During pregnancy, you will likely feel a range of emotions: joy, anticipation, exhaustion, vulnerability. For many pregnant individuals, anxiety is part of the mix. While it is a normal human emotion, anxiety can become pervasive and begin to affect your daily life.
Generalized anxiety disorder (GAD) affects 2% to 3% of the population, but the risk heightens in pregnancy. Up to 35% of pregnant patients develop clinical anxiety, with GAD affecting 1 in 12 pregnant and postpartum individuals (likely a lower estimate due to a lack of routine screening).
Anxiety during pregnancy is known to cause physical and emotional symptoms for expectant birthing people, such as social isolation and disrupted sleep. Less recognized are the significant impacts on the pregnancy – particularly the risk of preterm birth, before 37 weeks’ gestation.
Screening for maternal anxiety can help providers identify at-risk patients and intervene to reduce its health impacts for pregnant people and their infants.
The Department of Obstetrics and Gynecology at UT Southwestern recently completed a study in which we screened for anxiety in patients with and without a history of early delivery. The findings showed that previous preterm birth and anxiety are strongly linked, providing new insights into the importance of screening and strategies to help manage anxiety during and after pregnancy.
Screening for anxiety
Anxiety-related preterm birth is thought to be caused by a combination of factors that cause inflammation. Pregnancy can triple a pregnant person’s levels of cortisol, an inflammatory stress hormone. Anxiety can also be caused by early activation of the maternal hypothalamic pituitary system, which acts like an internal “timer” for regularly scheduled or preterm delivery.
4 key findings of the UTSW study
* Patients with a history of preterm birth had significantly higher General Anxiety Disorder (GAD-7) scores.
* 20% of patients with a history of preterm birth had a GAD-7 positive screen compared to those without a history (13%).
* 78% of patients who had a positive screen and accepted a referral had successful contact with a mental health provider.
* 17% of patients with a positive GAD-7 screen were ultimately diagnosed with a perinatal mood disorder.
The study highlights the need for universal maternal anxiety screening, which could help us better identify patients at risk for anxiety and offer personalized treatment options.
Infants born before 37 weeks face a higher risk of lifelong health problems such as underdeveloped lungs, high blood pressure, heart and kidney disease, and death – two-thirds of infant deaths occur in infants born preterm. About 10% of U.S. births are preterm, and a third of patients who have a preterm birth will deliver early in a later pregnancy.
In our study, we screened 1,349 pregnant individuals with the Generalized Anxiety Disorder 7 (GAD-7) questionnaire, which includes seven questions each assigned a score of 0 to 3 for a maximum possible 21 points. Higher scores mean the patient is more likely to have an anxiety disorder. In our study, patients with a score of 10 or higher were offered a referral to a mental health counselor.
Symptoms of anxiety in pregnancy
While mood changes are common during and after pregnancy, problems can develop when these symptoms start to negatively impact daily life:
- Difficulty concentrating
- Restlessness or irritability
- Trouble controlling feelings of worry
- Sense of impending danger, panic, or doom
- Problems falling or staying asleep
- Rapid breathing
Some of these overlap with normal pregnancy symptoms, making it difficult to differentiate. That’s where screenings with your health care provider come in. Screenings help identify thresholds at which regular stress starts to affect daily life and cause health problems.
The American College of Obstetrics and Gynecology recommends pregnant individuals be screened for depression and anxiety at the first prenatal visit, later in pregnancy, and at postpartum visits. Be honest when answering your provider’s questions during these screenings – we will never judge you for your responses. Screening questionnaires help us spot anxiety symptoms early so we can help you feel better.
Anxiety treatment options
Every person’s treatment journey is different, and the first steps typically involve self-care strategies such as practicing good sleep hygiene, getting regular exercise, and eating balanced meals. Patients may need help reducing stressors such as getting to and from appointments or having access to reliable childcare. Your doctor can connect you with community resources to lighten the load.
Counseling and medication are safe, effective options if your anxiety continues. We know that you may be reluctant to take medication during pregnancy. However, almost all mental health medications carry a very low risk of harm for your baby, and not taking medication when it’s needed may have risks, too. In 2023, ACOG released a strong recommendation against withholding or discontinuing medications for mental health conditions due to pregnancy or lactation status alone.
My colleagues and I at UT Southwestern and Parkland Health are passionate about making pregnancy safer – physically and mentally. By performing studies like these, we are better able to identify expecting patients who may need support and develop strategies to help improve the health of both the pregnant individual and their infant.