By Elizabeth Salas, MPH, Teratology Information Specialist, MotherToBaby California

If you are feeling anxious during your pregnancy, you’re not alone. It seems every year there are more articles and news stories on the latest health hazards. Whether you read it online or in a medical journal, hear it on the news or from friends and family, there’s no shortage of information on health concerns. This seems especially true during pregnancy.

 Having Questions Vs. Having Anxiety

 It’s normal to have questions and concerns during pregnancy. Every woman has them. Every woman also deserves to have her questions answered and concerns addressed. Beyond having questions about what’s safe to eat, products to use, or medications to take, pregnant women must balance their normal activities and responsibilities with scheduling prenatal appointments and preparing for their baby’s arrival. With so much to think about, it’s not unusual for pregnant women to feel a little bit anxious. So what’s the difference between having questions and having anxiety? How much anxiety is too much during pregnancy?

The month of May is Maternal Mental Health Awareness Month, and a great time to tackle these questions, raise awareness, and talk about mental health.

What Are Anxiety Disorders?

 While stressful events in our lives can cause anxiety that is mild and temporary, anxiety disorders are different in that the fear and anxiety can be excessive and/or persistent over time and can interfere with a person’s ability to function in their daily life. It is estimated that 13-18% of American adults or up to 40 million people each year experience an anxiety disorder.^{1, 6} Anxiety disorders include generalized anxiety disorder (GAD), panic disorder, post-traumatic stress disorder (PTSD), social phobia, and other phobias. These conditions can cause individuals to experience a great deal of worry or fearfulness. Anxiety disorders can cause physical symptoms such as difficulty sleeping, fatigue, headaches, muscle aches, irritability, lightheadedness, dizziness, trembling, hot flashes, feeling out of breath, and nausea among other symptoms.⁶

 Anxiety Disorders And Pregnancy

While more attention has been given to the study of anxiety disorders during pregnancy in the last decade, information is limited. Screening tools for anxiety disorders during pregnancy, such as those used to screen for depression during pregnancy and postpartum, have not been well studied and are not used regularly in obstetric clinics.² Without screening being part of routine prenatal care, it is up to pregnant women to express their concerns about anxiety to their healthcare providers. It also means that some women might not get the help they need.

Anxiety disorders during pregnancy are estimated to affect from 4%-39% of women.³ While some studies suggest that pregnant women are more likely to have anxiety disorders than non-pregnant women, other studies found that pregnant women are just as likely than non-pregnant women to have an anxiety disorder.⁴ How many women develop anxiety disorders during pregnancy is not well understood. A woman with a preexisting anxiety disorder may find that her condition is worse during pregnancy, but for others symptoms may stay the same. While gaps in our knowledge remain about anxiety disorders in pregnancy, the importance of maternal mental health is receiving more attention.⁵

What If I’m Having Problems With Anxiety?

Whether starting a new job, dealing with financial stressors, or struggling with a relationship or health complications, we have all experienced anxiety at some point in our lives. If your anxiety is affecting you more than usual or if you’re concerned you may be experiencing an anxiety disorder, talk to your healthcare provider right away. Your provider will ask about your symptoms and may give you a screening questionnaire to fill out. If you are having symptoms they will talk to you about your options and may refer you to a mental health provider. Depending on a woman’s diagnosis and the severity of her condition, she and her providers may decide to treat her condition with talk therapy, behavior modification, medications, or a combination of these. Many pregnant women take medications for anxiety during pregnancy and delivery healthy full-term babies.

Since anxiety disorders can cause significant physical symptoms and stress in a person’s life, these conditions require attention and treatment just like any other medical condition during pregnancy. Every woman and every pregnancy is different. Working together with your provider to keep you healthy during pregnancy isn’t just important for your health; it’s important for the health of your developing baby too.

WHERE CAN I GET MORE INFORMATION?

California Maternal Mental Health Collaborative

 To learn more about maternal mental health disorders, access a self-quiz, and obtain a list of resources that can help, visit the California Maternal Mental Health Collaborative website.

http://www.2020mom.org/mmh-disorders/

http://www.2020mom.org/get-help/

 National Institute of Mental Health

 To learn more about anxiety disorders, check the National Institute of Mental Health website and their Anxiety Disorders information booklet.

http://www.nimh.nih.gov/health/publications/anxiety-disorders/index.shtml?rf=53414

http://www.nimh.nih.gov/health/publications/anxiety-disorders/nimhanxiety_34436.pdf

 MotherToBaby

At MotherToBaby, we answer questions about exposures during pregnancy and breastfeeding. We receive questions on everything from hair dye to medications used to treat anxiety and depression and much more. Our service is free, confidential, and provides information that is evidence-based. Most importantly, our service is available to you and your healthcare providers. To speak to a MotherToBaby expert, you can call toll free at (866) 626-6847 or visit us online.  https://mothertobaby.org/

Elizabeth Salas is the Lead Teratology Information Specialist for MotherToBaby California, a non-profit that provides information to healthcare providers and the general public about medications and more during pregnancy and breastfeeding. She is based at the University of California, San Diego, and is passionate about the work MotherToBaby is doing to promote healthy moms, healthy pregnancies and healthy babies.

 MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about medications, vaccines, diseases, or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or call the Pregnancy Studies team directly at 877-311-8972. You can also visit MotherToBaby.org to browse a library of fact sheets, as well as visit our website for MotherToBaby Pregnancy Studies, www.PregnancyStudies.org.

References:

1. Combs H, Markman J. Anxiety disorders in primary care. Med Clin North Am. 2014 Sep; 98 (5):1007-23. doi: 10.1016/j.mcna.2014.06.003. Epub 2014 Jul 11. PubMed PMID: 25134870.
2. Evans K, Spiby H, Morrell CJ. A psychometric systematic review of self-report instruments to identify anxiety in pregnancy. J Adv Nurs. 2015 Mar 26. doi: 10.1111/jan.12649. PubMed PMID: 25818179.
3. Goodman JH, Chenausky KL, Freeman MP. Anxiety disorders during pregnancy: a systematic review. J Clin Psychiatry. 2014 Oct;75(10):e1153-84. doi: 10.4088/JCP.14r09035. PubMed PMID: 25373126.
4. Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet. 2014 Nov 15;384(9956):1775-88. doi: 10.1016/S0140-6736(14)61276-9. Epub 2014 Nov 14. PubMed PMID: 25455248.
5. Howard LM, Piot P, Stein A. No health without perinatal mental health. Lancet. 2014 Nov 15;384(9956):1723-4. doi: 10.1016/S0140-6736(14)62040-7. Epub 2014 Nov 14. PubMed PMID: 25455235.
6. National Institute of Mental Health. 2009. Anxiety Disorders. NIH Publication No. 09 3879. Retrieved from http://www.nimh.nih.gov/health/publications/anxiety-disorders/index.shtml

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