Anxiety-related disorders, such as posttraumatic stress disorder (PTSD) and obsessive–compulsive disorder (OCD), are common mental health issues, affecting one in five women—especially during family planning, pregnancy, and child-rearing. This period brings specific challenges, including concerns about passing anxiety to children, worsening symptoms during pregnancy or after birth, and uncertainty about how treatment might affect pregnancy outcomes. Clinicians often lack the expertise to address these concerns, which can lead to hesitation in starting treatment.
This narrative review by Dr. Willemijn Scholten and Ilja Saris, and colleagues of the Academic Collaborative Center Anxiety, was recently published in Gynecology and Obstretics. This paper provides a review of existing literature on anxiety-related disorders and pregnancy, synthesizing key findings from relevant theoretical and empirical studies.
“I hope this review reaches both clinicians and future parents. Parents deserve to make informed decisions. And clinicians need to be convinced that treating anxiety disorders should not be withheld because of a pregnancy.” – Willemijn Scholten
Anxiety during pregnancy
Research shows that anxiety-related disorders often run in families due to both genetic and environmental factors. These disorders are particularly prevalent during pregnancy and postpartum, and maternal anxiety is linked to a higher risk of preterm birth and low birth weight.
A central finding of the review is that exposure therapy, a core, first-line treatment for anxiety disorders, appears effective and safe during pregnancy, with no known adverse effects on the unborn child. Yet many therapists are reluctant to offer it. “The worry is that the stress levels during exposure therapy are too high for the pregnant patient or that the stress will hurt the baby,” Scholten explains. “But many people forget that having an untreated anxiety disorder already causes a great deal of stress. A follow-up study measuring actual stress levels during exposure therapy in pregnant women would be very interesting.”
The review also addresses medication. SSRIs, particularly sertraline, are considered safe during pregnancy, though side effects for mother and newborn are generally mild and transient. Stopping medication carries its own risk: relapse.
Clinical awareness
Addressing anxiety-related disorders in parents and parents-to-be is essential, as these disorders can negatively affect both parents and children. Greater clinical awareness is needed to improve care for this group.
Willemijn Scholten explains: “I hope this review reaches both clinicians and future parents. Parents deserve to make informed decisions. And clinicians need to be convinced that treating anxiety disorders should not be withheld because of a pregnancy. Especially not during the years when these disorders are most common.”