Anxiety during pregnancy: what’s normal, what helps, and when to get support

Pregnancy can bring huge joy, and a lot of worry. Is the baby okay? Will the birth go well? Will I be a good parent? How will we manage?

Some worry is a normal part of pregnancy. But for many people, anxiety becomes much bigger than that: constant, exhausting, and hard to switch off. If that’s you, you’re not alone, and you deserve support.

If you’re having thoughts of harming yourself or your baby, or you have chest pain, trouble breathing or a fast-beating heart, get medical help right away. Call 911 in an emergency, or call or text 988 if you’re in crisis.

How common is anxiety in pregnancy?

Very common. A large review of 102 studies, covering more than 220,000 women in 34 countries, found that:

• around 18% had anxiety symptoms in the first trimester
• around 19% in the second trimester
• around 25% in the third trimester
• around 15% met the criteria for an anxiety disorder

So roughly 1 in 5 pregnant people deal with significant anxiety. It’s one of the most common complications of pregnancy, even though it’s talked about much less than morning sickness.

Everyday worry or anxiety that needs help?

Everyday worry tends to come and go, matches what’s happening, and eases when you get reassurance or information.

It might be anxiety that needs support if:

• you worry most of the day, most days, and can’t switch it off
• worry keeps you awake, even when you’re exhausted
• you have panic attacks
• you need reassurance again and again, but it never lasts
• you’re checking things a lot, like the baby’s movements or symptoms online, and it isn’t helping
• you’re avoiding scans, appointments, or anything that reminds you of the pregnancy
• you have unwanted, upsetting thoughts or images that keep coming back
• it’s getting in the way of work, relationships or enjoying anything

When anxiety symptoms overlap with pregnancy

Pregnancy itself can cause a faster heartbeat, breathlessness, nausea, tiredness and poor sleep, which are also anxiety symptoms. That makes it hard to tell what’s what.

The safest rule: don’t assume it’s anxiety. The US Centers for Disease Control and Prevention (CDC) lists these as urgent warning signs during pregnancy and in the year after. Get medical care right away if you have:

• a headache that won’t go away or gets worse
• dizziness or fainting
• changes in your vision
• a fever of 100.4°F or higher
• extreme swelling of your hands or face
• thoughts about harming yourself or your baby
• trouble breathing
• chest pain or a fast-beating heart
• severe nausea and vomiting
• severe belly pain that doesn’t go away
• your baby’s movements stopping or slowing
• vaginal bleeding or fluid leaking during pregnancy
• severe swelling, redness or pain in your leg or arm
• overwhelming tiredness

Tell whoever you speak to that you’re pregnant. Being checked and told everything is fine is never a waste of anyone’s time.

Common worries in pregnancy

• the baby’s health, especially before scans and results
• miscarriage, especially after a previous loss
• the birth itself. An intense fear of childbirth is called tokophobia, and it’s worth raising with your provider, who can talk through your options and support
• whether you’ll be a good parent
• money, work, housing and relationships
• your changing body
• your own health and medicines

Unwanted, frightening thoughts

Many people have sudden, upsetting thoughts or images during pregnancy and after birth, like the baby being hurt, or even of doing something harmful themselves. These are called intrusive thoughts. They’re very common, and they horrify the people who have them precisely because they go against everything they want. Having them doesn’t mean you’ll act on them.

When intrusive thoughts are frequent and distressing, and you’re doing a lot to avoid or “cancel” them, it can be perinatal OCD, which is very treatable. Our post on how to stop intrusive thoughts explains more.

Please tell your provider about any thoughts like these. If thoughts of harming yourself or your baby feel like urges or plans, rather than unwanted thoughts, get help right away.

What raises the risk

You may be more likely to have anxiety in pregnancy if you:

• have had anxiety or depression before
• have had a previous pregnancy loss or a difficult birth
• conceived after fertility treatment
• have little support, or are going through relationship problems
• are dealing with money worries, housing problems or other big stresses
• have experienced trauma or abuse
• have complications in this pregnancy

What helps

• Tell your provider. Your midwife, OB-GYN or family doctor wants to know how you’re feeling, not just how you’re doing physically. ACOG, the main US body for obstetricians, recommends that everyone is screened for anxiety and depression during pregnancy and after birth.
• Breathe slowly. In for 4, out for 6. Slow breathing is safe in pregnancy and calms your body’s stress response.
• Move your body, if your provider says it’s okay. ACOG suggests at least 150 minutes a week of moderate activity, like brisk walking or swimming, which you can split into short sessions.
• Rest when you can. Tiredness makes anxiety much harder to handle.
• Keep caffeine under 200 mg a day, which is the amount ACOG considers moderate in pregnancy. That’s roughly one 12 oz cup of brewed coffee, or less if it’s strong, so check labels and remember tea, soda and chocolate add up too.
• Limit late-night googling. Symptom searches tend to surface the scariest stories. Write your questions down for your next appointment instead.
• Get informed about the birth. Birth preparation classes and talking through your preferences with your provider can make the unknown feel more manageable.
• Lean on people. Tell your partner, a friend or family member how you’re really feeling. Support groups for pregnant people can help too.

Treatment

• Talking therapy. Cognitive behavioural therapy (CBT) works well for anxiety in pregnancy, and it carries no risk to the baby.
• Medicine. Some anxiety medicines, including certain SSRIs, are commonly used in pregnancy. Every decision weighs the possible risks of a medicine against the risks of anxiety that isn’t treated. Your doctor can help you decide what’s right for you.
• If you already take medicine for anxiety, talk to your doctor as soon as you can. Don’t stop it suddenly, because that can cause withdrawal effects and a return of anxiety.

Where to get support

• National Maternal Mental Health Hotline: call or text 1-833-TLC-MAMA (1-833-852-6262). It’s free, confidential and open 24/7 in English and Spanish, with interpreters for many other languages.
• Postpartum Support International (postpartum.net) offers a HelpLine, online support groups and a directory of specialist therapists. Despite the name, it supports people during pregnancy too. It isn’t a crisis line.
• In a crisis: call or text 988, or call 911 in an emergency.

Frequently asked questions

Can anxiety during pregnancy harm my baby?

Everyday worries won’t harm your baby. Some studies have linked severe, long-lasting anxiety in pregnancy with outcomes like an earlier birth, but that’s one more reason to get support, not something more to worry about. Treating anxiety is good for both of you.

Is it normal to feel more anxious in the third trimester?

Yes. Anxiety symptoms tend to rise as the birth gets closer, with about 1 in 4 people affected in the third trimester. Worries about the birth and life with a new baby are very common. If anxiety is getting in the way of sleep or daily life, tell your provider.

Can I take anxiety medicine while pregnant?

Some anxiety medicines are commonly used in pregnancy. Whether it’s right for you depends on how severe your anxiety is, what’s worked before and your health. Talk to your doctor, and don’t stop any medicine without speaking to them first.

Will my anxiety go away after the baby is born?

For some people it does. For others it continues, or starts after the birth. About 15% of people have anxiety symptoms in the first six months after giving birth. If anxiety is still there, or appears after the birth, tell your provider. It’s very treatable.

How Breatheasy can help

Breatheasy can help you through anxious moments during pregnancy. Guided breathing exercises pulse your phone as you breathe in, so you can follow along lying down with your eyes closed. If anxiety turns into panic, tap “I’m feeling anxious” and Luma walks you through it. Ten-second check-ins and a journal help you keep track of how you’re feeling, which can be useful to share at your appointments. Breatheasy is a self-help tool and doesn’t replace your prenatal care, so always check any physical symptoms with your provider. Breatheasy is coming soon to iPhone and Android.

Sources

• Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis, Dennis and others, British Journal of Psychiatry, 2017
• Urgent maternal warning signs, Centers for Disease Control and Prevention
• Screening and diagnosis of mental health conditions during pregnancy and postpartum, American College of Obstetricians and Gynecologists
• Moderate caffeine consumption during pregnancy, American College of Obstetricians and Gynecologists
• Exercise during pregnancy, American College of Obstetricians and Gynecologists
• Mental health in pregnancy, NHS
• National Maternal Mental Health Hotline, Health Resources and Services Administration