Pregnancy Anxiety: Symptoms, Risk Factors, and Treatment
When Lisa*, 36, came to therapy she was 11 weeks pregnant. Her anxiety was negatively affecting her work, and she felt disconnected from her husband, family, and friends. She often described herself as feeling worried and afraid. This would be Lisa's first time in therapy. She knew these new feelings required a different level of support.
I'm Janel Coleman, an EMDR-trained licensed psychotherapist, trained full-spectrum doula, and AASECT Certified Sexuality Educator. I specialize in supporting women during the journey to motherhood. This blog will cover how to recognize anxiety in pregnancy, the risks, and how to manage symptoms to have a healthy pregnancy.
Pregnancy anxiety (also known as antenatal anxiety or maternal anxiety), is present when there are persistent feelings of worry, stress, or fear during pregnancy. Although many women may have already experienced some sort of anxiety disorder before trying to conceive, according to the American College of Obstetricians and Gynecologists, there are many people who experience anxiety for the first time during pregnancy. In fact, according to large systematic review, about 20% of women will have a new onset of anxiety during pregnancy.
Pregnancy Anxiety: What Is It?
Pregnancy anxiety is similar to generalized anxiety disorder in that there is an experience of constant worrying, stress, or fear, but during pregnancy. It is completely normal for pregnant people and expectant mothers to occasionally report feeling anxious or feeling nervous, especially if this is their first pregnancy or there was a previous loss. However, if the emotional distress or mood changes are consistently getting in the way of daily functioning, then it is important to pay closer attention and access outside support or treatment options.
Screening is important in prenatal care because common symptoms due to hormonal changes during pregnancy can cause anxiety symptoms to be overlooked. There is often an overlap of anxiety and depression symptoms because the impact of anxiety symptoms on one's daily life can cause depressive feelings, like sadness and low energy. Medical professionals must be aware of the signs to look out for and intentionally care about the physical and mental well-being of the mother, and not solely the baby's health.
What Does It Feel Like? 4 Symptoms of Perinatal Anxiety
1. Panic Attacks
Panic attacks are more than feeling anxious. They are a sudden and intense experience of fear, dread, or feeling like you are losing control.
During a panic attack you may experience :
racing or rapid heartbeat
shortness of breath
trembling or tingling in the body
Some people describe that a panic attack can feel like they are having a heart attack, dying, or "going crazy". Experiencing a panic attack, especially for the first time, can be a very scary experience. If you have repeated and unexpected panic attacks, coexisting with avoidance and fear of future attacks, then you may have a panic disorder. Risk factors for panic attacks include family history, history of health-related anxiety, and major stressful life events.
2. Intrusive thoughts
Anxiety during pregnancy can trigger intrusive thoughts. Intrusive thoughts are different from your usual way of thinking and can be described as disturbing or troubling. You may feel embarrassed and ashamed about what is popping into your head.
Some of the most common anxious intrusive thoughts that pregnant women often experience include:
fears of feeling sick, generally unwell, or experiencing severe morning sickness
fears of preterm labor or preterm birth
fears of giving birth or of labor complications including c-sections
fears of complications for the baby including low birth weight, jaundice, and overall health
Some pregnant people or expectant mothers may wonder if their intrusive thoughts are a symptom of obsessive-compulsive disorder (OCD). While perinatal OCD requires a full evaluation in order to be diagnosed, signs that it may be present include when there are intrusive thoughts related to harming the baby, thoughts of self-harm, the thoughts are highly distressing, and significantly get in the way of the mother's ability to care for and interact with her baby. Repetitive actions may accompany these thoughts with the intention to alleviate the anxious feelings. The good news is that having perinatal OCD does NOT mean you are necessarily going to act on these intrusive thoughts - but you absolutely should reach out for evaluation and treatment so that both your well-being and your baby's can be protected throughout your pregnancy.
3. Social Anxiety
Socializing and engaging with community is an essential part of self-care. Anxiety in pregnancy can result in self-isolation and increased social anxiety. For some pregnant women, they can experience an increased sense of feeling irritable, making it even more difficult to be in social situations. Anxiety during pregnancy can also be triggered by pressures from within your social system, such as family members or friends, to have specific experiences or feelings towards those experiences. For example, your social system may speak fondly of enjoying their bellies growing during pregnancy, but that is actually a part of pregnancy you are not enjoying. This pressure can lead to isolation and anxiety about your authentic experiences.
4. Physical symptoms
Physical symptoms of anxiety during pregnancy are often missed since they can overlap with uncomfortable pregnancy symptoms that many women experience. These can include:
Muscle pain or tension
Excessive sweating
Shortness of breath
Difficulty sleeping
Lightheadedness
Keeping track of the severity and onset of these physical symptoms can help your medical provider determine if the physical symptoms are expected during your phase of pregnancy or if they are an indicator of anxiety. Checking with your OBGYN about what levels of movement are recommended in your case can be helpful as some of these symptoms can be also lessened through regular exercise.
Practical Steps For Pregnant Women To Manage Anxiety
1. Create your birth plan
Birth plans can create a sense of agency during the often unpredictable experience of labor and delivery. You can plan in advance the type of environment or sensory experience you would like to have, the care for your baby, and considerations for when the unexpected does happen.
2. Prepare focused questions for prenatal appointments
A great doctor will leave time for you and your partner to ask questions. Preparing questions in advance can help with managing the effects of pregnancy brain fog and ease your worries about unknown parts of the experience.
3. Engage in gentle physical activity
Safe, moderate activities like walking or prenatal yoga lower cortisol, a stress hormone, and support mood regulation.
4. Practice relaxation techniques
A short mindfulness practice (5 minutes) or deep breathing exercises calm the nervous system and stress responses. Pregnancy-specific guided meditations can be found on youtube or apps like Insight Timer.
5. Build a reliable social support network
Isolation or an inadequate support system is a risk factor for prenatal anxiety. A dependable support network, that can be there to help with tasks and be a listening ear, is necessary during pregnancy and throughout the life of the child.
6. Sleep hygiene practices
Sleep can be a challenge during pregnancy. Sleep hygiene practices like a consistent bedtime, a cool room, comfortable pillows, winding down before bed, and limiting screen use can increase the quality of sleep and resilience to stress.
How Therapy Can Help with Pregnancy Mental Health
Therapy during pregnancy can support you in managing feelings of anxiety. A therapist provides a confidential and compassionate space to talk about any existing fears, changes in your physical and mental health, relationship challenges, and any concerns about postpartum and parenting. A therapist can support you in developing practical coping tools that can support you through the pregnancy and beyond. You might benefit from therapy if you experience persistent worry, difficulty sleeping, physical health symptoms like a racing heartbeat or tension in your body, avoidance of prenatal care or preparing for the baby, or an overall feeling of the anxiety being overwhelming.
Therapy approaches can include cognitive behavioral therapy (CBT) to address distorted beliefs or dysfunctional thoughts about yourself or the pregnancy. Mindfulness approaches can guide you in being present with your thoughts and accepting them. Additionally, Eye Movement Desensitization and Reprocessing (EMDR) can support you in healing from traumatic experiences or negative beliefs about yourself that are contributing to your anxious thoughts.
A mental health professional with specific prenatal anxiety training and experience is important. A therapist who understands the specific fears and concerns associated with the pregnancy experience and the biological experience of pregnancy will be able to know the difference between typical worries and other mental health conditions, as well as when a higher level of care may be needed.
FAQs about Anxiety in Pregnancy
Are there any anxiety medications safe in pregnancy?
Yes, there are anxiety medications considered safe in pregnancy by many psychiatrists. Selective serotonin reuptake inhibitors (SSRIS) like sertraline (Zoloft) are among the most commonly prescribed, and many OBGYNs and reproductive psychiatrists feel confident prescribing them during pregnancy. Other options, such as buspirone, may also be considered depending on the clinical picture. This is always a decision to make in close collaboration with your doctor, as the right choice depends on your own medical history, symptom severity, and trimester.
It's also worth noting that untreated severe anxiety carries its own risks in pregnancy for both the mother and baby. Taking medication for anxiety isn't always necessary, but for some people, it's the most responsible choice.
What is tokophobia and how does it differ from perinatal anxiety?
Tokophobia is the severe fear or phobia of being pregnant or giving birth. The difference between tokophobia and perinatal anxiety lies in focus and intensity. Perinatal anxiety typically moves across many worries at once, including the baby's health, finances, and what parenting will be like, while tokophobia narrows onto pregnancy and birth themselves at the intensity of a specific phobia, which is what drives the avoidance patterns described below. Tokophobia is actually more common than many people expect, with 16.5% of women experiencing it, according to a 2026 global meta-analysis. Tokophobia can cause some women to choose a C-section even when vaginal delivery is possible, seek an abortion, avoid sexual intercourse, not feel emotionally connected to the fetus, lack excitement about the pregnancy, hide their pregnancy, or feel disconnected from their support system. Tokophobia can occur even if someone has never experienced pregnancy. Treatment can include cognitive behavioral therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) to address past traumatic experiences related to pregnancy, labor, and delivery.
What are the top risk factors for anxiety during pregnancy
The most well-documented risk factors fall into four categories. Recognizing which ones apply to you is useful information to bring to your OBGYN, midwife, or therapist, since it can shape how closely your mental health is monitored during the pregnancy.
Hormonal influences: rapid shifts in estrogen, progesterone and cortisol increase reactivity to stress
Psychosocial stressors: financial strain, lack of or inadequate social support, intimate partner violence, childhood abuse, high number of adverse life events, state of the world, stress about disproportionate mortality and morbidity rates for Black women specifically
Mental health history: a prior history of anxiety, depression, post-traumatic stress disorder (PTSD), or other psychiatric conditions
Pregnancy complications: previous pregnancy loss,birth trauma, or medical complications associated with current pregnancy
When does anxiety peak in pregnancy?
While many women experience anxiety at all different points of pregnancy, the most common peak of pregnancy anxiety comes during the first or the third trimester. During the first trimester, hormones spike quickly, often leading to overall physiological sensitivity and increased cortisol. Additionally, struggles like morning sickness and excessive fatigue can deplete many pregnant women's ability to cope. Conversely, many pregnant women report that it's in the third trimester that fears about labor and the newborn phase start to become more present.
Are anxiety and depression common while pregnant?
Both anxiety and depression in pregnancy are a lot more common than many people realize. Up to 20% of women experience either depression or anxiety at some point in their pregnancy. What makes this most concerning is that even though postpartum depression and anxiety are some of the most common postpartum complications, as cited by ACOG, there is still a huge gap in not only screening but also treatment of these conditions.
What are other resources than talk therapy I can access?
Support is available at any hour, and you don't need to be in crisis to reach out. If you are having thoughts of harming yourself, or you feel unsafe, call or text 988 to reach the Suicide and Crisis Lifeline, which is free and confidential 24 hours a day. For pregnancy-specific support, the National Maternal Mental Health Hotline can be reached by call or text at 1-833-TLC-MAMA (1-833-852-6262). Postpartum Support International runs a HelpLine at 1-800-944-4773 along with providing the option of joining support groups for pregnancy anxiety, pregnancy after loss, and NICU parents. If you are in immediate medical danger, call 911 or go to your nearest emergency room. Sharing what you are experiencing with your OBGYN or midwife is also a great first step, since many practices screen for perinatal mood and anxiety conditions and can connect you with care directly.
Final thoughts
Pregnancy can be both an exciting and vulnerable time. Prenatal anxiety can exist with the new mental, emotional, and physical changes. Fortunately, the anxiety is manageable. It is important for you and your support system to recognize the symptoms and know when to seek additional help. Finding a therapist who specializes in perinatal mental health, or mental health during pregnancy, can be supportive even if you are simply concerned about managing stress during this time and preparing for the future. If you have risk factors for having anxiety during pregnancy, seeking care before the overwhelm of symptoms can be a proactive way to support the health of you and your baby.
Culturally competent care in women's health matters. Without this consideration, prenatal anxiety can go unnoticed. Finding medical providers, therapists, and support groups that are culturally responsive is essential to reducing adverse impacts of maternal mental health challenges.
Whether you're just starting to think about trying to conceive, are newly pregnant, or about to give birth, I encourage you to reach out for a complimentary consultation today.
Written By: Janel Coleman, LMSW
Clinically Reviewed by: Kristin Anderson, LCSW
*In our writing, we use vignettes that are common to many clients we treat but do not represent any one client. Any details that could identify a person have been changed or invented, in keeping with HIPAA and our obligations around client confidentiality.