A Guide to Protecting Your Mental Health During Pregnancy

It's More Than Just "Hormones" or "Mood Swings"

While hormonal shifts are a real and powerful part of pregnancy, it is a harmful myth that all emotional distress during this time can be dismissed as "just hormones." Prenatal anxiety and depression are real, treatable medical conditions, not just exaggerated pregnancy mood swings.

Prioritizing Your Mental Wellness for a Healthier Pregnancy

Taking proactive steps to care for your mental health is one of the most important things you can do for yourself and your baby. A supported and emotionally regulated parent creates a healthier environment for a developing baby and lays the foundation for a smoother postpartum transition.

What Are Prenatal Mood and Anxiety Disorders (PMADs)?

While often associated with the postpartum period, PMADs can and frequently do begin during pregnancy.

Understanding Prenatal Depression

Prenatal depression is a form of clinical depression that occurs during pregnancy, affecting more than 1 in 10 pregnant people. It is more than just feeling sad. Symptoms include:

• A persistent low mood, hopelessness, or emptiness.
• A loss of interest or pleasure in activities you used to enjoy.
• Significant changes in sleep or appetite (beyond normal pregnancy changes).
• Feelings of worthlessness or excessive guilt.
• Difficulty concentrating.
• Thoughts of self-harm.

It's important to recognize the signs of high-functioning prenatal depression, where you may appear fine on the outside while struggling intensely on the inside.

Understanding Prenatal Anxiety

Prenatal anxiety is even more common than prenatal depression. It is characterized by excessive, uncontrollable worry that interferes with your daily life. Symptoms include:

• Racing, intrusive thoughts you can't turn off.
• A constant sense of dread or that something terrible is about to happen.
• Physical symptoms like a racing heart, dizziness, or shortness of breath.
• Panic attacks.

The Trimester-by-Trimester Guide to Common Pregnancy Fears

Anxiety during pregnancy often follows a predictable pattern, with fears shifting as you move through each trimester. Our guide to managing anxiety during pregnancy offers more detail.

First Trimester: Fears of Loss and Viability

The first 12 weeks are often a period of intense, private worry. Common fears include miscarriage, ectopic pregnancy, and a general anxiety that the pregnancy isn't "real" or won't last.

Second Trimester: "Scanxiety" and Worries About Baby's Health

As the risk of miscarriage decreases, anxiety often shifts to the baby's health. The anatomy scan around 20 weeks can be a major source of "scanxiety." Worries about fetal movement also become common.

Third Trimester: Fears of Childbirth (Tokophobia) and the Postpartum Period

As the due date approaches, fears about labor, delivery, and potential complications can become all-consuming. For some, this can be a severe fear of childbirth known as tokophobia. You may also feel anxious about your ability to care for a newborn and the transition to parenthood.

What Causes Mental Health Challenges During Pregnancy?

Hormonal Shifts, Sleep Disruption, and Physical Discomfort

The massive hormonal changes of pregnancy, combined with sleep disruption and the often-intense physical discomforts (like nausea and pain), can put a significant strain on your nervous system and make you more vulnerable to anxiety and depression.

A History of Mental Health Conditions

If you have a personal or family history of anxiety, depression, or another mental health condition, you are at a higher risk for developing a PMAD during pregnancy.

Stress from a High-Risk Pregnancy or Previous Loss

Navigating a high-risk pregnancy brings a layer of stress and fear that can be a powerful trigger for anxiety. Similarly, a history of infertility or a previous pregnancy loss can make a subsequent pregnancy a time of intense worry rather than joy.

Can Stress and Anxiety Affect My Unborn Baby?

Understanding the Connection

This is a common fear, and it's important to address it with facts, not shame. Chronic, high levels of stress can affect an unborn baby because the stress hormone, cortisol, can cross the placenta. Everyday, manageable stress is not a concern. However, the kind of severe, untreated anxiety or depression that keeps your body in a constant state of fight-or-flight can have an impact.

Why Getting Help is the Best Thing You Can Do for Your Baby

This information is not meant to cause more guilt; it is meant to empower you. The single best way to protect your baby from the effects of chronic stress is to get effective treatment for your own mental health. Seeking therapy or talking to your doctor about medication is an act of profound love and protection for your child.

Proactive Strategies for Protecting Your Mental Health

Building Your Support System

You were not meant to do this alone. Proactively build your village. Talk to your partner, a trusted friend, or a family member about your fears.

Mindfulness and Stress-Reduction Practices

Simple practices like deep breathing, gentle prenatal yoga, or guided meditation can help calm your nervous system. Our guide to mindfulness during pregnancy offers a great starting point.

Creating a "Fourth Trimester" Plan

Much of the anxiety in late pregnancy is about the unknown of the postpartum period. Creating a postpartum recovery plan can give you a sense of control and preparedness.

When and How to Seek Professional Help

Signs It's Time to Talk to Someone

If your anxiety or depression is making it hard to get through the day, if it's impacting your relationships, or if you are having thoughts of self-harm, it is time to seek professional help.

Is Therapy and Medication Safe During Pregnancy?

• Therapy: Therapy is completely safe and highly effective during pregnancy. It is the first-line treatment for mild to moderate prenatal anxiety and depression.
• Medication: There are many antidepressant and anti-anxiety medications that are considered safe to use during pregnancy. The small potential risk of the medication must be weighed against the known risks of untreated maternal depression or anxiety. This is a nuanced conversation to have with a qualified provider, like a reproductive psychiatrist.