Early Warning Signs of Perinatal Anxiety in Expecting Mothers

Author:

Emma Loker

B.S

Editor:

Ashley Pena

LCSW

Pregnancy can be both an exciting and a highly stressful time in a person’s life. The anticipation of how life will change when your “bundle of joy” arrives can actually create feelings of stress and overwhelm. What’s more, the birth of a child is a significant life event that brings changes to your daily routine, and it comes with added responsibility and expenses.

When the stress and fear around pregnancy and birth start to interfere with your daily life, you could be experiencing a condition called perinatal anxiety. These anticipated changes, combined with worries over the health and care of your child, the birthing process, and other general concerns, are the reason why 1 in 5 women experience perinatal anxiety.⁵

However, once you learn to recognize common perinatal anxiety warning signs, you can begin to find a way out of it. Treatment can address your needs, and you can begin to cope with the daily worries and enjoy your pregnancy more.

What Is Perinatal Anxiety?

Perinatal anxiety (PNA) refers to the experience of anxiety during the period surrounding childbirth. Antenatal anxiety (also known as prenatal anxiety) is anxiety experienced during pregnancy, and postnatal anxiety (also commonly called postpartum anxiety) is anxiety experienced in the year after giving birth. The term perinatal anxiety encompasses both time frames.

Perinatal anxiety is considered a type of perinatal mood and anxiety disorder (PMAD) as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR). The DSM-5-TR is a reference book clinicians use to help them identify a mental health condition based on the symptoms a person shows.

PMAD is a broad term that includes mental health disorders that can occur during pregnancy and the postpartum period, such as depression, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Research has shown that perinatal anxiety can negatively impact a child throughout their lifetime, with complications such as behavior disorders, learning difficulties, and a higher rate of experiencing anxiety and depressive disorders.¹

So, if possible, it’s best to catch PMAD early and get the support you need.

What Are the Common Warning Signs of Perinatal Anxiety?

While feelings of stress and overwhelm are normal during pregnancy and postpartum, some perinatal anxiety warning signs can indicate the presence of a more serious condition.

First and foremost, perinatal anxiety is marked by excessive and persistent worry that can interfere with daily life as well as bonding with the baby. But, you may be thinking, many people experience symptoms of anxiety throughout their lives – how do I know if it’s perinatal anxiety?

One of the best ways to identify if the anxiety you’re feeling is a problem is to recognize how it is impacting your day-to-day activities. Persistent and intrusive thoughts that keep you from participating in basic activities and your relationships, and that affect your overall well-being, are all indicators that something more is going on that needs attention.

Perinatal Anxiety Symptoms

If you are experiencing one or more of the following anxiety symptoms during pregnancy or postpartum, we recommend that you reach out for support. Paying attention to perinatal anxiety warning signs will ensure you can take the necessary steps to mitigate your anxiety and begin to feel calmer – important steps for both you and your baby.

Symptoms of perinatal anxiety include, but are not limited to:

Constant and persistent worrying.
Feeling overwhelmed, irritable, or angry.
Difficulty sleeping.
Accelerated heart rate, trembling, dizziness, or headaches.
Obsessive or intrusive thoughts, often about harm coming to the baby.
Panic attacks
Difficulty concentrating.
Avoiding or withdrawing from people.
Excessive checking or second-guessing oneself.

Causes of Perinatal Anxiety

It’s easy to convince yourself that perinatal anxiety is just a normal part of being a mom, but it’s important to recognize that you aren’t imagining it. There are very real, physiological, and psychological causes of perinatal anxiety. Some of these causes might seem natural to you, and others may be surprising. Here are some of the potential causes of perinatal anxiety:⁴

- Hormonal changes during and after pregnancy: Levels of estrogen, progesterone, lactogen, and oxytocin vary during pregnancy and childbirth. Research has shown that these hormonal fluctuations may impact cognitive functioning and mood regulation.²
- Lack of sleep: Sleep doesn’t come easy for pregnant and new mothers, plus getting up every few hours to feed a newborn will leave any new parent lacking in quality sleep.
- The pressure of caring for a new baby: (Especially if the baby has health concerns) whether you’re a first-time parent or adding a child to your existing family, the fragility of a newborn can add pressure and stress to the entire family.
- Personal or family history of anxiety or depression: A pre-existing mental health condition can make you more likely to experience symptoms in the perinatal period.
- Previous pregnancy loss or complications: Prior miscarriages or difficulty conceiving may contribute to fears regarding loss of pregnancy.
- Lack of social support: Having a strong social support system is vital.
- Lack of financial stability: Worries around money (such as paying for diapers and formula) can add stress.

Perinatal Anxiety vs Postpartum Depression: Similarities and Differences

Postpartum depression (persistent depressive feelings occurring after childbirth and lasting more than two weeks) is a more well-known term compared to perinatal anxiety.⁶Very often, anxiety and depression go hand-in-hand.

Their comorbidity rate is high because both anxious and depressive thoughts can create a cycle in which a person feels helpless to stop the intrusive thoughts and fears running through their mind. Anxiety and depression can be very inhibiting for new and expecting mothers who feel the pressure of caring for a fragile newborn.

Anxiety and depression have their differences as well. While depression is marked by an inability to complete basic tasks and care for oneself, anxiety can be exhibited by an intense fear about meeting the infant’s needs, and hypervigilance about their safety.

Put simply, if a depressed mother can’t get in the game, an anxious mom is playing the entire field. Both conditions create an uncomfortable and sometimes dangerous atmosphere for the mother and baby.

Similarities Between Perinatal Anxiety and PPD

Both can occur during pregnancy or up to a year after.
Both range in severity and are common in expecting or new moms.
Both share risk factors, such as a history of mental illness, hormonal shifts, sleep deprivation, and lack of support.

Differences Between PPD and Perinatal Anxiety

The primary emotion for PPD is sadness/hopelessness, whereas the primary emotion for PNA is excessive worry/fear.
Thoughts of self-harm or harming the baby are more associated with PPD.
Obsessive, racing thoughts are more associated with PNA.

How to Manage Perinatal Anxiety: Coping Strategies for Perinatal Anxiety

One of the first steps to coping with perinatal anxiety is to accept that it is perfectly alright for you not to feel okay all of the time. Release the shame that comes with feeling burdened by something that you hoped and planned for. This is your first practice in what being a parent truly means: Showing up authentically for your child and accepting that life will never be the same.

On a positive note, anxiety can be one of the most manageable psychological disorders, and a significant reduction in anxiety symptoms can be achieved with or without medication. Interventions such as mindfulness practice, meditation, relaxation therapy, cognitive behavioral therapy (CBT), and pharmacotherapy have been shown to be effective in reducing perinatal anxiety symptoms.³

Perinatal Anxiety Treatment Options

There are several treatment options for anxiety, and most can be applied to perinatal anxiety. A regular practice of one or more of these treatment options can significantly decrease your anxiety triggers during pregnancy. Work with your doctor or therapist to choose a plan that works best for you and your baby.

Pharmacological Therapy

Antidepressant medication, most specifically, selected serotonin reuptake inhibitors (SSRIs), are most effective in treating perinatal anxiety. However, the research into medication use during and after pregnancy is patchy. Why?

Well, it’s generally recognized that there is considerably more research conducted on the general public than on prenatal and postpartum participants. The safety of medication during pregnancy or breastfeeding is still a widely debated topic. However, despite the limited amount of research-based evidence, some SSRIs, such as Sertraline, are considered to have a low-risk profile.⁴

Psychological Therapies

Coping strategies for perinatal anxiety can be learned through therapy. One of the most common and effective therapy approaches used for generalized anxiety disorder in the United States is cognitive behavioral therapy (CBT).

CBT trains individuals to recognize how their thoughts influence their feelings. It teaches people to notice their anxiety triggers and reframe their thoughts to reduce or alleviate their fears. Interpersonal therapy (IPT), which focuses on helping people express themselves and improve their relationships, is also effective in the treatment of anxiety.²

Mind-Body Interventions

Anxiety can manifest within the body through psychosomatic symptoms like headaches/migraines, body aches, dizziness, blurred vision, and stomach aches. Interventions that calm the mind and bring the person into a state of awareness in their body can decrease symptoms of perinatal anxiety.² Mind-body interventions, such as prenatal yoga, meditation, and mindfulness practices, are ways to calm the mind through movement or the regular practice of controlling one’s thoughts.

Ideally, a mix of these interventions is a good approach to coping with perinatal anxiety. Work with a doctor or licensed therapist to create a treatment plan that is best for you.

Frequently Asked Questions About Perinatal Anxiety

How Is Perinatal Anxiety Different From Normal Pregnancy Worries?

It is normal to feel more stressed and overwhelmed with responsibility when birthing and caring for a newborn. However, it’s vital to understand the typical perinatal anxiety warning signs listed in this article. The best measure of when to seek support is when there is a withdrawal from daily activities and key relationships, or your anxiety is interfering with your everyday life.

Can Perinatal Anxiety Affect Bonding With My Baby?

Yes, anxiety can make it harder for you to connect with the people you care about, even your infant. Most of the time, mothers experiencing mild to moderate anxiety symptoms can bond with their baby normally. However, in severe cases of perinatal anxiety, a person is too trapped within their negative thoughts and fears to be able to make and keep strong connections.²

When Should I Be Concerned About Anxiety During Pregnancy or After Birth?

If your anxiety and fears are keeping you from leaving the house or if you are having trouble sleeping due to repetitive and intrusive thoughts or are stuck in patterns of behavior, like locking and unlocking doors or flicking light switches, it may be time to seek treatment.

One significant sign of anxiety symptoms is a loss of appetite. This can be particularly concerning since an expectant mother’s diet impacts her unborn baby as well. If you are experiencing any of these perinatal anxiety warning signs, please be open with your doctor and ask for treatment options.

Mission Connection: Support and Professional Anxiety Treatment During Pregnancy

Life will have its challenges, but it’s important to know that you’re not alone in these – far from it. Reaching out for support during these difficult times can help you get back on track and receive the support you need and deserve.

At Mission Connection, our goal is to provide comprehensive mental health care for individuals who require all different forms of care, whether this be:

Inpatient, residential treatment: Ready for you if you need round-the-clock care.
Outpatient treatment: Helping you continue your life as normal while receiving support.
Intensive outpatient treatment: Support that bridges the gap between inpatient and outpatient support, for times when you need a high level of support but doesn’t require you to stay at our treatment facilities.
Virtual therapy: Meeting you where you’re at with therapeutic support from the comfort of your own home.

Our licensed therapists offer flexible programming to meet your needs and help you develop the tools to live a healthy life for you and your child.

Get started today by talking to one of our specialists and creating a plan that fits your schedule and meets your needs.

References

Postpartum Support International. (n.d.). About perinatal mental health. https://postpartum.net/perinatal-mental-health/
Palacios-Hernández, B., Ramírez-Alvarado, G., Téllez-Alanís, B., Lino-González, A. L., Penagos-Rivera, M., & Hernández-Galván, A. (2024). Hormones, psychotic disorders, and cognition in perinatal women: A mini review. Frontiers in Psychiatry, 14, 1296638. https://doi.org/10.3389/fpsyt.2023.1296638
Maternal and Child Health Journal. (n.d.). Perinatal generalized anxiety disorder: Assessment and treatment. https://www.liebertpub.com/doi/10.1089/jwh.2014.5150
(Note: The author appears to be incorrectly listed as the journal name—if actual authors are available, they should be used instead.)
Silverwood, V. A., Bullock, L., Turner, K., Chew-Graham, C. A., & Kingstone, T. (2022). The approach to managing perinatal anxiety: A mini-review. Frontiers in Psychiatry, 13, 1022459. https://doi.org/10.3389/fpsyt.2022.1022459
Mitchell, A. R., Gordon, H., Atkinson, J., Lindquist, A., Walker, S. P., Middleton, A., Tong, S., & Hastie, R. (2023). Prevalence of perinatal anxiety and related disorders in low- and middle-income countries: A systematic review and meta-analysis. JAMA Network Open, 6(11), e2343711. https://doi.org/10.1001/jamanetworkopen.2023.4371
Mayo Clinic Staff. (2022, November 24). Postpartum depression – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617