Anxiety disorder during pregnancy, guest post by Dr Lucinda Green

Worried about your anxiety disorder during pregnancy?

Priory expert advises on how to take care of yourself and your baby

For women with anxiety disorders who are concerned about the impact it will have on themselves and their child during pregnancy, Dr Lucinda Green, Consultant Perinatal Psychiatrist at Priory Wellbeing Centre Harley Street, has advised on how they can take care of their mental health at this time.

It is common to be anxious about many different things in pregnancy, including the possibility of having a miscarriage, coping with childbirth and the challenges of motherhood. Anxiety as a symptom can also be part of a mental illness, including panic disorder, generalised anxiety disorder (GAD), obsessive compulsive disorder (OCD), phobias and post-traumatic stress disorder (PTSD). Anxiety symptoms are also common in depression.

Women are twice as likely as men to be affected by an anxiety disorder during their lifetime.[1] At least 15% of women have an anxiety disorder during pregnancy.[2]

“It is important for women who have an anxiety disorder to think about the care and treatment they need during pregnancy”, says Dr Lucinda Green, a Consultant Psychiatrist at Priory Wellbeing Centre Harley Street.

“Pregnancy is not protective against mental illness. Having a previous anxiety disorder can increase the risk of this happening in pregnancy. However, having a current or previous anxiety disorder doesn’t mean that you will definitely become more anxious. Having good support, positive coping strategies for stress, and treatment if you need it, can all help you to manage your anxiety and prevent it worsening in pregnancy.”

Don’t suddenly stop taking your anxiety medication

Dr Green recommends that women with anxiety disorders talk to their GP or psychiatrist who can help them to weigh up the risks and benefits of medication during pregnancy.

“Decisions about whether to continue, stop or change medication in pregnancy are not straightforward.

“Selective serotonin reuptake inhibitors (SSRIs) antidepressants, such as sertraline, fluoxetine and citalopram, are the most commonly prescribed medications for anxiety. Many women take these medications in pregnancy. If your anxiety has been severe, causes a lot of distress, or impacts on your ability to manage everyday tasks, it may be best for you and your baby that you continue medication.”

Dr Green explains that, where possible, it’s important to have this conversation when planning the pregnancy, but if this isn’t possible, don’t worry: “Many pregnancies are unplanned so don’t worry if you haven’t managed to get advice about your medication.

“Many women have to make decisions about medication when they are already pregnant. You should not stop your medication or reduce the dose without discussing this with your doctor. Stopping medication suddenly can increase the risk of relapse.”

The impact of your anxiety on your pregnancy and baby

Many women worry about how their anxiety will affect their baby and this can make them even more anxious.

Dr Green says: “The research in this area is complex. Whilst there are studies which show that anxiety in pregnancy can have a lasting impact on babies, there are many different factors which will affect your baby’s wellbeing and development.

“Having an anxiety disorder does not mean that your baby will necessarily have problems later on. How you care for your baby after birth is very important. Getting treatment for an anxiety disorder so that you are as well as possible when your baby is born will help to make sure that he or she has the best start in life.”

For women worried that they may pass on their anxiety to their child, Dr Green says: “Anxiety disorders are caused by a combination of factors. Having a parent with an anxiety disorder is one of these, but it accounts for only around a third of the risk. So if you have an anxiety disorder it does not mean that your child will develop the same problems.”

Dr Green’s tips on managing anxiety during pregnancy

“There is a lot of help and support available for women who have anxiety and other mental health problems in pregnancy”, says Dr Green. “The help you need will depend on how severe your anxiety problems are. Talk to your midwife and GP to find out what help and support is available in your area.”

She also encourages women to consider the following suggestions:

1. Make time to relax – make time to do things you find relaxing, whether this is going for a walk with a friend or having a hot bath
2. Practise mindfulness – accessible through groups and apps such as Headspace, this helps you to focus on the present moment rather than worrying about things in the past or the future. It has been shown to be helpful for anxiety
3. Exercise – physical exercise can make a difference to anxiety. Talk to your midwife about exercises you can do in pregnancy, such as swimming or yoga
4. Look after your physical health – sleep and rest when you can, eat healthily and make sure you get treatment for any physical health problems
5. Avoid alcohol and drugs - these can make anxiety worse and importantly, can also cause significant harm to your unborn baby
6. Talk - it can be a relief to share your worries with someone you trust
7. Source support groups and helplines – ask your midwife or GP about local support groups for women who have anxiety in pregnancy. You can also contact one of the organisations listed below
8. Prepare for the birth – going to antenatal classes and making a birth plan with your midwife can help you feel more in control and reduce the anxiety you have about birth
9. Attend talking therapies – ask your GP to refer you for a talking therapy, such as cognitive behavioural therapy (CBT). You can self-refer to your local Improving Access to Psychological Therapies (IAPT) service for talking therapies. IAPT services usually give priority to women who are pregnant or who have a young baby
10. Talk about medication – talk to your GP or psychiatrist about using medication if your anxiety disorder is severe or does not respond to a talking therapy
11. Access your perinatal mental health service - if you have a severe mental health problem, you can be referred to a perinatal mental health service. This is a service with a team of mental health professionals who specialise in caring for women who have mental health problems in pregnancy and after birth

Further information, help and support

· Tommys - information about anxiety and panic attacks in pregnancy
· Netmums - information about anxiety and peer supporters offering advice and support online
· Maternal OCD - information and peer support for women with perinatal OCD. Peer support via phone, skype and email
· PANDAS Foundation - information and support, including a helpline and email support, for women experiencing anxiety and depression in pregnancy or the postnatal period
· Mind - information about perinatal anxiety
· Birth Trauma Association - information and support for women who have PTSD due to a traumatic birth
· Best Beginnings - videos of women describing their experience of antenatal and postnatal mental health, and treatment. Also available on the Baby Buddy App
· Headspace - meditation and mindfulness information and guidance