In modern-day society, anxiety has become increasingly prevalent worldwide, likely attributable to the overwhelming pace of modern life. It presents as  persistent worrying and apprehension often without a clear cause, accompanied by physical symptoms such as difficulty breathing, trouble sleeping, sweating, trembling, stomach pain, or nausea. These symptoms can significantly interfere with daily activities and diminish one’s overall well-being. Given the myriad stressors in today’s world, it is increasingly common for expectant mothers to grapple with anxiety during pregnancy. 

During pregnancy it is natural for expectant mothers to experience a range of emotions, from anticipation to anxiety. However, recent research conducted at UT Southwestern has found a strong link between anxiety levels and preterm birth1. This study showed that women who had given birth to preterm babies had significantly higher general anxiety disorder scores than other women. Furthermore, women who received a positive anxiety screening and underwent mental health therapy, while pregnant, often averted preterm birth. This underscores the importance of early intervention for treating anxiety symptoms. 

Fortunately there is a range of effective strategies for managing anxiety during pregnancy: 

1. Cognitive Behavioral Therapy (CBT) focuses on reframing negative thought patterns and incorporating anxiety management strategies2. While the most effective implementation of CBT involves working with a trained therapist, there are accessible resources available for self-guided CBT, such as workbooks and online courses.
2. Mindfulness techniques such as grounding exercises, in which one sits down and takes a few deep breaths while focusing on their surroundings. The intention is to notice things you can see, touch, hear, smell, and taste in order to bring one’s attention to the present moment and distract oneself from anxious thoughts. Studies have shown that pregnant women who participated in the mindfulness program, “mindful motherhood”, reported reduction in anxious feelings, stress, and hostility3.
3. Journaling can be beneficial in navigating anxious feelings by providing a means to help work through them. By documenting and writing down one’s worries, individuals can revisit them, offering an opportunity to reframe their perspective and gain insight into their emotions.
4. Incorporating relaxation techniques, such as yoga, massage, meditation, tai chi, and aromatherapy into daily routines can help to promote a sense of calmness and well-being during pregnancy
5. Physical activities such as walking or aquatic aerobic exercises offer not only physical benefits but act as effective stress management tools. Engaging in regular exercise can help to manage stress and anxiety levels.

In cases of severe anxiety symptoms, medication may be considered. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression and anxiety both during pregnancy and postpartum. SSRIs include fluoxetine (Prozac), citalopram (Celexa), Escitalopram (Lexapro) and Sertraline (Zoloft). However, there have been temporary infant symptoms linked with SSRIS use, include tremors, crying, feeding difficulties, and jitteriness4. These symptoms typically resolve within the first 28 days after birth. It is crucial to discuss with your healthcare provider whether the SSRI use during pregnancy is appropriate for you. However, studies have shown that Benzodiazepines such as Xanax during pregnancy should not be used due to potential association with increased risk for cleft lip birth defect (a split opening in the upper lip that is caused by the tissues forming the upper lip not coming together during fetal development)5. 

By implementing stress-reducing strategies, expectant mothers can aim for a healthier pregnancy journey and decrease the likelihood of premature birth. 

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REFERENCES

1. Rodriguez, A. N., Ambia, A. M., Fomina, Y. Y., Holcomb, D., Wolfson, T., Doty, M., Corona, R., Dominguez, J., Peters, M., McIntire, D., & Nelson, D. B. (2023). A prospective study of antepartum anxiety screening in patients with and without a history of spontaneous preterm birth. AJOG global reports, 3(4), 100284. https://doi.org/10.1016/j.xagr.2023.100284
2. Uguz, F., & Ak, M. (2021). Cognitive-behavioral therapy in pregnant women with generalized anxiety disorder: a retrospective cohort study on therapeutic efficacy, gestational age and birth weight. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999), 43(1), 61–64. https://doi.org/10.1590/1516-4446-2019-0792
3. Dunn, C., Hanieh, E., Roberts, R., & Powrie, R. (2012). Mindful pregnancy and childbirth: effects of a mindfulness-based intervention on women’s psychological distress and well-being in the perinatal period. Archives of women’s mental health, 15(2), 139–143. https://doi.org/10.1007/s00737-012-0264-4
4. Stephanie Collier, M. (2021, June 25). How can you manage anxiety during pregnancy?. Harvard Health. https://www.health.harvard.edu/blog/how-can-you-manage-anxiety-during-pregnancy-202106252512
5. Dolovich, L. R., Addis, A., Vaillancourt, J. M., Power, J. D., Koren, G., & Einarson, T. R. (1998). Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies. BMJ (Clinical research ed.), 317(7162), 839–843. https://doi.org/10.1136/bmj.317.7162.839