Anxiety During Pregnancy: Causes and Safe Treatment Options

Anxiety during pregnancy is not a sign you are failing at something that is supposed to feel calm and certain. It is a common, treatable experience, and the treatment path does not have to start with a controlled substance.

What This Article Covers

• How common anxiety during pregnancy actually is
• What drives it, hormonally and situationally
• Why benzodiazepines are generally avoided and what is used instead
• What the evidence says about therapy as a first-line option
• What untreated anxiety can mean for a pregnancy

How Common Anxiety in Pregnancy Actually Is

Anxiety during pregnancy is far more common than most people expect, and it is frequently underdiscussed compared with depression. A systematic review and meta-analysis covering more than 560,000 women across 43 countries found that comorbid anxiety and depression affects approximately 9 percent of pregnant women, with similar rates in the postpartum period. Anxiety occurring on its own, without a co-occurring depressive episode, is reported even more frequently across the perinatal research.

Pregnancy creates a specific set of conditions for anxiety to take hold: shifting hormones, physical symptoms that can mimic anxiety itself, a healthcare system full of screenings and unknowns, and often a genuine, appropriate concern for a baby’s wellbeing that can tip into something more constant and consuming. None of that makes the anxiety less real or less worth treating.

Why Benzodiazepines Are Generally Not the First Option

If you already take a benzodiazepine like Xanax or Ativan for anxiety, or if that is what you assumed treatment would involve, current clinical guidance points elsewhere.

The American College of Obstetricians and Gynecologists’ 2023 Clinical Practice Guideline on treatment and management of mental health conditions during pregnancy and postpartum recommends that benzodiazepines be avoided or prescribed only sparingly for perinatal anxiety, a strong recommendation based on moderate-quality evidence. This is not because benzodiazepines are dangerous in every context. It is because of specific, well-documented risks that concentrate around pregnancy and delivery.

The clearest concern is timing near birth. Benzodiazepine use shortly before delivery has been associated with floppy infant syndrome, involving hypothermia, lethargy, poor respiratory effort, and feeding difficulties, and withdrawal symptoms in the newborn can persist for months when the mother used medications like alprazolam, chlordiazepoxide, or diazepam. Earlier in pregnancy, the absolute risk picture is smaller than many people assume: the same clinical review notes that prenatal diazepam exposure has been linked to a small increase in oral cleft risk, but the added absolute risk is only about one additional case per 10,000 pregnancies.

None of this means benzodiazepines are never used. It means they are reserved for short-term, carefully considered situations rather than ongoing anxiety management, which is where non-controlled options come in.

What Is Used Instead

For pregnant patients who need medication for anxiety, SSRIs, the same medication class widely used for perinatal depression, are the preferred pharmacological option. Sertraline and escitalopram are commonly favored first-line choices, and paroxetine is the SSRI most often avoided during pregnancy.

This is a meaningful shift from older guidance. For years, clinical guidelines reviewed the safety data on psychiatric medications in pregnancy without making a clear recommendation to actually treat. The 2023 ACOG guideline changed that, actively recommending pharmacotherapy be initiated and titrated for perinatal mental health conditions rather than left as an open question between patient and prescriber.

Therapy as a First-Line Option, Not a Backup Plan

Medication is not the only evidence-based path, and for many people with perinatal anxiety, therapy comes first.

A randomized trial of cognitive behavioral group therapy adapted specifically for perinatal generalized anxiety disorder found that 26.8 percent of participants showed reliable improvement in sleep disturbance, a core anxiety symptom, with anxiety and sleep improving together as treatment progressed. That bidirectional improvement matters: anxiety and disrupted sleep tend to reinforce each other during pregnancy, and treating one tends to move the other.

Therapy adapted to the perinatal period, rather than generic anxiety therapy, also tends to address pregnancy-specific worries directly: fear around labor, body changes, and the transition to parenting, rather than treating pregnancy as incidental background to the anxiety.

Why Leaving It Untreated Is Not the Safer Default

Some patients decide to just tolerate anxiety during pregnancy, reasoning that any treatment carries more risk than doing nothing. The evidence does not support that framing.

Maternal anxiety disorders have been associated with adverse pregnancy outcomes, including spontaneous abortion, small for gestational age infants, preterm delivery, and prolonged or precipitate labor, according to guidance summarized by the CDC. Chronic, unmanaged anxiety also makes it harder to engage consistently with prenatal care, sleep adequately, and manage the physical demands of pregnancy.

The clinical goal is not “no exposure to anything.” It is matching the right treatment, therapy, a non-controlled medication like an SSRI, or both, to the severity of what a patient is experiencing.

About SiggyMD

SiggyMD provides clinician-supervised care for anxiety and depression, including for patients navigating pregnancy, with every treatment plan reviewed and approved by a licensed prescriber before anything is prescribed. Siggy’s current clinical scope centers on SSRIs and evidence-based support for anxiety and depression, and does not involve controlled substances.

“Pregnant patients are often more cautious about medication than anyone else I treat, and that caution is reasonable,” says Elizabeth Lokenauth, PA-C, of the SiggyMD clinical team. “What I want people to know is that untreated anxiety has real consequences too. We’re not choosing between a risky option and a safe one. We’re choosing the option that’s actually been studied and recommended for this exact situation, which for most patients is not a benzodiazepine.”

If anxiety is affecting your pregnancy, start your anonymous intake with SiggyMD to see what a clinician-reviewed plan looks like for you.

For related guidance, read our post on depression during pregnancy and what you can safely take.

What Members Are Saying

NP

N.P., 29

Generalized Anxiety, Second Trimester

“I assumed pregnancy meant I just had to white-knuckle through my anxiety since I didn’t want to take anything strong. Learning that SSRIs had real safety data behind them, and that my old anxiety medication was the one actually being avoided, changed the whole conversation with my care team.”

RF

R.F., 33

Perinatal Anxiety and Insomnia

“My anxiety and my sleep were feeding each other by the third trimester. Getting treatment that addressed both together instead of just being told to ‘try to relax’ made an actual difference.”

Member stories reflect real experiences. Names and identifying details have been changed to protect privacy. Results vary. You can begin anonymous intake without an account, name, email, or payment.

The Bottom Line

Anxiety during pregnancy is common, affects a meaningful share of pregnant patients worldwide, and has real, non-controlled treatment options. Current ACOG guidance favors avoiding or sparingly using benzodiazepines, while recommending SSRIs and structured therapy as the primary paths forward. Leaving significant anxiety untreated carries its own documented risks, which is why the right move is not avoidance, but getting matched to the treatment that fits what you are actually experiencing.

Sources

1. American College of Obstetricians and Gynecologists. Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 5. Obstetrics & Gynecology. 2023.

2. Ou L, Shen Q, Xiao M, et al. Prevalence of co-morbid anxiety and depression in pregnancy and postpartum: a systematic review and meta-analysis. Psychological Medicine. 2025.

3. Barrett EN, Alamo F, Inness BE, et al. The impact of cognitive behavioral group therapy for anxiety on GAD related sleep disturbance during the perinatal period. Sleep Medicine. 2026.

4. American Academy of Family Physicians. ACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation. American Family Physician. Accessed July 2026.

5. Centers for Disease Control and Prevention. Use of Benzodiazepine Medications During Pregnancy and Potential Risk for Birth Defects. Accessed July 2026.