Pregnancy can be both an exciting and worrying time for parents-to-be. Pregnant women experience a range of physical and emotional changes, all of which may trigger anxiety. Fear of the unknown, stress, feelings of insecurity over work or money, and daily pressures add to hormonal changes during pregnancy and may make women feel overwhelmed. Couple this with the constant worry over the baby’s health, and anxiety becomes a real possibility.

Boston-area researchers looked at the rates of detection and treatment of maternal anxiety by obstetricians during pregnancy and at six weeks postpartum. They screened nearly 500 women and compared the results with each woman’s medical records.

More than 20 percent of tested positive for an anxiety disorder, depressive symptoms, or both prenatally, and 17 percent screened positive at six weeks postpartum. But “the majority of women who screened positive were not identified by their providers during pregnancy or postpartum,” say the experts.

“Only 15 percent of positively screened participants had evidence of any mental health treatment during pregnancy. In the postpartum period, only 25 percent of positively screened postpartum women received treatment,” they report, adding that care is “seriously lacking and needs to be addressed.”

Elevated anxiety can affect mother-infant interactions, warn researchers from Michigan State University. They write, “Many postpartum women experience emotional dysregulation, often involving elevated anxiety.” A range of brain and hormone factors could contribute to this anxiety. They add that recent contact with infants seems to mitigate this anxiety.

Women who have suffered adverse outcomes in previous pregnancies are at particular risk. Miscarriage, fetal death, and preterm birth reduce women’s quality of life scores and significantly raise their anxiety scores during subsequent pregnancies. One study found that “health anxiety” was only elevated in pregnant women who had experienced earlier complications during pregnancy.

However, anxiety relating to childbirth is widespread among pregnant women. A team from the University of British Columbia, Canada, surveyed 650 women at 35 and 39 weeks gestation, with low-risk pregnancies. Twenty-five percent of women reported high levels of childbirth fear, and this was positively correlated with anxiety, daily stressors, and less available help. “Fear of childbirth appears to be part of a complex picture of women’s emotional experiences during pregnancy,” say the team.

A further study focused on mothers older than 35. The researchers, from Finland, reviewed women’s attitudes to the risks associated with pregnancy in this maternal age group. They write, “Being ‘at risk’ (due to age) causes anxiety and concern, which older pregnant women try to ease by preparing themselves for pregnancy and seeking information.

“While these women want to be as well-informed and prepared as possible, the information they receive can cause more anxiety rather than alleviate their concerns. It is important for healthcare providers to be aware of the different feelings and experiences of older pregnant women in order to meet their individual needs.”

A separate team from the University of British Columbia investigated the medical treatment of anxiety disorders in the months surrounding birth. They found complex results in which both drug and non-drug treatments were associated with positive and negative outcomes.

“No treatment decision was found to be risk-free,” they write. “The detrimental effects of untreated mental illness on the mother, as well as on the baby, highlight the need for treatment intervention. But the long-term effects of exposure to either medications or maternal mental illness are unknown, as yet.”

But they agree that women with perinatal anxiety disorders “require timely and efficient management,” aiming to reduce symptoms while ensuring the baby’s safety. “Although knowledge in the area of appropriate intervention is constantly evolving, rigorous and scientifically sound research in the future is critical,” they add.

One treatment evaluated by researchers from China is music therapy. They explored whether this approach could relieve anxiety in pregnant women confined to bed. They recruited 120 women and gave them music therapy for 30 minutes on three consecutive days.

Anxiety levels fell significantly in this group, compared to another group given usual healthcare. “Carefully selected music that incorporates a patient’s own preferences may offer an inexpensive and effective method to reduce anxiety for pregnant women with high risk pregnancies who are on bedrest,” the researchers conclude.