Mental Health During Pregnancy: Understanding Anxiety, Mood Changes, and When to Seek Help

Pregnancy is often framed as a time of glowing happiness — and while there are beautiful moments, the reality is far more complex. Hormonal shifts, physical discomfort, life changes, and the sheer weight of growing a new human can take a real toll on your mental health.

If you’re struggling emotionally during pregnancy, you’re not alone, you’re not failing, and you’re not broken. Perinatal mental health conditions are common, treatable, and nothing to be ashamed of.

This guide covers what’s normal, what might need attention, and how to take care of your mind as well as your body during this extraordinary time.

How Common Are Mental Health Issues During Pregnancy?

More common than most people realise:

Anxiety disorders affect approximately 15–20% of pregnant people, making anxiety more prevalent than depression during pregnancy (Dennis et al., 2017, Archives of Women’s Mental Health).
Prenatal depression affects an estimated 10–15% of pregnant individuals (Woody et al., 2017, Journal of Affective Disorders).
Up to 25% of pregnant people experience clinically significant symptoms of anxiety or depression at some point during pregnancy (Howard et al., 2014, The Lancet).
Tokophobia (severe fear of childbirth) affects 6–14% of pregnant people and can significantly impact wellbeing and birth planning (Nilsson et al., 2018, BMC Pregnancy and Childbirth).

Despite these numbers, perinatal mental health is frequently under-recognised and under-treated. Many people don’t seek help because they feel they “should” be happy, or they assume their feelings are just normal pregnancy hormones.

Here’s the truth: hormonal changes are real, and so is the need for support when those changes overwhelm you.

Normal Mood Changes vs. Something More

Pregnancy hormones — particularly the dramatic rises in oestrogen and progesterone — genuinely affect your brain chemistry. Some emotional fluctuation is entirely expected.

What’s Within the Range of Normal

Feeling tearful or more emotionally sensitive than usual
Mood swings — irritability one hour, joy the next
Worrying about your baby’s health, labour, or becoming a parent
Feeling overwhelmed by the practical demands of preparing for a baby
Occasional days of low mood or frustration
Mixed feelings about the pregnancy, even if it was planned

These experiences are common and usually manageable. They don’t necessarily indicate a mental health condition.

Signs That Something More May Be Going On

When emotions become persistent, intense, or start interfering with your daily life, it’s worth paying attention. Warning signs include:

Anxiety:

Constant, uncontrollable worry that doesn’t ease with reassurance
Racing thoughts, particularly at night
Physical symptoms: racing heart, shortness of breath, dizziness, nausea unrelated to morning sickness
Panic attacks
Avoiding situations, appointments, or information related to pregnancy
Intrusive thoughts (unwanted, distressing thoughts that feel out of character)
Difficulty concentrating or making decisions

Depression:

Persistent low mood lasting more than two weeks
Loss of interest or pleasure in things you normally enjoy
Feeling hopeless, worthless, or excessively guilty
Withdrawing from friends, family, or your partner
Changes in appetite (eating much more or much less than usual)
Sleep disturbance beyond what’s expected in pregnancy
Difficulty bonding with or feeling connected to your baby
Thoughts of self-harm or suicide

If you’re experiencing thoughts of self-harm or suicide, please reach out immediately. In the UK, call the Samaritans (116 123). In the US, call or text the 988 Suicide and Crisis Lifeline. In an emergency, call your local emergency number.

Understanding Prenatal Anxiety

Anxiety during pregnancy is more common than prenatal depression, yet it receives far less attention. It can manifest as:

Generalised Anxiety

Persistent, excessive worry about multiple aspects of pregnancy and life — your baby’s development, finances, relationships, labour, your ability to parent. The worry feels disproportionate and difficult to control.

Health Anxiety

Intense preoccupation with the baby’s health or your own. This might look like excessive googling of symptoms, frequent requests for reassurance from healthcare providers, or extreme distress between appointments.

Obsessive-Compulsive Symptoms

Pregnancy can trigger or worsen OCD-type symptoms. Intrusive thoughts — unwanted, distressing thoughts about harm coming to your baby — are more common than most people realise during the perinatal period. These thoughts are ego-dystonic, meaning they go against your values and desires. Having them does not mean you will act on them (Fairbrother & Woody, 2008, Journal of Clinical Psychiatry).

If intrusive thoughts are causing significant distress, a perinatal mental health specialist can help. Cognitive Behavioural Therapy (CBT) is highly effective for this.

Tokophobia

A profound fear of childbirth that goes beyond normal nervousness. It can lead to avoidance of prenatal care, requests for elective caesarean without medical indication, or extreme distress as the due date approaches. If this resonates with you, please speak to your midwife or doctor — specific support is available, including birth planning, counselling, and in some cases, specialist perinatal mental health teams.

Risk Factors: Who Is More Vulnerable?

Anyone can experience perinatal mental health difficulties, but certain factors increase risk:

Previous mental health conditions. A history of depression, anxiety, bipolar disorder, or other mental health conditions is the strongest predictor (Howard et al., 2014).
Previous pregnancy loss or traumatic birth. These experiences can profoundly affect how you experience subsequent pregnancies.
Lack of social support. Feeling isolated, unsupported, or in a difficult relationship increases vulnerability.
Unplanned pregnancy. Mixed feelings about an unplanned pregnancy are normal and don’t make you a bad parent — but they can contribute to emotional distress.
Financial stress or housing insecurity. Practical worries amplify emotional strain.
History of abuse or trauma. Pregnancy can resurface trauma, particularly related to body autonomy, medical procedures, or childhood experiences.
Fertility treatment. The emotional journey of IVF or other fertility treatments can leave lasting anxiety, even after a successful pregnancy.
Pregnancy complications. Conditions like gestational diabetes, preeclampsia, or a high-risk diagnosis create additional worry and medical burden.

Having risk factors doesn’t mean you’ll definitely struggle — it means it’s worth being proactive about support.

Self-Care Strategies That Actually Help

Self-care during pregnancy isn’t about bubble baths and scented candles (though those are lovely if you enjoy them). It’s about consistently protecting your mental wellbeing through practical, evidence-based strategies.

1. Move Your Body

Exercise is one of the most effective natural interventions for both anxiety and depression. A meta-analysis in the British Journal of Sports Medicine found that prenatal exercise significantly reduced depressive symptoms (Davenport et al., 2018).

You don’t need to run marathons — a daily 20–30 minute walk, prenatal yoga, or swimming all count. The key is regularity, not intensity.

Isolation is a significant risk factor for perinatal mental health problems. Even when you feel like withdrawing:

Stay in contact with people who make you feel safe and understood.
Consider joining a prenatal class or group — sharing experiences with others going through the same thing can be powerful.
Be honest with at least one trusted person about how you’re feeling. You don’t have to perform “happy pregnant person” for anyone.

3. Prioritise Sleep

Sleep deprivation worsens anxiety and depression. While perfect sleep is unrealistic during pregnancy, good sleep hygiene makes a real difference:

Consistent bedtime routine
Cool, dark room
Limiting screens before bed
Side sleeping with supportive pillows (see our guide on sleep positions during pregnancy)

4. Practice Mindfulness

Mindfulness-based interventions have growing evidence for reducing perinatal anxiety and depression (Lever Taylor et al., 2016, BMC Psychiatry). This doesn’t require sitting in silence for an hour:

Body scan meditation (5–10 minutes) — available on apps like Insight Timer, Calm, or Headspace
Mindful breathing — even three minutes of focused breathing can lower cortisol
Grounding exercises — the 5-4-3-2-1 technique (name 5 things you see, 4 you hear, 3 you can touch, 2 you smell, 1 you taste) can interrupt anxiety spirals

5. Limit Information Overload

The internet is full of pregnancy horror stories, conflicting advice, and worst-case scenarios. If you notice that researching pregnancy topics increases your anxiety rather than reassuring you:

Set time limits on pregnancy-related searching
Choose 1–2 trusted sources (your healthcare provider, NHS, ACOG) rather than scrolling forums
Unfollow social media accounts that make you feel inadequate or anxious
It’s okay to tell well-meaning friends and family that you’d rather not hear their birth stories right now

6. Nourish Yourself

Nutrition affects mental health. During pregnancy, focus on:

Omega-3 fatty acids (found in oily fish, walnuts, flaxseeds) — associated with lower rates of perinatal depression (Hsu et al., 2018, Journal of Clinical Psychiatry)
Regular, balanced meals — blood sugar crashes exacerbate anxiety and mood swings
Adequate hydration — dehydration can mimic anxiety symptoms
Prenatal vitamins — particularly folate, iron, and vitamin D, deficiencies of which are linked to mood disturbance

7. Prepare, Don’t Catastrophise

Anxiety often masquerades as “preparation.” There’s a difference between:

Healthy preparation: Taking a birth preferences class, packing your hospital bag, having open conversations with your partner about roles
Anxiety-driven rumination: Researching every possible complication, planning for worst-case scenarios repeatedly, feeling unable to stop “what if” thinking

If you notice you’ve crossed from preparation into rumination, try to redirect your energy. Write down your fears, then consciously do something else. If the worries keep returning, that’s a sign to seek support.

When and How to Seek Help

When to Reach Out

There’s no threshold you need to meet before you “deserve” help. If your mental health is affecting your quality of life, your relationships, your ability to function, or your enjoyment of pregnancy — that’s enough.

Specific triggers to seek help:

Symptoms lasting longer than two weeks
Anxiety or low mood that’s worsening over time
Panic attacks
Intrusive thoughts that cause significant distress
Difficulty eating, sleeping, or caring for yourself
Using alcohol or substances to cope
Feeling disconnected from or resentful toward your pregnancy
Any thoughts of self-harm or suicide (seek help immediately)

Where to Get Help

Your midwife or GP. They can screen for perinatal mental health conditions and refer you appropriately. Many maternity services now include routine mental health screening at booking and later appointments.
Perinatal mental health teams. Specialist NHS teams (in the UK) or perinatal psychiatry services provide expert care for mental health during pregnancy and the postnatal period.
Talking therapies. CBT and counselling are first-line treatments for mild to moderate perinatal anxiety and depression. Many services offer self-referral.
IAPT / Improving Access to Psychological Therapies (UK). You can self-refer for talking therapy through the NHS without a GP referral.
Peer support organisations. Charities like PANDAS Foundation, MIND, Postpartum Support International (US), and the Maternal Mental Health Alliance offer helplines, online communities, and resources.

Treatment Options

Talking therapies:

Cognitive Behavioural Therapy (CBT) is the most evidence-based approach for perinatal anxiety and depression (NICE, 2014).
Interpersonal therapy (IPT) focuses on relationships and role transitions — particularly relevant during the shift to parenthood.
Counselling provides a safe space to process complex emotions about pregnancy, parenthood, and identity.

Medication:

Some antidepressants and anti-anxiety medications are considered safe during pregnancy. SSRIs (such as sertraline) have the most reassuring safety data and are commonly prescribed when therapy alone is insufficient (NICE, 2014; Molenaar et al., 2018, The Lancet Psychiatry).
The decision to take or continue medication during pregnancy is personal and should be made with your healthcare provider, weighing the risks of untreated mental illness against the risks of medication.
Stopping medication abruptly without medical guidance is dangerous. If you discover you’re pregnant while taking psychiatric medication, contact your prescriber before making changes.

Crisis support:

UK: Samaritans (116 123), Crisis Text Line (text SHOUT to 85258)
US: 988 Suicide and Crisis Lifeline (call or text 988), Postpartum Support International helpline (1-800-944-4773)
International: befrienders.org for local crisis lines worldwide

For Partners and Support People

If someone you love is struggling during pregnancy, here’s how you can help:

Listen without fixing. Sometimes the most powerful thing you can do is hear them without jumping to solutions.
Validate their experience. “That sounds really hard” goes further than “Try not to worry.”
Learn about perinatal mental health. Understanding what they’re going through reduces the temptation to dismiss or minimise it.
Encourage professional help gently. Offer to help find a therapist, attend an appointment together, or make the initial phone call.
Take on practical tasks. When someone is struggling emotionally, everyday tasks feel mountainous. Cooking a meal, handling logistics, or managing household responsibilities can be deeply supportive.
Look after yourself too. Partners can experience their own mental health challenges during pregnancy and the postnatal period. Your wellbeing matters.

The Bottom Line

Your mental health during pregnancy matters — not just for you, but for your baby and your family. Perinatal mental health conditions are common, they’re not your fault, and they respond well to treatment.

You don’t have to be in crisis to ask for help. You don’t have to push through. And you certainly don’t have to pretend everything is fine when it isn’t.

Pregnancy changes your body and your brain. Being honest about that — with yourself and with the people who care for you — is one of the bravest and most important things you can do.

References

Davenport, M.H., et al. (2018). Prenatal exercise for the prevention of prenatal depression and anxiety. British Journal of Sports Medicine, 52(21), 1397–1404.
Dennis, C.L., et al. (2017). Prevalence of antenatal and postnatal anxiety. Archives of Women’s Mental Health, 20(2), 315–325.
Fairbrother, N., & Woody, S.R. (2008). New mothers’ thoughts of harm related to the newborn. Journal of Clinical Psychiatry, 69(9), 1431–1437.
Howard, L.M., et al. (2014). Non-psychotic mental disorders in the perinatal period. The Lancet, 384(9956), 1775–1788.
Hsu, M.C., et al. (2018). Omega-3 fatty acids and perinatal depression. Journal of Clinical Psychiatry, 79(6), e1–e10.
Lever Taylor, B., et al. (2016). Effectiveness of mindfulness-based interventions in the perinatal period. BMC Psychiatry, 16, 32.
Molenaar, N.M., et al. (2018). Guidelines on treatment of perinatal depression with antidepressants. The Lancet Psychiatry, 5(6), 461–462.
NICE. (2014). Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance. CG192. National Institute for Health and Care Excellence.
Nilsson, C., et al. (2018). Definitions, measurements and prevalence of fear of childbirth. BMC Pregnancy and Childbirth, 18, 28.
Woody, C.A., et al. (2017). A systematic review and meta-regression of the prevalence and incidence of perinatal depression. Journal of Affective Disorders, 219, 86–92.