What is anxiety?
Everybody gets anxious from time to time but, when a person experiences continuous, uncontrolled worrying that cannot be pinned down to a specific cause, this is called “generalized anxiety disorder.” If you suffer from generalized anxiety disorder, along with excessive worrying, you will feel nervous and restless. Youll find it difficult to relax, and you may be haunted by a fear of worst-case scenarios. For those with generalized anxiety disorder during pregnancy, such worrying and fear may be related to the anticipated day of delivery. For instance, you may worry that labor and delivery may be painful, or that you will experience a complication such as premature delivery, stillbirth or another serious medical condition.
People with generalized anxiety disorder frequently experience physical signs and symptoms. These can include rapid heartbeat (tachycardia), gastrointestinal upset, tremors, shakiness or dizziness, excessive sweating, and cold hands and feet. You also may worry that you have some medical condition. During pregnancy, this type of worry can manifest as a belief or suspicion that you suffer from a serious pregnancy complication, such as placenta previa, gestational diabetes, or preeclampsia.
Although generalized anxiety disorder is the most common type of anxiety during pregnancy, other anxiety disorders that may affect a pregnant woman include panic attack, obsessive-compulsive disorder, phobias, social disorder, and post-traumatic stress disorder.
How common is generalized anxiety disorder during pregnancy?
Generalized anxiety disorder (GAD) is thought to occur frequently during pregnancy; however, the few available studies have been conducted using standardized diagnostic criteria rather than self-reporting questionnaires, and this is not an ideal tool. Nearly 10 percent of mothers suffer from GAD at some point during pregnancy. According to a review involving thousands of pregnancies, the bulk of pregnancy-associated GAD occurs during the first trimester, during which 7 percent of pregnant women develop GAD. The incidence drops down to 2 percent in the second trimester, then rises slightly to 3 percent in the third trimester. Its possible that the incidence is actually higher than what the reviewed studies suggest because many women who become pregnant are already taking medication, such as antidepressants, which reduce the anxiety that otherwise would show up.
How is generalized anxiety disorder diagnosed during pregnancy diagnosed?
As with all anxiety disorders, generalized anxiety disorder is a clinical diagnosis, meaning that it is diagnosed based purely on the patients history, symptoms, and other complaints that are assessed during an interview. Mental health care providers can interpret the findings using any of a handful of diagnostic tools to arrive at a diagnosis. One such tool consists of the diagnostic criteria provided in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which requires the presence of at least three of the following, occurring for more than 6 months, interfering with the performance of normal activities:
- Restlessness or feeling keyed up or on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Muscle tension
- Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
Another tool is called the GAD-7 scale, which provides a numerical grading of anxiety based on the presence or absence of the following 7 criteria:
- Feeling nervous, anxious, or on edge
- Not being able to stop or control worrying
- Worrying too much about different things
- Trouble relaxing
- Being so restless that it is hard to sit still
- Becoming easily annoyed or irritable
- Feeling afraid as if something awful might happen
Finally, the Beck Anxiety Inventory quantifies anxiety using the following 21 criteria:
- Numbness or tingling
- Feeling hot
- Wobbliness in legs
- Unable to relax
- Fear of the worst happening
- Dizzy or lightheaded
- Heart pounding or racing
- Feelings of choking
- Hands trembling
- Fear of losing control
- Difficulty breathing
- Fear of dying
- Indigestion or discomfort in the abdomen
- Face flushed
- Sweating (not due to heat)
Does generalized anxiety disorder cause problems during pregnancy?
GAD often includes symptoms that happen in pregnancy in general, such as sweating, and indigestion or heartburn. Consequently, GAD can exacerbate some of the physical discomforts of pregnancy. Furthermore, under certain circumstances, anxiety conditions can trigger premature labor. Additionally, pregnancy and the time just before and after birth can exacerbate a GAD that was present prior to pregnancy.
Does generalized anxiety disorder during pregnancy cause problems for the baby?
Pregnancy-related anxiety may trigger premature birth, particularly if the mother suffers from medical conditions in addition to the anxiety disorder.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the anxiety
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat anxiety during pregnancy?
Though surrounded by controversy, there is some evidence that the group of drugs called “benzodiazepines” can cause certain birth defects when used during the first trimester. However, because they are potentially addictive, benzodiazepines are commonly used for a short period of time (for example, to end an anxiety crisis). Therefore, their risk of harming your baby from such short exposure is low. Other anti-anxiety medications, particularly a drug called buspirone, which is given for long-term treatment, have not been shown to be harmful to babies, but studies have been limited. The group of drugs called “selective serotonin reuptake inhibitors (SSRIs)” is frequently used to treat certain anxiety orders, such as panic disorder and post-traumatic stress disorder. There are conflicting reports about the potential harm during pregnancy of SSRIs to the baby. Talk to your doctor about these potential risks.
Who should NOT stop taking medication for anxiety during pregnancy?
Since anxiety can provoke premature delivery and possibly spontaneous abortion (miscarriage), there is a strong motivation to continue treatment of long-active anti-anxiety drugs. However, you and your doctor may decide to try tapering down the usual dose to see how low a dose you can tolerate without your anxiety returning.
What should I know about choosing a medication for my anxiety during pregnancy?
A variety of anti-anxiety drugs and antidepressants are given for generalized anxiety disorder. The concern about possible birth defects varies among the different drugs. If you have just been diagnosed and are not yet taking medications, your doctor can recommend and prescribe a drug that is thought to carry a low risk of complications to your baby.
You may find Pregistrys expert reports about the individual medications to treat anxiety here. Additional information can also be found in the sources listed at the end of this report.
What should I know about taking a medication for my anxiety when I am breastfeeding?
A category of drugs called “tricyclic antidepressants” have been shown to enter breastmilk in concentrations comparable to those of the mothers blood. This is an old group of drugs that usually are not at the top of the list for anxiety treatment anyway, but you should be aware of them. There is evidence that buspirone, which is effective for generalized anxiety disorder, enters breastmilk, but this does not necessarily mean that its harmful to a nursing infant. On the other hand, if you are doing well on an anti-anxiety drug, the prudent thing to do may be to continue your treatment and use infant formula. As always, it is best to discuss the plan with your childs pediatrician.
What alternative therapies besides medications can I use to treat my anxiety during pregnancy?
Various psychotherapies are available. One that has been proven particularly effective for GAD is cognitive-behavioral therapy. If you are pregnant and have just been diagnosed with GAD and have not tried medication yet, a trial of cognitive-behavioral therapy without drug treatment may be worthwhile.
What can I do for myself and my baby when I have anxiety during pregnancy?
It is important to manage mental health conditions with the same seriousness as we approach physical conditions. If you received a diagnosis of anxiety disorder, it means that there are symptoms that may have negative consequences for you and your baby. Therefore, you must balance realistically the risks of drug treatment versus the risks of no drug treatment. Unless your anxiety is very mild, usually the less risky route is to continue taking the drug.
Resources for anxiety pregnancy:
For more information about anxiety during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:
- Anxiety and Depression Association of America
- Massachusetts General Hospital Center for Womens Mental Health