Definition and Diagnosis
Perinatal anxiety disorders encompass generalized anxiety, panic disorder, and obsessive-compulsive symptoms with onset or marked worsening during pregnancy or the postpartum period, frequently centered on fears about fetal or infant health, harm, or the individual's adequacy as a parent.
Epidemiology
Anxiety symptoms are common in the perinatal period and, in many studies, are reported at rates equal to or higher than postpartum depression, though they receive comparatively less clinical attention and are frequently under-recognized.
Risk Factors
Risk factors include a personal or family history of anxiety disorders, prior pregnancy loss or birth trauma, high-risk or complicated pregnancy, first-time parenthood, limited social support, and co-occurring depressive symptoms.
Symptoms and Subtypes
Presentation includes excessive, hard-to-control worry about the pregnancy, delivery, or infant's wellbeing, physical symptoms of anxiety such as restlessness and muscle tension, panic attacks, and, in some cases, intrusive, unwanted thoughts of accidental or intentional harm to the infant that cause marked distress despite being egodystonic.
Diagnosis
Diagnosis follows standard criteria for the relevant anxiety or obsessive-compulsive disorder, applied with attention to perinatal onset and content, using validated screening tools alongside clinical interview to distinguish clinical anxiety from the normative worry common in new parents.
Treatment
Treatment includes CBT (including perinatal-specific protocols), and pharmacotherapy with SSRIs when indicated, selected with consideration of pregnancy and breastfeeding safety profiles. Psychoeducation, peer support groups, and involvement of partners in care planning are valuable adjuncts.
Prognosis
Most individuals respond well to therapy and, where needed, medication, with significant reduction in symptoms and improved capacity to bond with and care for the infant. Untreated perinatal anxiety can persist and negatively affect maternal wellbeing and infant development, making early identification important.
Reference
Sadock, B. J., Sadock, V. A., & Ruiz, P. Kaplan & Sadock's Synopsis of Psychiatry (11th ed.).