Anxiety During Pregnancy

Written and Fact-Checked by: Jenna Carberg

Is Anxiety During Pregnancy Normal?

Some worry during pregnancy is normal. You are responsible for a new life, your body is changing, and there is a great deal you cannot control. But for many people, the worry becomes constant, hard to switch off, and starts to affect sleep, work and enjoyment of the pregnancy. That is anxiety that deserves attention and treatment.

Anxiety during pregnancy is common. A meta-analysis of 102 studies and more than 220,000 women found:

  • Anxiety symptoms in 18% of women in the first trimester, 19% in the second and 25% in the third.
  • A diagnosed anxiety disorder in about 15% of pregnant women.

It is also as important as depression. The American College of Obstetricians and Gynecologists (ACOG) notes that anxiety in pregnancy is a strong predictor of depression during pregnancy and after birth. See depression during pregnancy and postpartum anxiety.

Normal Worry vs. an Anxiety Disorder

Normal pregnancy worry Anxiety that needs support
Focus Specific worries that come and go Constant worry that jumps from one fear to the next
Control Reassurance helps Reassurance does not last; worry feels uncontrollable
Daily life You can sleep, work and enjoy things It disrupts sleep, work, relationships or appointments
Body Occasional nerves Racing heart, tension, restlessness, nausea or panic

Some pregnancy symptoms, such as poor sleep and fatigue, overlap with anxiety, which is one reason it is easy to miss.

Types of Anxiety in Pregnancy

  • Pregnancy-related anxiety: worry tied specifically to the pregnancy, mostly about the baby’s health and about labor and birth. Researchers recognize it as its own pattern, though it is not a formal diagnosis. Severe fear of birth is called tokophobia.
  • Generalized anxiety disorder: excessive, hard-to-control worry about many things most days, affecting about 4% of pregnant women.
  • Panic attacks and panic disorder: sudden surges of intense fear with physical symptoms. See panic disorder.
  • Obsessive-compulsive disorder (OCD): affects about 3% of pregnant women, often involving intrusive thoughts and checking. See perinatal OCD.

Intrusive Thoughts

Unwanted, frightening thoughts about harm coming to the baby are common. According to ACOG, most people who find these thoughts distressing will not act on them, and the risk of harm is low. They are still worth raising with your clinician, especially if they are frequent.

Screening: How Anxiety Is Picked Up

ACOG recommends that everyone be screened for anxiety and depression at the first prenatal visit, later in pregnancy and after birth, using validated questionnaires such as the GAD-7. On the GAD-7, a score of 5 to 9 often reflects mild symptoms, 10 to 14 moderate and 15 or higher severe. You can take it on this site in a few minutes; nothing is saved or sent anywhere. If you have not been screened, you can ask.

Does Anxiety During Pregnancy Affect the Baby?

This is one of the most common worries, and it deserves an honest, non-alarming answer.

  • A meta-analysis of 29 studies found anxiety during pregnancy was associated with a higher chance of preterm birth and low birth weight.
  • The effect on birth weight was small, about 56 grams (2 ounces) on average.
  • There was no significant link with preeclampsia, cesarean delivery or Apgar scores.
  • Some research links high anxiety or depression in pregnancy to later emotional and behavioral difficulties in children, One review estimated that anxiety or depression during pregnancy may account for about 10% to 15% of those outcomes, which means most of the picture comes from other factors.

Researchers also note that it is not known whether treating anxiety changes these outcomes. What that means for you: these findings are a reason to get support for your own well-being, not a reason to blame yourself or add worry about worrying.

Can Stress Cause a Miscarriage?

  • Most miscarriages are caused by chromosome problems in the developing pregnancy, which are not caused by anything the mother did.
  • A meta-analysis found psychological stress was associated with higher odds of miscarriage, but it was based on only 8 observational studies, and the authors noted that early signs of a miscarriage, or a past miscarriage, can themselves cause stress. That makes it impossible to say stress caused the loss.
  • No study has shown that reducing stress prevents miscarriage. There is also no proof that sex or exercise causes miscarriage.

If you have had a pregnancy loss, it was very unlikely to be caused by your stress.

Treatment for Anxiety During Pregnancy

Therapy

ACOG considers psychotherapy a first-line treatment for anxiety in pregnancy. Cognitive behavioral therapy (CBT) has the strongest evidence: a large meta-analysis of randomized trials found it reduced perinatal anxiety both in the short term and the long term. Online and app-based CBT had a smaller effect.

Mindfulness and Yoga

  • Mindfulness-based programs reduced anxiety in pregnant and postpartum women, especially those who already had symptoms, though long-term benefits are less certain.
  • Yoga may help, but the reviews of yoga research are of low quality.

Sleep

Poor sleep and anxiety feed each other. In a randomized trial, a digital CBT program for insomnia during pregnancy improved sleep and also reduced anxiety and depression symptoms. See postpartum insomnia.

Exercise

Exercise is safe and recommended in an uncomplicated pregnancy, and it reduces depression. But the largest meta-analysis found exercise did not reduce anxiety during pregnancy, so it is a good habit rather than a treatment for anxiety on its own.

Medication

For moderate or severe anxiety, medication is often added to therapy. SSRI antidepressants are the first-line choice in pregnancy. See antidepressants during pregnancy, including what is known about other anxiety medications.

Natural Remedies for Anxiety During Pregnancy

“Natural” does not mean safe in pregnancy, and most herbal products have never been tested in pregnant people. Some can also contain contaminants. Here is what is known:

Remedy What the evidence says
Kava Avoid. Linked to rare but serious liver injury, with added risks in pregnancy
St. John’s wort Avoid. May be unsafe in pregnancy and interacts dangerously with antidepressants, birth control and other drugs
Valerian Not enough evidence it helps anxiety; safety in pregnancy unknown
Lavender A few small pregnancy trials reported benefit and no side effects, but safety in pregnancy is not established
Magnesium Poor-quality evidence for anxiety, no pregnancy trials; supplements above 350 mg a day exceed the adult upper limit

Before taking any supplement or herb, check with your ob-gyn, midwife or pharmacist. The approaches with the best evidence, including CBT, mindfulness and better sleep, are also the safest.

When to Get Help

Talk to your ob-gyn or midwife if worry or panic:

  • Lasts more than a couple of weeks or keeps getting worse
  • Disrupts your sleep, work, relationships or prenatal care
  • Comes with low mood, hopelessness or loss of interest
  • Includes frequent intrusive thoughts that frighten you

Find a therapist who treats anxiety in pregnancy

You can call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262), free and available 24 hours a day in English and Spanish. It is not a crisis line; if you have thoughts of harming yourself, call or text 988, or call 911 in an emergency.

Frequently Asked Questions

Is it normal to have anxiety during pregnancy?

Some worry is normal, and anxiety symptoms are common, affecting roughly 1 in 5 pregnant women. Anxiety that is constant or disruptive deserves treatment.

Can anxiety during pregnancy harm my baby?

It is associated with a slightly higher chance of preterm birth and low birth weight, but the effects are small and not proven to be caused by anxiety. Getting support is good for you and your pregnancy.

Can stress cause a miscarriage in early pregnancy?

Most miscarriages are caused by chromosome problems. Studies linking stress and miscarriage cannot show that stress was the cause.

What are natural remedies for anxiety during pregnancy?

CBT, mindfulness and improving sleep have the best evidence and are safe. Herbal remedies are mostly untested in pregnancy, and kava and St. John’s wort should be avoided.

Is anxiety worse in early pregnancy?

Studies find anxiety symptoms in about 18% of women in the first trimester, rising to about 25% in the third.

How is anxiety during pregnancy treated?

Therapy, especially CBT, is first-line. For moderate or severe anxiety, an SSRI antidepressant may be added.

Should I be screened for anxiety during pregnancy?

Yes. ACOG recommends screening for anxiety and depression at the first prenatal visit, later in pregnancy and after birth.

PostpartumDepression.org Team
Written by:

Jenna Carberg was diagnosed with postpartum depression following the birth of her daughter in 2016. It was a healthy birth but in the following days, Jenna's mood changed quickly. Doctors suggested that it might be the "baby blues", but her husband Chris suggested she seek a second opinion. Jenna was diagnosed with postpartum depression and began a journey that lasted 9 long months with significant ups and downs. Jenna's mental health care and her experiences became a passion for her to share with the world. She and her husband Chris founded PostpartumDepression.org as a support website designed to help women suffering in silence and their loved ones.

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