Anxiety and Pregnancy

Abstract

Some anxiety is normal for pregnant women, however, when a woman experiences an inability to concentrate; has trouble functioning at work or home; experiences a frequent sense of panic, fear, or restlessness; has obsessive thoughts; or does not enjoy things that used to make her happy, it is a cause for concern for childbirth professionals. Prolonged anxiety is associated with preterm birth and low birth weight. A number of alternative treatments may help decrease anxiety, including an adequate diet, meditation, exercise, and childbirth education. Education of both parents may increase partner support and aid in their communication.

Full text

Anxiety
and
Pregnancy
by
Lee
Stadtlander,
PhD
Abstract: Some anxiety is nonnal for
pregnant women, however, when a
woman experiences an inability to con-
centrate; has trouble functioning
at
work
or home; experiences a frequent sense
of
panic, fear, restlessness: has obsessive
thoughts;
or
does
not
enjoy things
that
used to
make
her happy,
it
is
a cause
for
concern
for
childbirth professionals. Pro-
longed anxiety is associated with preterm
birth
and
low birth weight. A number
of
alternative treatments
may
help de-
crease anxiety. including an adequate
diet, meditation. exercise.
and
childbirth
education. Education
of
both parents may
increase partner support
and
aid
in their
communication.
Keyword
s:
anxitty, wony,
prrgnan
cy
Feelings
of
anxiety during pregnancy are relatively com-
mon, with estimates ranging from
1o-15
% (Dayan
et
al. 2oo6)
to
33
%
(Lee
et
al., 2007)
of
pregnant women experiencing
some
level
of
anxiety during this maj
or
life transition. Preg-
nant
women worry
about
the
upcoming labor
and
anticipated
pain (
Sj<>gren,
1997},
they may be concerned
about
the
health
of
the
child they are carrying,
or
the
physical changes they
experience (Huizink, Robles
de
Medina, Mulder, Visser, &
Buitelaar, 2004).
Women
's levels
of
anxiety tend
to
naturally
decline across pregnancy without intervention (Dunkel, Schet-
ter, & Robbins,
2011}
. However, there
is
a difference between
normal worrying and all-romuming anxiety during pregnancy
(
also
known
as
antenatal anxiety
).
If a woman experiences an
inability to concentrate; has trouble functioning
at
work
or
home; experiences a frequent sense
of
panic, fear
or
restless-
ness; has obsessive thoughts;
or
does
not
enjoy things
that
used
to
make her happy,
it
is
a cause for concern for childbirth
professionals.
Other
signs
of
a serious anxiety disorder can
be
physical, including heart palpitations and muscle tension.
32
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onal
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High levels
of
ongoing anxiety can have adverse health
effects
on
the
mother
and
on
the
child (Nicholson
et
al.,
2oo6
). High pregnancy anxiety levels have been associ-
ated with preterm birth
and
low birth weight (Dunkel
et
al., 2012). Effects also include a range
of
adverse childhood
outcomes, including negative emotionality (Gutteling,
de
Weerth
, & Buitelaar, 2005; Huizink
et
al. 2002), attention
deficit hyperactivity disorder (van
den
Bergh
et
al.,
2005
),
developmental delays (Huizink
et
al 2003
),
and
changes in
brain grey
matter
volume {Buss
et
al., 2010
).
Mothers with
anxiety are more likely
to
access prenatal services late,
to
attend
prenatal appointments less frequently, and
fail
to
have regular scans (Kim
et
al ..
2006
, Redshaw & Henderson,
2013
).
Some studies have found
that
these women have
more visits
to
the
obstetrician, mainly related
to
the
fear
of
childbirth,
and
show a preference for an elective caesarean
section (Andersson
et
al
.,
2004
; Rubertsson
et
al., 2014
).
The mechanism by which increased anxiety causes
adverse outcomes for
the
child
is
unclear. Several studies
suggest anxiety-driven stimulation
of
the
maternal hypotha-
lamic-pituitary-adrenal axis,
and
the
consequent
elevation
in maternal and fetal levels
of
the
stress
hormone
cortisol
as
a contributing factor (Sarkar, Bergman, O'Connor. & Glover,
2009; Talge, Neal, & Glover, 2007
).
Increased cortisol levels
may impair fetal growth
by
inhibiting placental growth
(Gennari-Moser
et
al., 2001). Regulation
and
decreasing
utero-placental blood Row (Weinstock, 2005) can affect
the
onset
and
duration
of
labor by interfering with mecha-
nisms
that
modulate uterine contractions (Grammatopoulos
& Hillhouse, 1999), potentially precipitating
the
need for
interventions such as emergency cesarean delivery (Laursen,
Johansen, & Hedegaard,
2009
).
Risk
Factors
While
anyone can develop anxiety, a few criteria
put
a
woman
at
higher risk for a severe anxiety disorder (Biaggi,
Conroy. Pawlby, & Pariante, 2016; Giardinelli
et
al., 2012;
Goodman
& Tyer-Viola, 2010). Such criteria include lack
of
a
partner
or
of
social support, a history
of
abuse
or
of
domestic
violence, a personal history
of
mental illness, an unplanned
or
unwanted pregnancy, adverse events in life
and
high-
perceived stress, present
or
past pregnancy complications,
and
pregnancy loss.
continued
on
next
page
w.bell
Jaru&)
2017

An
. c y
11111
I
cgn<Jll'Y
continued
from
previous
page
Treatments
Severe anxiety may requi
re
medication, which should
be carefully evaluated
by
a physician. While medication
is
one
solution to anxiety, there are other, less invasi
ve
options.
Therapy sessions with a psychologist, psychiatrist,
or
coun-
selor may help to determine the cause
of
the
anxiety
and
can
help
the
woman to develop a plan to help ease her worries
or
learn relaxation techniques. Some other options include:
Sufficient sleep. Some research (Hall
et
al.,
2009
)
has found
that
lack
of
sleep could exacerbate anxiety,
so
pregnant women should aim for seven
to
ei
ght
hours a night
whenever possible.
Whole
fresh foods. A growing
amount
of
research has
shown
that
nutrition has an effect
on
mental health (Habel
& Cui haney, 2003). Eating a well-balanced diet, nutrient-
dense, whole
and
unprocessed foods
{i
ncluding fruits,
vegetables, fish, nuts, dairy and whole grains
),
instead
of
pro-
cessed
and
fast
foods
is
thought
to
support healthy bacteria
in the gut, which
in
turn may help lessen anxiety.
Staying active. Something
as
quick and easy as a
to
-minute walk can decreases levels
of
tension. Research
has found
that
people who get regular exercise are 25% less
likely to develop anxiety
or
depression (Harrison, Brown,
Hayman, Moran, & Redman, 2016).
Taking
control
of
knowledge. Learning
about
preg-
nancy and parenting can help couples feel more prepared.
Encourage reading
of
appropriate pregnancy books and tak-
ing a childbirth clas
s.
Building a
support
system. Encourage women to
spend time with pregnant friends as well
as
with experienced
parents. They might consider joining an online community
to
connect with others who are coping with
the
same feel-
ings. See
the
Patient Resources for some suggested sites.
Scheduling
time
to
relax. Researchers (Beddoe &
Lee
,
2008
; Guardinoa
et
al., 2014) have found
that
regular
meditation. acupuncture, massage, and yoga have benefits
for people with anxiety.
Partner
support.
Partner support
is
a
key
aspect for
prevention interventions for prenatal depression and anxiety
(Pilkington, Milne, Cairns & Whelan, 2016). The transition to
parenthood
is
a significant stressor for both parents
that
can
result
in
increased marital conflict and decreased relationship
quality. Preventive interventions that aim to promote parents'
mental health and
well
-being should help partners support
each
other
in
adjusting to this significant life
event
Prenatal
classes discussing the need for communication about
the
couple's feelings about pregnancy and childbirth are helpful.
Other
prenatal class communication topics may include
the
use
of
'T
statements. For example instead
of
saying,
"
You
don
't make any time for us anymore
·,
sa
y "I feel lonely
when
we
spend
less
time together." Discussions of
other
sup
-
ports (e.g., family and friends)
that
can be accessed with
the
new baby can be helpful. This improves communication and
will
most likely decrease argument and anxiety.
In
summary, some anxiety
is
normal for pregnant wom-
en, however, if a woman experiences an inability to concen-
trate; has trouble functioning
at
work
or
home; experiences
a frequent sense
of
panic, fear
or
restlessness; has obsessive
thoughts; or does
not
enjoy things
that
used
to
make her
happy, it
is
a cause for concern for childbirth professionals.
Prolonged anxiety
is
associated with preterm birth and low
birth weight
due
to
the
effects
of
cortisol.
A number
of
alternative treatments may help decre.ue
anxiety, including an adequate diet, meditation, exercise, and
childbirth education. Education
of
both
parents may increase
partner support and aid
in
their communication.
See
the
Patient Resources for some suggested materials and websites.
Patient
Resources
Acker.
S.
(2015).
Anxiety
&Pregnancy
:
31
Usefu/7ips
roMan-
age
Anxiety
During
&
After
Pregnancy
. Maestro Publishing
Group.
Cushman, A
.,
Doe
,
M.
, Leif, J
.,
Brilliant, J
.,
& Piver, S.
(
20
12
).
The
Mindful
Way
through
Pregnancy
:
Meditation,
Yoga
,
and joumalingfor
Expectant
Mothers
. Boulder. CO: Shamb-
hala; Har/Com
Re
.
Domar. A. D. & Curry Oakes, S. (2016).
Finding
calm
for
the
e~epectant
mom:
Tools
for redudng
stres
s,
anxiety.
and
mood
s
wings
during
your
pregnancy.
New
York
,
NY
: TarcherPerigee/ A
Penguin Publishing Group
Websites
•
&by
Center.
~naging
Stress
and
Anxiety
During
Pregniln<:y.
http:/
/www.babycenter.com/ o_managing-
stress-and-anxiety-during-pregnancy
_168 3· be
•
Post
-
Partum
Support
lnternationaJ. Anxiety
During
Pregnancy
&.
Postpartum:
http:
//
www.postpartum.
net/
learn-more/anxiety-during-pregnancy-postpartum/
•
What
to
Expect. Anxiety
dwing
Pregnancy:
What•s
Normal
and
What's
Not? http:
//
www
.whattoexpect.
com/pregnancy/anxiety/
continued
on
next
page
VOOme
32
um
r 1
Januasy
2017
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onal
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of
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i
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i
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Education
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33

An.¥icty
1nd
Prt
gnancy
continut:d
from
pm~iouJ
page
References
And~on.
L. Sundstrom Porom;u.
1..
Baxo.
M
~
Wulff.
M
.•
Bondes~m
.
K...
& Strom. M. (200}) . Point
p~ak!na
of
psychi.Jtric
disorden during the
SKond tnmester
of
pregn01ncy
:
.J
population
b.1sed
study.
Ammcan
journal
ofObstttria and
Cyntcology,
189
.
148
'54· d01.org/to.to67fmob.
2ooH36
Beddoe.
A.
E &
Lee,
K.
A (2oo8). Mi
nd
body i
nteiVenbOI'IS
during preg·
nilncy
.
Jo.umol
ofObrt~
Gyn«olozic and fkonato.l
Nwsint,
J7(2),
•6;
·
•75·
001
:
IO
.IIIt{j.
155269<>9.2008
.00218.x
Biaggi,
A , Conroy.
S~
Pawlby.
S
~
&
P.Jri.1nte.
C.
(2016). Identifying the
women
at
ris,k
of
antenatal anxiety and
depres,s,ion
: A
s,ystematic
review
.
Journal
of
Ajfoctivt
DiJordm,
191. 62-
77-
http://
dx
.do
i.
org/to.1o16fj.
pd..lOI).l
1.014
Buss.
C..
O.Jvis,
E. P
..
Muftuler-.
L L
~.Jd.
K.
. &
~ndm.Jn.
C.
A.
(2010)
.
Htgh
~ncy
anxiety during mKI-gesution IS ;usocgted wtth decreated
griiy
matttr dmsity m 6 9
year~ld
chddrm.
~ocnnology.
JJ.
141
•53
· http://dLdoi.org/ro.rot61j.psyneuen.2009-07-
0to
Dayan.
j
.,
Creveuil.
C..
M.Jrks
,
M.
.•
Conroy. S .•
~rhcovtez.
M.,
Dreyfus.
M. et.JI. (2006). Prenatal depression.
prenii~l
anxtety,
.Jnd
spontane·
ous preterm birth: A prospectJve cohort study
.Jmong
women
with
early
.Jnd
regul,u
care
.
Prychowmallc
MtdlaM
,
68
. 9;8"946. do
l:
10.1097/0I.
psy.0000244025.20549..bd
Dunkel Schetttr.
C.
& Robbins. C M. {
Apnl
.
2011
).
Correlates,
.Jnd
Predic-
tors
of
Pregn.Jncy
Related
Anxiety
.
In
:
O.Jvis
.
E.
, edttor.
The
IXwlopmmtal
Con~quttiUS
of
funotal
Maternal
Stress
and
Anxitty.
Sympostum
conducted
.Jt
the meetinr,
of
the
Wes,tern
Ps,ycholog1C.JI
Asroci~tJon
;
los
Angeles
.
uliforni.J.
Dunkel Schetter.
C.
&
T.:mner.
L (2012)
Anxoety
. depress.on
~nd
stress m
pregn.Jncy:
impliurions
for
mothers.
ch
ildren.
rese~rch.
~nd
pr<Ktice.
Cunmt
OpinioiiS
m
PsychNlrq.
25
.
141
148.
doi
:
10
.
1097
/
YCO
.obot3e328350J68o
Genn.Jr
t-
Moser.
C .
Kh.ankin,
E V
..
Schuller. S
..
Escher.
G
~
Frey.
B.
M
.•
Port·
m.Jnn
,
C-B
..
.... &
Moh.aupt.
M. G.
(2o11
).
~gul~tJon
of
pbcenul
growth
by
aldosterone
~nd
cortisol.
Endocrinology.
IJ2
,
263
271
dot: http:/ldx.doi.
org/tO.I2tolen..lOI0·0)25
Gi
Mdinelb,
L, Innocenti,
A.
,
Benn
i.
L.
Stef.mmi.
M.
~
ltno. G
.,
luniird
i,
C.
,
...
&
Fan~elli.
C. (
2012)
. Depression
~d
~nxiety
in
perinaW
period
:
Prevalence and nsk
factors
m
~n
ltali.ln
sample.
Ardrtves
a/Women's
Mental
Health
, IJ,
21
30.
doa:IO
.
IOO]
/S007J]·Oit-o249 8
Goodman. J-H. &Tyer-
Viola,
L (2010
).
Detection.
tre~tment.
and refeml
of
perinatal depressi
on
.Jnd
anxtety
by
obstetnal
provaders
.
journal
of
Womtn's
Health
,
19
, 4n 490· doi:
ao
.1o89fjwh.2oo8.
1352
wmm<ttopoulos, D.
K.
& Hillhouse,
E..W
. (t999
)-
Role
of corticotropin-
rele.mng hormone in onset
of
bbour.
Lan
crt.
J54
· 1546
1549
· doi: http
://
dx
.doi.org/JO.I016/So140..(j]36(99)o}418-2
Guardino.
C.
M
.•
Dunkel
~tter
.
C.
,
Bower.
J.
E.
,
lu
. M.
C
~
&
Sm.:alley
.
S.
l.
(2014
).
IUndomized controlled
palot
tr~l
of
mmdfulness trammg
for
stress
reduction during
pregn.Jncy
.
Prycholoo
and
Health
.
29{3
).
334
·349·
dot
: 1 o. 1 o8o/o8870446.2o 1 J-852670.
Gutteling, B. M
..
de Weerth,
~
Buttei.J.Jr
. J-K. (2005
).
Preniital stress and
children's cortisol reaction to the
first
d.JY
of
school
.
Psydtaneuroemlomnol-
ogy.
J0.
$-4
1
S49
· http
:l/
dx
.
doa
.orglro.ror6
/j.
psyneuen.200).01.002
Hall.
W.
A.
,
Hauck.
Y. L.
C~rty.
E.
M., Hutton,
E.
K.
.
FenwKk.
J
..
&
Stoll.
K.
(2009).
Ch1ldb1rth
fear,
anxiety.
fatJgue,
and sleep deprivation
in
pregnant
women
. journal
ofObJtrtric
,
Cyrrecologtcal
. and
~onacal
Nunin:,
JB(s)
.
567
-
576.
doi
: I0.1111/j.•552 6909-
l009.0I0)4
.x
H.Jrrison.
C. L,
Brown.
W.
) .•
Hayman
. M
.,
Moran.
L J
..
&
R~man.
L
M.
(2016)
.
The
role
of
phys.al activity
in
preconception. pregruncy •
.md
postpartum
he;;tlth
.
Scmnon
m Rqroducuw
MtdiDne
,
J.f
(2
).
u8~37
·
doi:
10.10))1V0036 1)83530
Hobel
,
C.
&
Culhaney,
J. (200J).
Role
of
psychosoml and nutritional
stres,s
on poor
pregn.Jncy
outcome.
journal
of
Nutn11on
,
1709S
17•7S
.
Huizink.
A.
~
Robles,
de
Medina..
P.
G ..
Mulder.
E j ..
V'ISSel'
. G. H.. &
Bu
-
ttela.Jr, j .
K.
(
2002)
.
Psychological
measures
of
prenml
stress .JS
prediaon
of i
nbnt
temper.Jment.
journal
of
the
Amtncan
Aaufemy
of
CJuld
Pfychialrf
.
.fl.
1078
1o85-
http
:/l
dx
.d01.org/tO.IQ9]/00004583 2002CJ9000-o0008
Huirink.
A.
~
Robles
de Medina.
P.
G.
, Mulder. E. j
.•
V'tsSer
. G. H., &
Buttebar. J.
K.
(2003).
Stress
during pregnancy
IS
.JSSoct.Jted
wtth develop·
ment.Jl
outcome
in
inf.Jncy
.
journal
of
Child
PrychoiDoand
Psychtatry
,
44·
810 818
.
doi
:
10
.
1111/1469
7610.00166
Humnk. A
C..
Mulder, E j ..
Robles,
de
Med1na..
P.
G.
.
Visser
. G. H .. &
Buneb.Jr, J-
K.
(2004).
Is
preg~W~cy
anxiety a
dtstinctt~
syndrome?
Early
Human
Dewlopmmt. 79· lh"91. http://dx.do
i.
org/to.to16/j.earlhum-
dev.2004.04 .
014
Ki
m.
H. G ..
Mandell
, M
.,
Crandall.
C..
Kuskowski.
M.
A.
.
Dieperank.
B
..
&
Buchberger.
R.
L (2oo6). Antenatal
ps,ychiatnc
.Uness
and
.Jdequacy
of
pre-
n.Jtal
are
in
.Jn
ethniully diverse inner-
city
obnetnc popubtion.
ArchivtJ
of
Womms Mental
Htalth
. 9·
103
·
107
. dot:
10.I007
/
S00737~5-o117
5
Lee
. A M
~
Llm. S.
K.
.
Sze
Mun
l.lu. S. M
~
Chong.
C..
S_ Chui. H. W
..
&
Fong.
D V (2007). Prevalence.
course.
and
risk
fwors, for
antemul
aJWrty
.Jnd
depression.
Obszttria
and
Gynecology.
110
,
1102
·
1112.
dot:
IO
.
IOlJ]
/oL
AOG.0000287o65·
59491
-70
L.tursen
.
M.
, Johmsen.
C.
, &
Hedeg~ml
.
M. (2009).
Fear
of
childbirth
~nd
nsk
for
b1rth
comphcat10ns
in
nulliparous women m
the
Danish
~tiOna!
Barth
Cohort.
B}OC
:
An
lntemalional
journal
of
Obrtrtria
and
CynoMJ!Dgy.
11
6,
1350
1
355
·
doi
:
IO
.llll/)1471 0528.
2Q09
.
022SO.X
Nicholson
. W.
K..
Setse.
R .•
Hill
Briggs
,
F.
. Cooper. L
~
Strobtno. D .. &
Powe.
N.
R.
(2oo6).
Depres,sive
symptoms and health-related
qu.JI•ty
of
life
in
early
pregnancy.
Obstetrics
and
Gynecology
.
107
.798 8o6. do
i:
IO
.
tf197
/
ot
.
AOG
.oooozo4•90-96JS2.
05
Pilkington,
P.
,
Milne
,
L,
C.tirns
,
K.
. & Whelan. T. (
2016)
. Enh.anang rectp-
roe.JI
~rtner
support
to
prevent pennaul depression
.:and
anxtety: A Delphi
cons,ensus
study.
BMC
Prychtalrf,
16(1
),
1
23
. do
i:
to
.u86/u.2888 016 0721-o
Redshaw
. M. & Henderson. J.
(2013)
.
From
.:tntenml to
postnii~l
depres
<ion
: Ass,oc;..ted
factors
and
miti~ting
influences. joumal
of~m
>
lkalth
.
ll
,
518
525
. doi:t0.1089/jwh.2012-4152
Rubertsson.
C..
Hellstrom, J ..
Cross.
M
••
&
SydsJO
. G. (
2014
).
Anxoety
in
e.:trly
pregnancy:
Prev.Jience
and contr•butang
factors.
kluvn
ofWomeni
Mmta.
llkalth.
17(3)
.
221
·
228
.
doi
:
1o
.
too7/soon7
013-o409.0
S.Jrkar
.
P
~
Bergman
. K
..
O'Connor, T. G
..
Glover,
V. (2oo8
}.
M.:ttern;d
ante·
n.Jtal
anxiety and
~mniotic
flu
id cortisol and testosterone: Ponible imp
li
a
lions
for
f~l
programming.
journal
of~uromJomnolo:y.
.zo.
489
496.
doi: I0.
1111/j.a365
2826.2oo8.o1659.X
Sj
Ogren
.
B.
(1997
).
Reasons
for
anxiety .Jbout childbirth
in
100
pregn.Jnt
"''Omen
.
Journal
of
P.rydtoJomatlc
Ob1t~tna
and
Cyrrtcology.
18
, 266-
272.
doa
:
http
://
dx
.
doi
.org/to.3109/o •67482970908o698
T.:tlge
. N. M
..
Ne.:~l
,
C &
Glover.
V. (2007
).
Anten.J~I
m.:ttemal
stress
.:tnd
long· term effects on duld neurodevelopment:
How
.:~nd
why?
}ourrcal
afCiuld
Psychology
and
Prycluatry.
48
,
245
261
. doi:
10
.
1111
/j.•469
761o.zoo6.o1]14.X
V.Jn
den
Bergh
. B.
R.
H
..
Mennes. M
..
Oonerla.Jn, J
.,
Stevens
. V
.•
Stiers
.
P.,
Marcoen
.
A.
&
Llg.te
,
l.
(2005).
High
antenatal matemalanxtety
is
related
to
tmpulsivlty
during performance
on
cognitive
~s,ks'"
14
.Jnd
15
year·
olds.
1-kurosaenu
and
Biobeha111or
Rn~i~
29
. 259'269. doi: http
://
dx
.do
i.
Org/IO
.IOI6/j.neubiorev.200+IO.OIO
Weinstock. M. (zoos). The potential mfluenct' of materml stress hormones
on
dt>Velopment
and ment.ll health
of
the offspnng.
Bnun
BehaVIor
and
Im-
munology
,
19,
2~
-
308
.
dot
: http://dLdoi.org/tO.IOI6fj.bbi.2004-09-oo6
Lu
Stadtlander
is
a
reJearcher,
profoJsor,
and the
coordinator
of
the
Health
Prychology
program
at
Walden
Univmity.
As
a
clinical
health
psychologist.
she
brings
together
prrgnancy
and
psychological
issu~.
International Journal of Childbirth
Educat.ton
I V
:llume
32
N
trr:bell
:l!aly
2017