Anxiety Disorders During Pregnancy

pregnancyAnxiety disorders are extremely common and treatable; however, during pregnancy, treatment options can become complicated and the disorder often poses a risk to both the mother and the fetus.[1]

If untreated, significant and ongoing prenatal anxiety exposes the fetus to excess glucocorticoids, steroid hormones that regulate the metabolism of glucose.1 They are part of the feedback mechanism in the immune system that turns immune activity down.1 Excess of this hormone may influence the fetus’ susceptibility to enduring neuroendocrine changes.1 These changes optimize the internal environment to provide the life support system for the placenta, embryo, and fetus, including increased appetite and energy storage, blood volume expansion, and prevention of further pregnancy during that time.1 With an increase of glucocorticoids, the fetus is at risk of preterm labor and low birth weight.1

There are many anxiety disorders that can occur during pregnancy. First, there is panic disorder. The normal pregnancy-related changes—such as increased heart rate, shortness of breath, heartburn, sweating, and dizziness—can often be misinterpreted as harmful.1 As these symptoms become prominent during the sixth and 28th week of pregnancy, many women report the onset of panic symptoms.1

Second, generalized anxiety disorder (GAD) forms from intolerance of uncertainty and inaccurate beliefs about the future.1 Many mothers worry about the impending arrival of their baby and all the things that could go wrong.1 This can lead to lying awake at night worrying and making plans to deal with each imagined scenario.1

Third, obsessive-compulsive disorder (OCD) is increased by pregnancy, as the mother thinks about the overwhelming responsibility for the baby’s wellbeing and safety.1 Oftentimes, obsessions focus on possible harm to the baby, and compulsions include washing and cleaning rituals and compulsively checking on the baby.1 Some of these thoughts are common and normal for new mothers; however, ritualizing and attempts to control or suppress these thoughts often reinforce and escalate anxiety.1

Fourth, while most women report some fear of delivery, for some it can turn into a childbirth-related specific phobia.1 Fear is often learned through previous traumatic deliveries, negative information, or witnessing others’ fearful behavior.1 This extreme fear can be associated with prolonged labor, increased perception of pain, and avoidance of labor in favor of cesarean birth.1

Lastly, post-traumatic stress disorder (PTSD) can result from premature delivery, preeclampsia, pregnancy loss, or lack of emotional or social support.1 A history of rape, childhood sexual abuse, and domestic violence are common among pregnant women with PTSD.1 These women often avoid health care providers, are extremely sensitive to bodily exposure, and have dissociation, flashbacks, or an excessive need to control situations.1

There are treatments for anxiety disorders during pregnancy.1 The first is cognitive-behavioral therapy, which helps reduce stress, increase exercise, improve sleeping habits, and offers social support.1 During pregnancy, the aim of this therapy is to correct distorted and catastrophic thinking, misinterpretations of physical symptoms, and maladaptive behavioral patterns that may escalate to anxiety.1

Psychoeducation is another treatment that helps to correctly identify benign physical symptoms that serve to counter fearful misappraisals.1 Coupled with anxiety management strategies, such as deep breathing, it has shown effectiveness in decreasing anxiety during pregnancy.1

Women who have moderate to severe prenatal anxiety often require pharmacological treatment as well.1 However, there is mixed information that create stigma and fear that often leads women to decline effective pharmacological treatment, take less than the recommended dose, or stop treatment prematurely.1 This can lead to relapse of anxiety and suicidal ideation.1 The risks and benefits need to be weighed by the doctor and the parents, as untreated anxiety may cause more harm than the medicines that treat it.1

[1] Avni-Barron, O., & Wiegartz, P. (2011, September 6). Issues in Treating Anxiety Disorders in Pregnancy. Psychiatric Times. Retrieved November 25, 2013, from http://www.psychiatrictimes.com/anxiety/issues-treating-anxiety-disorders-pregnancy/page/0/1

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