Current Psychiatry Reports

, Volume 10, Issue 4, pp 331–335 | Cite as

Anxiety disorders in pregnancy

  • Bavanisha Vythilingum


There is now growing realization that many women suffer from new onset or worsening of anxiety disorders during pregnancy. Studies of anxiety symptoms in pregnancy show that a significant portion of women are affected. Anxiety symptoms in pregnancy have been associated with adverse fetal and infant outcomes. Furthermore, having an anxiety disorder during pregnancy is one of the strongest risk factors for postnatal depression. Although the literature on treating anxiety disorders in pregnancy per se is sparse, response to standard treatment is good. The risk of teratogenicity with pharmacotherapy must be considered, but it can be minimized by judicious tapering and cessation of medication during high-risk periods.


Anxiety Disorder Anxiety Symptom Generalize Anxiety Disorder Panic Disorder Edinburgh Postnatal Depression Scale 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Ross LE, McLean LM: Anxiety disorders during pregnancy and the postpartum period: a systematic review. J Clin Psychiatry 2006, 67:1285–1298.PubMedGoogle Scholar
  2. 2.
    Glover V, O’Connor TG: Effects of antenatal stress and anxiety: implications for development and psychiatry. Br J Psychiatry 2002, 180:389–391.PubMedCrossRefGoogle Scholar
  3. 3.
    Heron J, O’Connor TG, Evans J, et al.: The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 2004, 80:65–73.PubMedCrossRefGoogle Scholar
  4. 4.
    Wenzel A, Haugen EN, Jackson LC, Brendle JR: Anxiety symptoms and disorders at eight weeks postpartum. J Anxiety Disord 2005, 19:295–311.PubMedCrossRefGoogle Scholar
  5. 5.
    Sholomskas DE, Wickamaratne PJ, Dogolo L, et al.: Postpartum onset of panic disorder: a coincidental event? J Clin Psychiatry 1993, 54:476–480.PubMedGoogle Scholar
  6. 6.
    Bandelow B, Sojka F, Broocks A, et al.: Panic disorder during pregnancy and postpartum period. Eur Psychiatry 2006, 21:495–500.PubMedCrossRefGoogle Scholar
  7. 7.
    Wisner KL, Peindl KS, Hanusa BH: Effects of childbearing on the natural history of panic disorder with comorbid mood disorder. J Affect Disord 1996, 41:173–180.PubMedCrossRefGoogle Scholar
  8. 8.
    Cohen LS, Sichel DA, Dimmock JA, et al.: Impact of pregnancy on panic disorder: a case series. J Clin Psychiatry 1994, 55:284–288.PubMedGoogle Scholar
  9. 9.
    Majewska MD, Harrison NL, Schwartz RD, et al.: Steroid hormone metabolites are barbiturate-like modulators of the GABA receptor. Science 1986, 232:1004–1007.PubMedCrossRefGoogle Scholar
  10. 10.
    Barron WM, Mujais SK, Zinaman M, et al.: Plasma catecholamine responses to physiologic stimuli in normal human pregnancy. Am J Obstet Gynecol 1986, 154:80–84.PubMedGoogle Scholar
  11. 11.
    Uguz F, Gezgink K, Zeytinci IE, et al.: Obsessive-compulsive disorder in pregnant women during the third trimester of pregnancy. Compr Psychiatry 2007, 48:441–445.PubMedCrossRefGoogle Scholar
  12. 12.
    Neziroglu F, Anemone R, Yaryura-Tobias JA: Onset of obsessive compulsive disorder in pregnancy, the puerperium and premenstruum. Am J Psychiatry 1992, 149:947–950.PubMedGoogle Scholar
  13. 13.
    Williams KE, Koran LM: Obsessive-compulsive disorder in pregnancy and childbirth. In Obsessive Compulsive Disorder: Theory and Management. Edited by Jenike M, Baer L, Minichiello WE. Chicago: Yearbook Medical Publishers; 1990:89–95.Google Scholar
  14. 14.
    Wenzel A, Gorman L, O’Hara MW, et al.: The occurrence of panic and obsessive compulsive symptoms in women with postpartum dysphoria: a prospective study. Arch Womens Ment Health 2001, 4:5–12.CrossRefGoogle Scholar
  15. 15.
    Loveland Cook CA, Flick LH, Homan SM, et al.: Posttraumatic stress disorder in pregnancy: prevalence, risk factors and treatment. Obstet Gynecol 2004, 103:710–717.PubMedGoogle Scholar
  16. 16.
    Beck CT: Post-traumatic stress disorder due to childbirth: the aftermath. Nurs Res 2004, 53:216–224.PubMedCrossRefGoogle Scholar
  17. 17.
    Menage J: Post-traumatic stress disorders in women who have undergone obstetric and/or gynaecological procedures. J Reprod Infant Psychol 1993, 11:221–228.CrossRefGoogle Scholar
  18. 18.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 1994.Google Scholar
  19. 19.
    Ruscio AM, Chiu WT, Roy-Byrne P, et al.: Broadening the definition of generalized anxiety disorder: effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication. J Anxiety Disord 2007, 21:662–676.PubMedCrossRefGoogle Scholar
  20. 20.
    Shear KM, Oommen M: Anxiety disorders in pregnant and postpartum women. Psychopharmacol Bull 1995, 31:693–703.PubMedGoogle Scholar
  21. 21.
    DiPietro J, Ghera M, Costigan K, et al.: Measuring the ups and downs of pregnancy stress. J Psychosom Obstet Gynaecol 2002, 25:189–201.CrossRefGoogle Scholar
  22. 22.
    Weisberg RB, Paquette JA: Screening and treatment of anxiety disorders in pregnant and lactating women. Womens Health Issues 2002, 12:32–36.PubMedCrossRefGoogle Scholar
  23. 23.
    Northcott CJ, Stein MB: Panic disorder in pregnancy. J Clin Psychiatry 1994, 55:539–542.PubMedGoogle Scholar
  24. 24.
    Villeponteaux VA, Lydiard RB, Laraia MT, et al.: The effects of pregnancy on pre-existing panic disorder. J Clin Psychiatry 1992, 53:201–203.PubMedGoogle Scholar
  25. 25.
    Abramowitz JS, Schwartz SA, Moore KM, et al.: Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature. J Anxiety Disord 2003, 17:461–478.PubMedCrossRefGoogle Scholar
  26. 26.
    Leckman JF, Mayes LC: Preoccupations and behaviors associated with romantic and parental love. Perspectives on the origin of obsessive-compulsive disorder. Child Adolesc Psychiatr Clin N Am 1999, 8:635–665.PubMedGoogle Scholar
  27. 27.
    Stein DJ, Bouwer C: A neuro-evolutionary approach to the anxiety disorders. J Anxiety Disord 1997, 11:409–429.PubMedCrossRefGoogle Scholar
  28. 28.
    Andersson L, Sundstrom-Poromaa I, Bixo M, et al.: Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Obstet Gynecol 2003, 189:148–154.PubMedCrossRefGoogle Scholar
  29. 29.
    Milgrom J, Gemmill AW, Bilszta JL, et al.: Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord 2008, 108:147–157.PubMedCrossRefGoogle Scholar
  30. 30.
    Sutter-Dallay AL, Giaconne-Marcesche V, Glatigny-Dallay E, Verdoux H: Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: a prospective survey of the MATQUID cohort. Eur Psychiatry 2004, 19:459–463.PubMedCrossRefGoogle Scholar
  31. 31.
    Schneider ML, Moore CF, Kraemer GW, et al.: The impact of prenatal stress, fetal alcohol exposure, or both on development: perspectives from a primate model. Psychoneuroendocrinology 2002, 27:285–298.PubMedCrossRefGoogle Scholar
  32. 32.
    Bergman K, Sarkar P, O’Connor TG, et al.: Maternal stress during pregnancy predicts cognitive ability and fearfulness in infancy. J Am Acad Child Adolesc Psychiatry 2007, 46:1454–1463.PubMedCrossRefGoogle Scholar
  33. 33.
    Huizink AC, Mulder EJ, Buitelaar JK: Prenatal stress and risk for psychopathology: specific effects or induction of general susceptibility? Psychol Bull 2004, 130:115–142.PubMedCrossRefGoogle Scholar
  34. 34.
    Schoeman J, Grové DV, Odendaal HJ: Are domestic violence and the excessive use of alcohol risk factors for preterm birth? J Trop Pediatr 2005, 51:49–50.PubMedCrossRefGoogle Scholar
  35. 35.
    Wadhwa PD, Glynn L, Hobel CJ, et al.: Behavioral perinatology: biobehavioral processes in human fetal development. Regul Pept 2002, 108:149–157.PubMedCrossRefGoogle Scholar
  36. 36.
    Hansen D, Lou HC, Olsen J: Serious life events and congenital malformations: a national study with complete follow-up. Lancet 2000, 356:875–880.PubMedCrossRefGoogle Scholar
  37. 37.
    Hedegaard M, Henriksen TB, Sabroe S, Secher NJ: Psychological distress in pregnancy and preterm delivery. BMJ 1993, 307:234–239.PubMedGoogle Scholar
  38. 38.
    Buist AE, Barnett BE, Milgrom J, et al.: To screen or not to screen-that is the question in perinatal depression. Med J Aust 2002, 177(Suppl):S101–S105.PubMedGoogle Scholar
  39. 39.
    Austin MP, Lumley J: Antenatal screening for postnatal depression: a systematic review. Acta Psychiatr Scand 2003, 107:10–17.PubMedCrossRefGoogle Scholar
  40. 40.
    Matthey S: Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders. Depress Anxiety 2007 Nov 26 (Epub ahead of print).Google Scholar
  41. 41.
    Bastani F, Hidarnia A, Montgomery KS, et al.: Does relaxation education in anxious primigravid Iranian women influence adverse pregnancy outcomes? A randomized controlled trial. J Perinat Neonatal Nurs 2006, 20:138–146.PubMedGoogle Scholar
  42. 42.
    Zohar J, Westenberg HG: Anxiety disorders: a review of tricyclic antidepressants and selective serotonin reuptake inhibitors. Acta Psychiatr Scand Suppl 2000, 403:39–49.PubMedCrossRefGoogle Scholar
  43. 43.
    Fricchione G: Generalized anxiety disorder. N Engl J Med 2004, 351:675–682.PubMedCrossRefGoogle Scholar
  44. 44.
    Källén BA, Otterblad Olausson P: Maternal use of selective serotonin re-uptake inhibitors in early pregnancy and infant congenital malformations. Birth Defects Res A Clin Mol Teratol 2007, 79:301–308.PubMedCrossRefGoogle Scholar
  45. 45.
    Nulman I, Rovet J, Stewart DE, et al.: Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry 2002, 159:1889–1895.PubMedCrossRefGoogle Scholar
  46. 46.
    Chambers CD, Hernandez-Diaz S, Van Marter LJ, et al.: Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med 2006, 354:579–587.PubMedCrossRefGoogle Scholar
  47. 47.
    Sanz EJ, De-las-Cuevas C, Kiuru A, et al.: Selective serotonin reuptake inhibitors in pregnant women and neonatal withdrawal syndrome: a database analysis. Lancet 2005, 365:482–487.PubMedGoogle Scholar
  48. 48.
    Levey L, Ragan K, Hower-Hartley A, et al.: Psychiatric disorders in pregnancy. Neurol Clin 2004, 22:863–893.PubMedCrossRefGoogle Scholar
  49. 49.
    Schulz MS, Cowan CP, Cowan PA: Promoting healthy beginnings: a randomized controlled trial of a preventive intervention to preserve marital quality during the transition to parenthood. J Consult Clin Psychol 2006, 74:20–31.PubMedCrossRefGoogle Scholar
  50. 50.
    Iqbal MM, Sobhan T, Ryals T: Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant. Psychiatr Serv 2002, 53:39–49.PubMedCrossRefGoogle Scholar
  51. 51.
    Mehdizadeh A, Roosta F, Chaichian S, Alaghehbandan R: Evaluation of the impact of birth preparation on the health of the mother and the newborn. Am J Perinatol 2005, 22:7–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Hamilton-Dodd C, Kawamoto T, Clark F, et al.: The effects of a maternal preparation program on mother-infant pairs: a pilot study. Am J Occup Ther 1989, 43:513.PubMedGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Department of Psychiatry, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa

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