INFORMATION FOR WOMEN WHO HAVE STRESS DURING PREGNANCY OR BREASTFEEDING
What is stress during pregnancy?
There is an expression that a little bit of stress is a good thing, because it keeps you on your toes, and everybody feels stressed out from time to time, particularly during pregnancy. When we talk about having stress during pregnancy, we mean that you feel as though you are in a constant struggle throughout the day on many days. You may have an anxiety disorder, or at least you have features of an anxiety disorder. You may be on the border between what mental health professionals would call normal and what would qualify as a bonafide anxiety disorder.
How common is stress during pregnancy?
Since stress is not a disease per se, there is no way to calculate or estimate how many pregnant women suffer from stress. However, a condition called generalized anxiety disorder (GAD) has a prevalence of 8.5 – 10.5 percent during pregnancy, and following delivery, it occurs as 4.4 10.8 percent. GAD is one of several behavioral conditions that group into what psychiatrists and psychologists call anxiety disorders.
How is stress during pregnancy diagnosed?
Anxiety disorders are diagnosed based on specific diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V). Such a diagnosis requires three or more of the following, occurring for more than six 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)
The GAD-7 scale is another tool. It provides a numerical grading of anxiety based on the presence or absence of the following 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, there is the Beck Anxiety Inventory, which also quantifies anxiety, but using 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 stress cause problems during pregnancy?
Severe stress can exacerbate the physical discomforts of pregnancy. Under certain circumstances, stress and especially an anxiety condition can trigger premature labor. It also can interfere with your sleep, and that lack of sleep can then cause additional stress, leading to a vicious cycle.
Does stress during pregnancy cause problems for the baby?
Severe stress can trigger premature birth.
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 stress. These can be significant
- 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 stress during pregnancy?
A class of anti-anxiety drugs called benzodiazepines may cause certain birth defects if given during the first trimester. However, these drugs are very addictive, so they are used only for very short term treatment anyway. A drug called buspirone, which is given for long-term treatment for generalized anxiety disorder, has not been shown to be dangerous during pregnancy, although studies are limited. Selective serotonin reuptake inhibitors (SSRIs) are another class of drugs given as treatment for certain anxiety orders. In particular, SSRIs are given for panic disorder and post-traumatic stress disorder (PTSD). SSRIs are not thought to be harmful during pregnancy or breastfeeding.
Who should NOT stop taking medication for stress during pregnancy?
If you are being treated for an anxiety disorder, you and your doctor may decide to try tapering down the usual dose to see how low a dose you can tolerate without feeling stressed.
What should I know about choosing a medication for my stress during pregnancy?
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 for the developing baby. This may end up being buspirone or an SSRI.
You may find Pregistrys expert reports about the 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 stress when I am breastfeeding?
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, breastfeeding, while good for both mother and baby, is not necessary, so if you are doing well on an antianxiety drug, the prudent thing to do may be to continue your treatment and use infant formula. Whatever you do, it is best to discuss the plan with your childs pediatrician.
What alternative therapies besides medications can I use to treat my stress during pregnancy?
Psychotherapy can be helpful, particularly a type called cognitive-behavioral therapy (CBT). If you are not taking any medication yet, a trial of CBT without drug treatment may be worthwhile. However, medication may ultimately be helpful later in pregnancy or following birth. If you feel stressed out but do not have an identifiable anxiety condition, exercise could also be helpful. This can involve taking long, brisk walks, or even just stretching. There are many exercise classes for pregnant women that incorporate relaxation, mindfulness, and guided visualization that can help to reduce the normal stress of pregnancy.
What can I do for myself and my baby when I have stress during pregnancy?
Realize that stress can have real consequences for you and your baby. Balance the risks of drug treatment against the risks of no drug treatment in consultation with your doctors.
Resources for stress in pregnancy:
For more information about stress during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or visit the following links:
- Massachusetts General Hospital Center for Womens
Mental Health https://womensmentalhealth.org/
- Anxiety and Depression Association of America: Pregnancy and Medication