How to Manage Anxiety During Pregnancy

I want to let you in on a little secret, whether you struggled with anxiety prior to pregnancy or recently developed anxiety during pregnancy, YOU ARE NOT ALONE! In fact, according to a study released by the Mental Health Journal, it is estimated that between 20-40% of pregnant women will experience some form of anxiety or depression during their pregnancy. Unfortunately, although you may have heard from a friend, sister or mother-in-law that pregnancy would be the happiest time in your life, for up to 40% of women, pregnancy isn’t always sunshine and rainbows. Anxiety is a serious condition that is so often overlooked. It is something that many women suffer with in silence with limited relief in symptoms. So, why does anxiety seem to get worse in pregnancy and is there anything you can do to manage symptoms? I am glad you ask because, have no fear, Dr. Zen is here!

What causes anxiety during pregnancy? 

As many of you may know, anxiety is multifactorial and can be related to hormone fluctuations, prior heartbreaking miscarriages, as well as nutrient deficiencies and sleep disorders. If you experienced severe nausea during your pregnancy and struggled to consume adequate high quality protein and omega-3 fatty acids, your body may be struggling to create adequate neurotransmitters. Remember neurotransmitters are what regulate our mood and in order to create neurotransmitters our body needs amino acids. We get the majority of our amino acids from protein so without adequate protein we do not have enough amino acids to create neurotransmitters. Another common cause for anxiety in pregnancy is lack of high quality sleep. We know that getting comfortable at night with your growing belly can be difficult and it can be hard to find positions that make you feel comfortable. This lack of high quality sleep (both non-REM and REM sleep) has been suggested by researchers to negatively impact our mood by stimulating our amygdala activity. The amygdala is a part of our brain involved in emotions and mood regulation. An increase in activity has been associated with anger and irritability. It’s also the response why when we are tried, we are often quick to anger. 

What are the symptoms of anxiety disorder during pregnancy? 

Whether you experienced anxiety before pregnancy or it is something that recently started, chronic low-grade anxiety is not normal and something that usually requires further attention. Of course, it is normal to be worried about the unknown future, the health of your baby and the type of mother you will be, but for some women, this worry can become debilitating. It is also common for anxiety during pregnancy to not be related to the baby at all and be something you experience like butterflies in your belly, or heart palpitations that appear to come on with no triggering event or thought. Again, since anxiety can be associated with other more serious medical conditions including high blood pressure (pre-eclampsia) or hyperthyroidism, if you experience the new onset or worsening of anxiety during pregnancy, please consult your doctor. Although anxiety can occur at any time during pregnancy, the rate of generalized anxiety disorder appears to be the highest during the first trimester, this is thought to be due to the dramatic change in hormones seen between a non-pregnant and newly pregnant woman.  Again, this may also be related to a higher risk of nutrient deficiencies also associated more often during the first trimester with patients with severe nausea or morning sickness. 

What are the effects of untreated anxiety on the baby? 

Although anxiety is common does not mean it is normal and this is especially true during pregnancy. Untreated anxiety can be associated with an increased risk of preterm birth, low birthweight, as well as smaller head circumference in recent studies. Although addressing anxiety during pregnancy is critical for a healthy labor and delivery experience. I also urge my patients to address anxiety during pregnancy because untreated anxiety during pregnancy can often show up during postpartum as well. 

What are some treatments for anxiety during pregnancy? 

Although there are some pharmaceutical interventions that can be used in pregnancy, for the most part, the majority of the anti-anxiety medications on the market are not available to patients during pregnancy due to the limited understanding of how these medications may affect the fetus. Although in severe cases, your doctor may suggest pharmaceutical interventions like an SSRI (anti-depressant), most women try to avoid these as much as possible. Although SSRIs do not appear to cause an increased risk of major congenital malformations in the fetus, there are some documented cases of SSRIs impacting an infant shortly after birth and can lead to symptoms such as jitteriness, tremor, crying and trouble feeding. Other common pharmaceutical interventions used include the use of benzodiazepines, like lorazepam (Ativan) and alprazolam (Xanax). However, benzodiazepines have been largely controversial as previous studies showed an association with the use of benzodiazepines and an increased risk of cleft lip and cleft palate. Newer studies, however, did not see the same association, so the verdict is still out. Since this is still a debated topic, many women often would like to refrain from their use, if possible. 

How to Manage Your Anxiety Naturally

Although new onset or worsening of anxiety during pregnancy can be associated with hormonal fluctuation which is something we can not change, we can, however, make a few lifestyle and dietary modifications to help manage and in some cases, resolve your anxiety. 

  • Seek Help- Before we discuss natural treatment options, it is important we address the elephant in the room. Anxiety can again be multifactorial and can be related to a variety of factors. Talking to your doctor, health coach and counselor is a great first step to getting the support you need. It is also an important support you can also establish now that can also serve you in the future during labor and delivery as well as postpartum. Making time to meet with a counselor, health coach and/or your doctor is a great first step. (I know finding a counselor can sometimes be difficult but consider asking your friends, family or check out Sondermind for resources for counselors in your area). 

  • Proper nutrition - as we discussed nutrient deficiencies can be an important factor in anxiety. Making sure you are eating a healthy and well- balanced diet is a critical way to resolve your anxiety. Focusing on incorporating healthy fats and proteins with every meal is an important first step. Be aware that your taste and appetite may change throughout your pregnancy so although a particular food was repulsive to you a few weeks ago, consider experimenting with it again. I also suggest considering high quality clean protein shakes and bone broths as another easy way to get some extra protein in a simple and delicious form. Although a home made smoothie would be my preferred option, a quick Orgain Ready Go protein shake is great to have on hand for days you really don’t feel like eating. 

  • Hydrate, Hydrate, Hydrate- if there is one thing that often gets overlooked when it comes to anxiety it has to be proper hydration. Studies have found that dehydration has been directly associated with anxiety and depression. Making sure you are consuming about half your body weight in ounces per day is an important way to combat your anxiety. Adding in some cucumber, lemon or electrolyte powder can be a great way to get some additional electrolytes (bone broth is also another natural way to get more water and the added electrolytes). 

  • Ensure adequate sleep- whether it’s dimming the lights, creating a calming bedtime routine or investing in that pregnancy pillow you have been resisting, make sleep a priority! Adequate sleep not only can help with mood regulation but it can also reduce the risk of other pregnancy related complications including gestational diabetes. 

  • Breathwork - breathwork is an extremely powerful and underused technique that is evidence-based and a medication-free treatment for anxiety. I always like to remind patients that telling someone to “relax and take a breath” when they are actively anxious never works, instead I encourage you to set aside 5-10 minutes every day to complete some breathwork. The more you practice breathwork the more beneficial it becomes. 

  • Earthing - slipping off your shoes and placing your feet in the sand, grass, dirt or even rocks can be a great way to reconnect with nature. Earthing (otherwise known as grounding) has been documented by researchers to be associated with an increase in blood flow (great if you have noticed you have been more swollen during pregnancy), improved sleep, better mood, more energy, and a reduction in pain. Taking 5-10 minutes every day to spend time in nature with your shoes off, is something that can be done at the same time as your breathwork. 

  • Singing - Did you know that singing out loud (or at humming) iis a great way to reset your parasympathetic (rest and relaxation) nervous system. The vibrations that happen while you sing or hum activate the vagus nerve and help reduce symptoms of anxiety. 

  • Daily movement - unless your doctor says otherwise, daily movement, even just 5-10 minutes of walking, dancing or yoga can be a great way to stimulate your mood and reduce anxiety. 

  • Find your community- experiencing anxiety during pregnancy is no fun but remember you aren’t alone, up to 40% of pregnant women also experience anxiety. But here is the thing, you don’t have to suffer in silence. Make it a point to schedule a fun lunch date with your friends every week, or join a community of mamas to be. 

  • Schedule a monthly massage (Doctor’s Order!)- if there is one thing we don’t do enough of during pregnancy is making time for ourselves. Of course, we are constantly thinking about the baby, all of our doctor’s visits and how to prepare the nursery but, it is equally as important to make time to truly nourish our body, mind and spirit. Setting up regular self-care time is an extremely important way to support your body and your mood during pregnancy. 

  • Magnesium- deficiency in magnesium during pregnancy may increase your risk of high blood pressure and premature labor and has also been associated with an increase in anxiety. Make sure to consult with your doctor before starting any new supplements.

About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...