Anxiety during pregnancy: what's normal, what helps and where to get help in Singapore

Some anxiety during pregnancy is normal. NUH calls feeling anxious a normal response to uncertainty, and SingHealth says this kind of worry often eases once family or your doctor reassures you. It's worth a doctor's look when you feel anxious most of the time for more than two weeks, or it stops you managing work or home. Start small: write the worry down and raise it at your next antenatal check.

What to do about anxiety during pregnancy, step by step

1. Write the worry down in one line. The NHS suggests two columns, the worry on one side and a calmer thought on the other, like "The scan will find something" beside "I'll know more after the scan."
2. Count how often you check symptoms, search online or ask someone to reassure you. The NHS suggests cutting these down bit by bit over a week.
3. Go for a short walk or call a friend when the urge to check comes, as the NHS suggests. Our guide to safe exercise during pregnancy covers how much is fine.
4. Take your list to your next antenatal check and say how you've been feeling. In a KKH survey of more than 50 gynaes, more than half said they seldom start this talk, so bring it up yourself.
5. Ask if your clinic does a mood screen. KKH screens every pregnant patient with the EPDS questionnaire at a second-trimester check, and it's a screen, not a diagnosis.
6. Breathe slowly for a few minutes when the worry spikes. SingHealth says deep breathing and progressive muscle relaxation can calm the mind and body, and mindfulness for parents has short exercises.
7. Tell your partner what's on your mind and one thing that would help. SingHealth suggests sharing your worries with family and friends and getting help with tasks.
8. Protect your sleep. KKH's perinatal mental health guidelines include sleep, diet and activity tips for pregnant women with anxiety, and our guide to pregnancy sleeping positions helps with comfort.
9. Book a doctor's visit sooner if you've felt anxious most of the time for more than two weeks, as NUH advises. You don't need to wait for your next check-up.

Normal worry, or anxiety that takes over?

Worry comes with pregnancy. SingHealth says many women feel some uncertainty, worry or stress, and that it often passes after reassurance. About 10% of women have anxiety that affects daily life, SingHealth says, and KKH puts mood and anxiety disorders in pregnancy and after birth at up to 20% of women.

NUH looks at how long it lasts and how much it gets in the way. Anxiety is worth checking if it lasts more than two weeks, or if you don't feel like yourself and can't keep up your usual roles at work or at home. That holds even when you know exactly why you're worried. This table lines up what NUH and the NHS describe.

If it's more tears and short temper than worry, mood swings during pregnancy covers that. Worry that starts or carries on after the birth is in postpartum anxiety.

Common pregnancy fears and worries in Singapore, and what helps

SingHealth says a hard past experience can make pregnancy changes feel especially scary, and first-time mums can feel overwhelmed by all the new demands. Here's one thing to try for each of the usual worries.

For the detail, 10 weeks pregnant explains NIPT and 20 weeks pregnant covers the scan. Miscarriage risk by week sets out the figures. The kick counter keeps the daily count for you.

The maternity leave calculator and baby cost estimator do the sums. When to announce pregnancy covers telling work, and fear of giving birth covers labour fears and tokophobia.

What to say to your partner, family and doctor

You don't need perfect words. SingHealth's advice is to tell family and friends what worries you and discuss your options. Short, plain lines work:

• With your partner: "I don't need you to fix this. Can you listen, and come to my next check-up with me?"
• If your mum or mother-in-law is planning the confinement: "Thank you for wanting to help. We're still deciding the confinement plan, and we'll tell you once we've agreed." Mother-in-law conflict has more lines.
• At the check-up, tell your gynae: "I've felt anxious most days for a few weeks, and it's affecting my sleep. Can we talk about it today?"
• For your manager: "I have an antenatal check on Tuesday. I've moved my calls and I'll be online after."

NUH's Women's Emotional Health Service offers couple counselling, so your partner can come too. Involved dads has ideas for partners. If you already take medicine for anxiety or low mood, tell your gynae you're pregnant early, and read antidepressants in pregnancy for what doctors weigh.

How anxiety in pregnancy is treated

Treatment starts with an assessment. NUH says its team aims to offer treatment without medicine, though medicine may be recommended in some cases. Its psychologists and occupational therapists teach relaxation and offer CBT or mindfulness-based therapy. SingHealth says CBT has been proven to work for anxiety.

Where medicine is needed, SingHealth says options are available for pregnant mothers, after a perinatal psychiatrist has assessed you. SingHealth also says an anxiety disorder isn't something you can just snap out of. KKH says that with the right treatment, women recover and are able to prepare for the birth and care for their baby.

When to see a doctor

See your GP, polyclinic doctor or gynae if:

• You've felt anxious most of the time for more than two weeks, even if you know the reason (NUH).
• You don't feel like your usual self, or can't keep up your usual roles at work or at home (NUH).
• You have panic attacks: palpitations, sweating, and a sense you might lose control or collapse (NUH).
• Checking, searching or asking for reassurance fills your day, or you avoid anything to do with illness, which can mean putting off a scan (NHS).
• Unwanted thoughts or images keep coming back, or memories of a hard previous birth replay in your mind (NUH).
• You've had a mental illness or a pregnancy loss before. KKH says both raise the risk, so tell your gynae early.
• You have thoughts of harming yourself or your baby. Call 995 or go to the nearest A&E now, or call SOS on its 24-hour hotline, 1767 (SOS).

Start with a GP, polyclinic doctor or your gynae, who can refer you. For advice on getting help, email KKH's Women's Mental Wellness Service at pnd@kkh.com.sg, and KKH replies within 3 to 5 working days. NUH's Women's Emotional Health Service supports women in pregnancy and the first year after birth: call 6772 2037, Monday to Friday, 8.30am to 5pm, or email wehs@nuhs.edu.sg.

You can also WhatsApp SOS CareText on 9151 1767 at any hour. Our page of mental health helplines for parents lists the rest.

Frequently asked questions

Is anxiety during pregnancy normal?

Yes, some is. NUH calls feeling anxious a normal response to uncertainty, and pregnancy brings plenty of it. If you feel anxious most of the time for more than two weeks, or it gets in the way of work or home life, NUH advises seeing a doctor.

Where can I get help for anxiety during pregnancy in Singapore?

Start with your gynae, a polyclinic or a GP. KKH's Women's Mental Wellness Service answers emails at pnd@kkh.com.sg, and NUH's Women's Emotional Health Service takes calls on 6772 2037 on weekdays. In a crisis, call SOS on 1767 or 995.

How do I stop pregnancy fears and worries taking over?

Write each worry down with a calmer thought beside it, and cut back on checking and searching bit by bit, as the NHS suggests. SingHealth adds deep breathing and a walk. If worry still fills most of your day after two weeks, see your doctor.

Can anxiety during pregnancy affect my baby?

Small doses of stress are unavoidable in pregnancy, NUH says. It links poorer outcomes for mother and baby to anxiety that's left uncontrolled, so getting help early is good for you both.

Is it safe to treat anxiety while pregnant?

NUH aims to treat anxiety without medicine where it can, using CBT, mindfulness-based therapy and relaxation. Where medicine is needed, SingHealth says there are options for pregnant mothers, chosen after a perinatal psychiatrist assesses you. Antidepressants in pregnancy covers what doctors weigh.

Why am I so anxious in pregnancy after a miscarriage?

KKH says the emotional effects of a pregnancy loss often come back in the next pregnancy, so this is a known pattern. Tell your gynae early, so they know. Coping after miscarriage covers the grief, and miscarriage risk by week sets out the figures.