Pre- and Postnatal Anxiety

Many women experience some degree of anxiety during their pregnancies or immediately afterwards. This may be directed towards the gestation itself, including labor and delivery, or it may be more generalized. Anxiety during pregnancy is termed prenatal anxiety, while it is called postnatal anxiety if it occurs in the period from delivery to one year postpartum.

Prenatal Anxiety

Approximately 85% of women undergo moderate to severe stress, because of factors such as:

• Financial difficulty
• Poor job conditions
• Overwork and exploitation at home
• Marital strain
• Complicated pregnancies

What is Prenatal Anxiety?

Prenatal anxiety (pregnancy anxiety) is described as a state of distress or anxiety considered distinct from other anxious states. This is because it is primarily related to worries about the baby’s health, and one’s own experiences with the healthcare team, hospital, and during labor and delivery. Fear of death or serious complications of childbirth are often present.

In addition, the patient may be afraid to fail as a mother. ‘Anxious’, ‘concerned’, ‘panicky’, and ‘afraid’ are all terms that such patients feel to appropriately describe their feelings.

Effect of Prenatal Anxiety on Pregnancy Outcome

Prenatal anxiety has been shown to be associated with preterm delivery i.e., the birth of an infant at a gestational period of less than 37 weeks. This is linked to increased sickness as well as infant mortality.

Prenatal anxiety is associated with a 1.5 times higher rate of preterm birth than in other women, irrespective of other risks to the mother or the baby. Moreover, the timing of labor was observed to be linearly affected by the presence of pregnancy anxiety.

Anxious women have shown less desire to be actively involved in their labor and delivery. They have also  been seen less assertive in expressing their needs, and expected childbirth to be more painful than non-anxious women.

Factors which do not alter Pregnancy Outcome in Anxious Women

• Medical risk
• Racial origin
• Socioeconomic status
• Personality (feeling of self-worth and optimism, having a feeling of competence)

Prenatal Anxiety and Child Outcomes

Studies have shown that the presence of maternal anxiety negatively affects the way the fetal nervous system develops. This occurs via altered functioning of the mother’s hypothalamo-pituitary-adrenal axis, which controls most endocrine functions. This leads to poor physiological homeostasis and eventually results in impaired cognitive, motor, and behavioral development in the child. This effect is particularly powerful when the anxiety is directed towards one pregnancy specifically.

In a study, up to three out of four women with prenatal anxiety or depression continued to have such symptoms during the early childhood years of their children. This had negative effects on the infant’s psychosocial development.

Postnatal Anxiety

Postnatal anxiety has been seen less common than prenatal anxiety. However, women who have had difficult deliveries or have had complications of childbirth tended to have higher rates of postpartum anxiety.

Postnatal anxiety has also been linked to the development of impaired bonding with the infant, detachment, or unwillingness to care for the baby, or resentment towards the infant. Since a high proportion of women with prenatal depression continue to have depression postpartum, this appears to be an obvious and significant risk factor.

Those women who have previously suffered from any form of anxiety disorder before pregnancy or development of prenatal anxiety, should ask their healthcare provider for help and support to improve their health and the health of their child. This is suggested both in the early child-raising years and in later life.

Maternal anxiety is associated with negative effects on the child’s emotional development, temperament, the behavioral reactivity to new situations, delayed muscular and learning skills, hyperactivity and poor attention span, childhood anxiety, and behavioral aberrations.

References

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4447112/
• https://www.ncbi.nlm.nih.gov/pubmed/2340819
• http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/mentalhealthinpregnancy.aspx

Further Reading

• All Postnatal Anxiety Content
• Support for Prenatal and Postnatal Anxiety
• Treatment for Pre and Postnatal Anxiety
• Symptoms of Pre and Postnatal Anxiety

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.