Pregnancy is often considered a joyful and exciting time for expecting mothers and their families. However, for many women, it can also pose significant emotional challenges, including stress, anxiety, and depression. While those with pre-existing mental health conditions may find their symptoms exacerbated during pregnancy, others may encounter issues like postpartum depression for the first time. Although stress is a normal part of life, growing evidence suggests that chronic or intense stress during pregnancy can have lasting effects on a child’s emotional and physical development and well-being.
In this article, we will discover how stress hormones during pregnancy can affect a developing baby, explore the science behind fetal programming and epigenetics, and explain why early mental health intervention is not only helpful—it is crucial. We will also discuss evidence-based treatment options, including innovative therapies like ketamine, and share ways to break the stigma surrounding mental health during pregnancy.
When a pregnant woman experiences acute stress, such as after a serious argument with a partner or family member, her body enters a fight-or-flight state, releasing stress hormones like cortisol and adrenaline. While these hormones play a vital role in short-term survival, prolonged elevation due to chronic stress can allow them to cross the placenta and impact the developing fetus.
Research has shown that high levels of maternal cortisol can “program” the baby’s stress response system, essentially wiring their brain to be more reactive to stress later in life. This is known as fetal programming—the idea that conditions in the womb can shape a child’s long-term mental and physical health.
Numerous studies have shown that children born to mothers who experienced very high levels of stress during pregnancy are more likely to develop mental health challenges later in life. High maternal stress and anxiety have been linked to:
Epigenetics is the study of how environmental factors, such as stress, diet, trauma, or exposure to toxins, can influence gene expression without changing the underlying DNA sequence.
Think of DNA as a piano: every person has the same set of keys, but epigenetics determines which keys are played, how often, and how loudly. During pregnancy, if a mother experiences chronic stress, it can alter the “sheet music” her baby’s developing body uses to interpret those genetic instructions. In other words, stress can influence which genes get turned “on” or “off” in the fetus, potentially impacting how the baby’s brain develops, how their immune system functions, and how they regulate stress hormones throughout life.
What’s especially important is that these epigenetic changes can be passed down to future generations. This means the effects of unaddressed stress or trauma during one pregnancy may ripple through family lines, shaping the health of children and even grandchildren.
This is why supporting maternal mental health is not just a personal issue; it’s a generational one. Ensuring emotional health during pregnancy helps create the healthiest foundation possible for future generations.
It’s not always easy to identify anxiety or depression during pregnancy. Many women dismiss their symptoms as “normal pregnancy hormones,” but here are some signs to watch for:
Too often, pregnant women feel ashamed or guilty for struggling with their mental health. Society tends to romanticize pregnancy with images of the “glowing mother-to-be,” which leaves little space for the complex emotional realities many women face, such as feelings of fear, sadness, irritability, body image issues, or even numbness. When those feelings arise, many women suffer in silence, believing they’re failing at motherhood before their baby is even born.
Mental health struggles during pregnancy are common and do not signify weakness or failure. They represent a natural response to the significant hormonal, emotional, and social changes that come with this stage of life.
When a mother takes steps to care for her mental health, whether through therapy, community support, mindfulness practices, or evidence-based medical treatment such as ketamine therapy, she’s not only improving her own health; she’s actively shaping a safer, more supportive environment for her baby’s development.
While early intervention for depression and anxiety during pregnancy is crucial to giving both mother and baby the best possible start, the foundation begins with preventative care. Proactively equipping individuals with tools to manage stress, such as therapy, mindfulness practices, appropriate medications, movement, and other healthy coping strategies, can help build emotional resilience before pregnancy-related challenges arise.
Someone who has learned to self-soothe and regulate their emotions in a healthy way is far better prepared to navigate the emotional ups and downs of pregnancy. Equally important is ensuring the mother-to-be is in a safe, supportive environment, surrounded by nurturing relationships. Supportive partnerships, family dynamics, and social systems can significantly reduce chronic stress and improve one’s ability to cope with adversity when it does arise.
Catching and treating anxiety or depression early—even in the first trimester—can significantly reduce risks for both mother and baby. Early intervention helps:
Treating mental health conditions during pregnancy requires a careful and compassionate approach. Fortunately, safe and effective options are available, including non-invasive approaches such as various styles of psychotherapy, mindfulness practices, and medical interventions like oral antidepressants, ketamine, and psychedelic-assisted therapies. Let’s take a closer look at each.
Cognitive Behavioral Therapy (CBT):
The core idea behind CBT is that our thoughts, emotions, and behaviors are interconnected. Changing distorted thinking patterns can improve how we feel and behave. CBT can be effective in treating anxiety, depression, and PTSD. Techniques often include journaling, cognitive restructuring, behavioral experiments, and exposure exercises. Patients learn to recognize negative automatic thoughts, replace them with more balanced ones, and gradually confront avoided situations more confidently and clearly.
Internal family systems therapy (IFS):
Internal Family Systems (IFS) is a type of therapy founded on the concept that the mind consists of various "parts" or subpersonalities, each possessing its own perspective, memories, and motivations. These parts—such as the inner critic, the wounded child, or the protective controller—often emerge in response to trauma or emotional wounds. Rather than attempting to suppress or eliminate these parts, IFS invites individuals to approach them with curiosity and compassion, guided by the "Self"—a core, centered state within each person that embodies calm, confidence, and compassion.
Mindfulness and meditation
Mindfulness-based therapies incorporate meditation, breathwork, and present-moment awareness to assist individuals in regulating their emotions and fostering a more compassionate relationship with their thoughts and experiences. Individuals learn to observe their thoughts and feelings without judgment, preventing the spiral of negative thinking and emotional reactivity. By learning to focus attention on the breath, body sensations, or sounds, patients develop greater emotional stability, reduced stress, and improved mental clarity.
Talking with others who are going through similar experiences can be incredibly validating and reduce feelings of isolation. Prenatal and postpartum support groups—offered locally through hospitals, birthing centers, or therapists, as well as online—create safe spaces to share, connect, and receive support. Some are led by mental health professionals, while others are peer-led, but both offer community, education and compassion.
Some medications, such as certain SSRIs (Selective Serotonin Reuptake Inhibitors), are considered relatively safe to use during pregnancy and are commonly prescribed to treat depression and anxiety. While no medication is entirely without risk, the potential benefits of treating moderate to severe mental health conditions during pregnancy may outweigh the risks of untreated illness—for both the mother and the baby. Medication decisions during pregnancy should always involve a thoughtful discussion between the patient and their healthcare provider, ideally including a perinatal psychiatrist—a specialist trained in managing mental health during pregnancy and postpartum.
Ketamine is a rapid-acting treatment for severe depression, including cases where traditional antidepressants have not been effective. While it is not typically recommended to be used during pregnancy and is not regarded as a first-line treatment during this time, ketamine may be a lifesaving option prior to conception in preparation and as a highly effective treatment for postpartum depression. If mothers are breastfeeding their baby, the typical recommendation is to wait 12-24 hours after treatment to resume.
Ketamine therapy is best paired with psychotherapy to leverage its fast-acting antidepressant effects while assisting patients in shifting their mindset, processing emotions, and beginning to integrate healthy lifestyle habits that support long-term mental health. Many patients describe the experience as a "reset," noticing significant improvements in mood, even when other medications or traditional therapy have failed to provide relief.
If you’re pregnant and struggling with stress, anxiety, or depression, know this: your feelings are real, and they matter. You are not alone, and you don’t have to suffer in silence. Prioritizing your mental health isn’t selfish; it’s one of the most loving and essential things you can do for both yourself and your baby.
Today, there are more treatment options than ever—from therapy and medication to newer approaches like ketamine therapy—all designed to support your healing and protect the well-being of both parent and child. Early intervention and open, stigma-free conversations can change the course of not just one life, but generations to come.
If you or someone you love is experiencing depression or anxiety during pregnancy, don’t wait. Talk to your OB-GYN, connect with a therapist, or call a mental health support line. You're not alone—and with the right support, healing is not only possible; it's within reach.
About the author:
Libby Rivas serves as the Clinic Manager at Innerbloom Ketamine Therapy, bringing a unique blend of professional expertise, personal experience, and heartfelt compassion to her role. Married to Dr. Ray Rivas, Libby is deeply rooted in the health and wellness community, equipping her with a profound understanding of how to support others. With extensive experience in small business management and customer service, Libby ensures that every patient at Innerbloom receives personalized care and attention.
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