You’re pregnant, and worried about your unborn baby. That’s perfectly normal, of course. Low to moderate levels of anxiety are experienced by every mother-to-be in pregnancy. They tend to fluctuate during the pregnancy according to certain “milestones” (eg. anxiety about being able to keep the pregnancy, foetal abnormalities, how the delivery is going to go etc.), but anxiety disorders are estimated at about three per cent or so.
Some mums-to-be, however, worry more than others, to the point where their anxiety about pregnancy becomes a disorder, and doctors have realised that this sort of chronic, intense anxiety has negative effects on the mother and the foetus.
They first recognised that intrauterine growth retardation and pre-term labour were associated with this. Research is now showing that anxiety can have subtle effects on the baby’s response to stress and even metabolism, and that these may impact well into childhood and beyond.
“Anxiety runs on a spectrum, and there are no guidelines on the timeframe, but I’d say if it interferes with functioning for a month or more in general, or seems out of proportion to the triggers, then it may be more likely to be a disorder then just anxiety symptoms,” explains Dr Cornelia Chee, Consultant & Director, Women’s Emotional Health Service at the Department of Psychological Medicine, National University Hospital.
How can we tell if someone is suffering from this?
There are actually several different anxiety disorders. The most common one would be the “garden variety” anxiety, where your family member or colleague seems to be irritable, tense, have difficulty concentrating, have headaches, or body aches.
Some others may have panic attacks (episodes of intense anxiety, a feeling of losing control, palpitations, trembling and sweating, among the symptoms) which may come with the above anxiety disorder or as a stand-alone.
Yet another type of anxiety disorder is obsessive-compulsive disorder, in which a mother may become overly concerned about a baby’s hygiene and safety, and have to perform repeated checks on him/her, or only allow certain people to touch the baby.
Finally, a rather specific anxiety disorder is that of post-traumatic stress disorder. Symptoms of this may include unwanted re-experiencing of the trauma, hyperarousal (for example, being easily startled), avoidance of reminders of the traumatic experience, and numbing.
A woman who may have had an intensely distressing delivery where there was intense horror, shock or helplessness involved – which occasionally happens because, let’s face it, no delivery is ever guaranteed to be entirely predictable and emergencies can arise – can experience the delivery as a trauma and have symptoms of PTSD. Some women even avoid having another baby again because of an intensely traumatic previous delivery. The literature on this is very sparse.
What’s the worst case that you have come across?
The worst case I have ever come across was a woman who developed intense anxiety soon after she got pregnant. She worried incessantly about everything and couldn’t control her thoughts at all, felt constantly tense and irritable, and slept very poorly.
Ironically, despite it being a welcome pregnancy after failed subfertility treatment, she was feeling so miserable that she constantly had to battle with thoughts of wanting to end the pregnancy. She lay in bed all day and couldn’t even parent her seven-year old son properly. After a course of medication she eventually experienced a relief in her symptoms and was able to return to work during the later part of her pregnancy.
We always need to do an individualised risk-benefit analysis and discuss this thoroughly with the mum-to-be.
What are the risks of medication to the baby versus the risk of having an untreated anxiety disorder, given that this is a risk too?
Mild anxiety is easily managed with non-medication strategies but the more moderate to severe the symptoms are, the less likely one is to respond to non-medication strategies.
What are the mother’s resources and preferences?
Antidepressants, which despite their name, are effective for anxiety disorders, can be used in pregnancy. There will never be drug studies done on pregnant women, so the kind of research evidence that doctors use to recommend medications cannot thus be obtained, but we have case reports and birth registries, and the data we do have is reassuring.
Some antidepressants have been around for about 50 years, and not shown to increase the risk of miscarriages or malformations.
What kinds of coping techniques can mums-to-be learn?
• Seek others who are in the same boat. Information and support can be helpful (though conflicting advice can make one even more confused). Choose someone you trust who has the experience and is willing to understand that everyone has a slightly different set of circumstances and baby.
• Exercise if your doctor allows you. Regular exercise is best.
• Be aware of the need to take care of yourself first, both physically and emotionally. This should not be relegated to what’s left over of your time and energy after all the other demands on you.
• Think positively and flexibly. Pregnancies and babies always spring surprises so it’s best to develop the idea of “rolling with it”.
• Don’t be afraid to seek help. One of the differences I see between mums who may have been born in Western countries is that they are more likely to see me “just to get a baseline assessment and in case I need help”, which may or may not be the case. Mums who are born locally tend to suffer in silence for far too long before they come forward.
Where to get help
The National University Hospital (NUH) has a Women’s Emotional Health Service. Call the hotline at 6772 2037 to book an appointment.