Findings indicate that exercise during pregnancy can be an important component of mental health treatment in addition to psychotherapy or medication management.
- Vol 37, Issue 8
- Volume 37
- Issue 8
Conventional and Integrative Approaches to Treating Anxiety in Pregnancy
Women should be provided with multiple options for treatment if they decide to engage in mental health care during this critical period.
CLINICAL
Anxiety is not unusual during pregnancy and postpartum for new mothers. However, for some women, anxiety symptoms are more severe, and cause distress, avoidance of activities, interfere with their ability to function at home or at work, or care for their children. One-third of women will suffer from an anxiety disorder in their lifetime.1 Perinatal anxiety is common and often underreported, with the prevalence ranging from 4% to 33.4% (
The
Treatment
Current treatment recommendations for perinatal anxiety disorders include psychotherapy alone or in combination with pharmacotherapy. A variety of therapeutic modalities, such as cognitive behavioral therapy (CBT), have been shown to be both safe and effective for treating mild to moderate perinatal mood and anxiety disorders as an adjunctive measure or as monotherapy.7 Unfortunately, less resourced and geographically isolated communities may experience cultural, logistical, and financial barriers to accessing psychotherapy services.8
For women with moderate to severe anxiety disorders that do not respond to psychotherapy and/or that is impairing functioning, ACOG recommends considering the initiation or re-initiation of pharmacotherapy with a selective serotonin reuptake inhibitor (SSRI) or serotonin norepinephrine reuptake inhibitor (SNRI).5 These medications are well studied and can be very helpful and, in some cases, necessary for managing symptoms.
The choice to use medications is very personal; the woman’s obstetrician and/or psychiatrist should discuss this option with her. The decision should be based on risks and benefits, weighing the risk of exposure to medication on the unborn baby against the severity and risk of untreated illness. The most common risks associated with antidepressant medications exposure are low birth weight, preterm birth, poor neonatal adaptation syndrome, and persistent pulmonary hypertension of the newborn (
An increasing number of women consider complementary and integrative approaches for alternatives or as adjunctives for treatment options during pregnancy. Complementary and integrative medicine emphasizes a
Some of the most common forms of integrative practice are mindfulness-based interventions. Mindfulness-based stress reduction (MBSR) provides training in mindfulness meditation techniques as a self-regulation approach to stress reduction and emotion management. Mindfulness-based cognitive therapy is an adaptation of cognitive behavioral therapy with a focus on developing
Yoga is a mind and body practice with origins in ancient Indian philosophy that combines postures, breathing, and meditation. Yoga has been associated with a reduction in sympathetic activity, balancing heart rate variability, normalizing HPA axis activity, and influencing monoamine changes.16 Over the past decade, yoga has become increasingly popular for promotion of fitness and relaxation, and prenatal yoga classes have become widely available both in studios and online.
The 2017 National Health Interview Survey (NHIS) found that yoga is the most common complementary practice used by US adults.16 Studies looking specifically at the practice of yoga in pregnant women have shown that anxiety symptoms (self-reported and interview screening scales) were significantly decreased in response to even a one-time 20-minute yoga session, and participants continued to show
Regular physical activity has also been shown to be beneficial for pregnant and postpartum women for both physical and mental health. ACOG recommends that healthy pregnant women should aim to get at least 2.5 hours of moderate-intensity activity per week. Physical activity has been associated with reduction of pregnancy-related complications, including the risk of weight gain and gestational diabetes, as well as enhancing overall psychological well-being.18 During pregnancy, exercise may reduce the symptoms of anxiety as well as increase overall quality of life. Women who report exercising more frequently during pregnancy have lower than average anxiety symptoms (self-report measures).19 Findings indicate that exercise during pregnancy can be an important component of mental health treatment in addition to psychotherapy or medication management.20
Conclusion
Anxiety is common during the perinatal period and can have negative effects on mother and neonate. Women should be provided with multiple options for treatment and encouraged and supported to engage in care during this critical period. The high prevalence of
Complementary approaches are becoming increasingly used by women and may provide benefits for mental health treatment. Available evidence suggests that complementary approaches, specifically mindfulness-based interventions, yoga, and exercise have shown benefit for improving symptoms of perinatal anxiety disorders. Reductions in anxiety symptoms with mindfulness-based interventions, yoga, and exercise suggest an expanding and adjunctive role for complementary approaches to perinatal mental health treatment. More research is needed to systematically evaluate the use of nonpharmacological, integrative modalities for maternal mental health.
Dr Ballone is a Consultation-Liaison Psychiatry Fellow, The George Washington University Medical Center/Inova Fairfax Hospital Department of Psychiatry, Falls Church, VA; Ms Moffitt is an MD Candidate, Sidney Kimmel Medical College, Philadelphia; Dr Becker is Associate Professor and Director, Graduate Medical Education, Integrative Women’s Mental Health, Department of Integrative Medicine and Department of Psychiatry and Human Behavior, Thomas Jefferson University and Jefferson Health, Philadelphia, PA. The authors have nothing to disclose regarding the subject of this manuscript.
References
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18. ACOG Committee Opinion No. 650: physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2015;126:e135-42.
19. Watson SJ, Lewis AJ, Boyce P, Galbally M. Exercise frequency and maternal mental health: Parallel process modelling across the perinatal period in an Australian pregnancy cohort. J Psychosom Res. 2018;111:91-99.
20. Haßdenteufel K, Feißt M, Brusniak K, et al. Reduction in physical activity significantly increases depression and anxiety in the perinatal period: a longitudinal study based on a self-report digital assessment tool. Arch Gynecol Obstet. 2020;302:53-64.❒
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