Prenatal Depression and Anxiety: Pregnancy Isn’t Always Bliss

Depression and Anxiety during Pregnancy

Many people are familiar with the terms postpartum depression and anxiety, but prenatal depression and anxiety are not as well-known. Both prenatal and postpartum depression and anxiety fall into the category of “perinatal mood and anxiety disorders,” which refers to any type of mood (such as depression or bipolar) or anxiety disorder (such as generalized anxiety, obsessive compulsive, and post-traumatic stress disorders) that occurs during pregnancy or up to one year after giving birth.

Prenatal depression and anxiety develop while a mother is pregnant and are more common than many people realize. Almost 54% of women experience anxiety and 37% experience depression at some point during pregnancy. Depression and anxiety are more likely to affect women at the very beginning and end of their pregnancies, during the first and third trimesters.

Women may experience depression and anxiety for a number of reasons during pregnancy. Pregnancy can cause physical and emotional changes that can make women more vulnerable to stress. These changes include:

  • Physical pain and discomfort, such as nausea, vomiting, muscle aches and pains, heartburn, fatigue, headaches, and frequent urination.
  • Hormonal changes, including increased levels of estrogen and progesterone, which can lead a woman to feel more emotionally vulnerable.
  • Anxiety and fear related to delivery, the baby’s health, and becoming a parent.

In addition to stress related to pregnancy and parenting, women may be dealing with other issues in their lives, such as family, work, or financial problems, that can result in stress, moodiness, and worry.

What are the signs of prenatal depression and anxiety?

Symptoms of Depression:

  • Feeling sad or down.
  • Diminished interest or lack of pleasure in activities that were once enjoyable.
  • Low energy.
  • Moving more slowly and appearing more sluggish than usual.
  • Changes in sleep, either sleeping too little or too much.
  • Feelings of worthlessness or guilt.
  • Difficulty concentrating.
  • Thoughts that you might be better off dead.

Symptoms of Generalized Anxiety:

  • Excessive worry that is hard to control.
  • Feeling irritable or on edge.
  • Restlessness.
  • Low energy.
  • Muscle tension.
  • Difficulty sleeping.
  • Difficulty concentrating.
More than half of women experience anxiety and over one-third experience depression during pregnancy.

What are risk factors for prenatal depression and anxiety?

Risk factors are experiences that increase the likelihood of developing a condition. Certain experiences may put women at higher risk of experiencing depression and anxiety during pregnancy:

  • History of depression, anxiety, or other mental health issues.
  • Family history of mental illness. 
  • Low self-esteem prior to pregnancy. 
  • Lack of support from family and friends.
  • Past history of abuse or domestic violence. 
  • Difficulty getting pregnant and utilizing assisted reproductive technology, like in vitro fertilization (IVF). 
  • Unplanned pregnancy. 
  • Having a high-risk pregnancy. 
  • Having multiples, such as twins or triplets. 
  • Developing medical conditions during pregnancy like hypertension or gestational diabetes. 
  • Experiencing other stressors, like financial problems, conflict with a spouse or partner, or housing instability. 

In many cases prenatal depression and anxiety may be caused by a combination of biological and environmental factors. While certain factors may increase your risk for an emotionally challenging pregnancy, there are tools and resources available to help you cope with these challenges.

How can depression and anxiety affect my baby?

Prenatal depression and anxiety can have an impact on a developing baby. There is some research evidence to suggest that stress during pregnancy may be related to preterm birth, lower birth rate, and developmental delays. However, taking steps to address these issues and making efforts to bond closely with your baby after birth is also associated with positive developmental outcomes for children. Therefore, it’s important to remember that even if you struggle with depression and anxiety during pregnancy, you can recover and develop a close mother-child bond.

Prenatal depression and anxiety are most common during the first and third trimesters.

Coping with Depression and Anxiety during Pregnancy

Taking steps to reduce mood and anxiety symptoms can help you have a more relaxing, positive pregnancy experience. Of course there will be ups and downs, but taking steps to manage your stress can help you recover from the downs more easily. Consider the following to help reduce stress during pregnancy:

  • Take it easy. Now is not the time to add more to your plate. Pregnancy requires lots of rest and relaxation as you grow your baby and prepare for parenthood. If possible, avoid taking on big projects that can add extra stress, like moving, changing jobs, or getting a new pet.
  • Phone a friend. Loneliness and isolation are common symptoms of depression, but connecting with others can be a powerful tool for coping. If you already have a good support system of friends or family, make an effort to reach out to someone you trust. If you don’t have anyone you can talk to, consider joining a support or psychotherapy group for new parents. 
  • Give yourself permission to be imperfect. Putting unrealistic expectations on yourself can lead to a constant state of stress and feelings of failure, which are recipes for anxiety and depression. If thoughts of perfection creep up, try to challenge them by reminding yourself that you’re doing your best and that is enough.

Even if you struggle with depression and anxiety during pregnancy, you can recover and develop a close mother-child bond.

When should I get help?

Most pregnancies involve a degree of worry, moodiness, and insomnia, symptoms that are also found in mood and anxiety disorders. Because of the overlap, it can be difficult to know when your symptoms are too much and it’s time to get help. Signs that you should consider seeking professional help include:

  • Your symptoms have lasted for over two weeks and are not improving. 
  • Your symptoms are interfering with your ability to function and carry out responsibilities, such as attend your prenatal appointments or care for other children.
  • You feel all alone or like you don’t have anyone to talk to. 
  • You have thoughts of harming yourself or suicide. 

Depending upon what you’re looking for, you may consider group or individual therapy. Group therapy allows you to connect with other soon-to-be parents who are experiencing similar feelings. Individual therapy provides you with an opportunity to work one-on-one with a therapist, who can help you understand your feelings and develop coping skills. There are several different types of mental health providers to choose from, including psychiatrists, psychologists, and therapists. For more information about how to get help for perinatal mood and anxiety disorders, see Postpartum Support International, which offers a free online provider directory and support from local coordinators who can assist you with finding treatment.

Resources:

American Academy of Pediatrics. (2018). Depression and anxiety during pregnancy and after birth: FAQs.

Postpartum Support International. (2019). Pregnancy & postpartum mental health overview.

Sources:

Biaggi, A., Conroy, S., Pawlby, S., & Pariante, C. M. (2016). Identifying the women at risk of antenatal anxiety and depression: A systematic review. Journal of Affective Disorders, 191, 62-77.

Marc, I., Toureche, N., Ernst, E., Hodnett, E. D., Blanchet, C., Dodin, S., & Njoya, M. M. (2011). Mind‐body interventions during pregnancy for preventing or treating women’s anxiety. Cochrane Database of Systematic Reviews, 7.

Schetter, C. D., & Tanner, L. (2012). Anxiety, depression and stress in pregnancy: Implications for mothers, children, research, and practice. Current Opinion in Psychiatry, 25(2), 141-148.

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