Considerations in managing anxiety disorders during the perinatal period

It is important to identify and manage a person’s anxiety during pregnancy and after they give birth because:

• those with antenatal anxiety are more likely to develop postnatal depression
• anxiety during pregnancy can lead to poorer outcomes including preterm birth, low birth weight and poor neonatal adaptation
• children whose parent had anxiety during pregnancy may experience long-term adverse effects including increased susceptibility to neurodevelopmental problems and cardiovascular disease
• postnatal anxiety can impair a carer’s emotional availability and infant interactions.

There is insufficient evidence to guide a specific treatment approach for patients with anxiety disorders during the perinatal period; treatment is the same as for other patients. However, if psychotropic use is considered, discuss the potential harms and benefits of treatment with the patient and, if they consent, their significant other(s)—see Psychotropic use during pregnancy and Psychotropic use while breastfeeding.

Treating a patient with severe anxiety during the perinatal period can be complex—if possible, refer them to a specialist perinatal mental health service. Often a multidisciplinary team approach is required involving the usual treating clinician, a psychiatrist (preferably with perinatal expertise), the obstetric team and a paediatrician.

For further information and support for clinicians and patients, see the Perinatal Anxiety and Depression Australia (PANDA) website. The PANDA National Helpline (1300 726 306) provides risk assessment, support, counselling and information (including referral advice about local medical, mental health and family services) for new and expectant parents.

The Gidget Foundation Australia provides free telehealth counselling for parents in the perinatal period.

For considerations in managing anxiety disorders in partners, see here.