or midwife to report your attack as soon as you are calm enough.

Can anxiety in pregnancy cause high blood pressure?

Yes, anxiety can cause blood pressure spikes anytime, including during pregnancy. High blood pressure puts you at increased risk of preeclampsia, which can result in premature labour, among other complications, so it is important to attend all your antenatal appointments for regular checks. You can also check your blood pressure at home if your doctor or midwife supports this. They may feel this is unnecessary, and it could exacerbate your anxiety without due cause. At-home blood pressure checks are not a routine antenatal care recommendation.

Will my antenatal anxiety go away after birth?

This depends on the cause. Antenatal anxiety can go away after birth. It can develop into postpartum anxiety, which can also be treated. Antenatal anxiety is considered a strong predictor of postnatal anxiety. Anxiety disorders are very common, especially in women, and it could be that you have one even after the postpartum period. However, with proper diagnosis and treatment, most people can live normal lives with such disorders. Anxiety does not mean you are less of a mother in any way. In fact, many parents would say that worry is par for the course when you have children. It’s just the kind that disrupts your wellbeing and everyday activities and requires extra help.

For more advice on taking care of yourself in pregnancy, labour, and birth, check out Unii’s Antenatal Classes, with prenatal video episodes taught by senior NHS midwives, an award-winning obstetrician and gynaecologist, and six other leading healthcare experts. Only at unii.com.

Coping with Antenatal Anxiety: FAQs from Mothers-to-Be