Mood swings & mommy brain: The emotional challenges of pregnancy

The physical changes in a woman's body during pregnancy receive plenty of attention, but less consideration is given to the emotional changes she experiences. Pregnancy can be an exciting time but it's also very stressful, which can cause emotions to run high. In addition to physical health, a mother's emotional well being and mental health are also important. 

Related: Body changes during pregnancy

"Pregnancy is a huge transition in a woman's life, and it involves a complex mix of emotions, both good and bad," said Dr. Mary Kimmel, an assistant professor and co-director of the perinatal psychiatry program at the University of North Carolina School of Medicine in Chapel Hill. She advised women to be aware of their thoughts and feelings, and to find a place to talk about these feelings and work through them. 

Now that you've figured out how to get pregnant, here are seven common emotions a woman may experience before and after her baby is born. 

Related: Am I pregnant? 12 early signs of pregnancy

Mood swings

Whether it's described as moodiness, irritability or crabbiness, pregnancy can cause a roller coaster of emotions. 

A 2019 review published in the journal Archives of Women's Mental Health found a high frequency of mood instability among pregnant and postnatal women.

"Pregnancy is a transition point in a woman's life and during any transition, a person's emotions can be up and down," Kimmel told Live Science. She said that some women's emotions don't change that much when they are expecting, but it's not unusual for women to have mood swings, especially during the early and late stages of pregnancy. 

It's not entirely clear why these mood fluctuations occur, Kimmel said, because a number of changes are happening in a woman's body, and they are all tied to her emotions. 

One reason may be the changes in hormone levels. "Some women are sensitive to changes in estrogen, while others are affected by rising levels of progesterone or stress hormones," Kimmel said. 

Fear & anxiety

On a biological level, both the anxiety and fear systems in the brain ramp up during pregnancy. 

By the end of her pregnancy, a woman may be scared of being in pain during labor or concerned that something could go wrong during delivery. "There is a lot a woman does not have control over during pregnancy," Kimmel said, and this uncertainty can fuel fearful thoughts. 

Fear and anxiety are normal emotions, and people have them for a reason, Kimmel said. In pregnancy, these emotions help ensure that a woman keeps her baby safe, cared for and protected after she gives birth. But a woman needs to recognize when a fear is getting stuck in her head or whether she can cope with it, Kimmel noted. 

Women who were pregnant or gave birth during the COVID-19 pandemic had increased levels of fear and anxiety, a 2021 study reported in the journal Medicina Clínica. The study also found that nearly 15% more women experienced symptoms of postpartum depression after giving birth during the pandemic. 

Related: What is mental health? 

If a woman has had anxiety in the past then she is more at risk of having it during her pregnancy because of the increased stress she may experience, Kimmel said.

Research has shown that a mother's anxiety during pregnancy might affect her baby. A 2013 study found that infants born to mothers who had high levels of anxiety during pregnancy had a weakened immune response to vaccines by six months of age, compared to babies with more relaxed moms, Live Science previously reported. 

A 2020 study published in the journal Brain and Behavior reported that in 70 Iranian women, mindfulness practices, such as meditation or taking time to be in the moment, reduced maternal anxiety. The study authors recommended that health providers include mindfulness in prenatal programs to help reduce maternal anxiety.

Forgetfulness

The mental fogginess and occasional memory lapses that could cause a woman's keys to be misplaced and her cell phone to go missing has sometimes been described as "pregnancy brain" or "baby brain." (These same symptoms are referred to as "mommy brain" or "momnesia" after giving birth.)

Related: Mother's Day science: From 'baby brain' to cognitive boost

Although a common complaint, studies of memory and other cognitive changes in pregnancy and early motherhood have shown mixed results. Some research has suggested that fuzzy thinking and forgetfulness before and after birth may be a result of hormonal fluctuations, especially higher levels of progesterone. Sleep deprivation or the stress of adjusting to a major life transition may also be to blame. 

"It is the time in your life [that your brain] is most plastic during adulthood," Jodi Pawluski, a research associate who studies maternal mental health at the University of Rennes 1 in France, previously told Live Science.

A 2016 study published in journal Nature found that pregnancy alters the structure of women's brains and that these changes lasted for at least two years after they had given birth –– to the point that the scientists could tell if a woman was pregnant or had recently given birth by an MRI of her brain. The grey matter in their brain, vital for processing information, shrank, as did the hippocampus, the region associated with memory. However, the researchers could not explain exactly what their findings implied, although they might have implications in parental decision-making later in life.

With all that's going on in a pregnant woman's body and all the thoughts running through her mind, it makes sense that a woman may not be remembering some things, Kimmel said. But other reasons for forgetfulness could be that a woman is prioritizing things differently and doing more multitasking, Kimmel suggested. 

Weepiness

Some pregnant women may find themselves unexpectedly crying at a sappy commercial or bursting into tears after throwing up due to morning sickness. 

Women may cry more easily and frequently when they're expecting and in the early stages of new motherhood because these experiences involve a complex mix of emotions, Kimmel said. Sometimes tearfulness is how our emotions come out, she explained. Fluctuating hormone levels may also contribute to crying spells. 

If a woman has been crying a lot and it doesn't seem to be letting up, it may be a symptom of depression, which can affect about 7% of women during pregnancy, according to the Mayo Clinic. Depression during and after pregnancy is a serious condition, with health consequences for mother and baby. Doctors encourage women to seek help if they think they may be depressed.

The National Suicide Prevention Lifeline offers free and confidential crisis counseling available 24 hours a day, seven days a week on at 1-800-273-TALK (8255). Online chat is also available.

Negative body image

During the second and third trimesters, as a woman's baby bump becomes more visible and she gains more weight, she may feel dissatisfied with her body and its appearance, and this may affect her self-esteem. Some pregnant women marvel at their rapidly changing bodies and feel radiant, while others worry about the weight gain and regaining their figures after delivering. 

Related: Having a baby: Stages of pregnancy

These changes to a woman's looks, shape and perceived attractiveness may bring up a complicated mix of feelings, Kimmel said. In order to address some of these body-image concerns, pregnant women must accept that they are pregnant and that their bodies are changing as a result, she said. 

"Fat Talk," in which a woman or others make disparaging comments about her pregnant body can cause harm. A 2020 study about body dissatisfaction during pregnancy, published in the Journal of Affective Disorders, found that Fat Talk influenced how individual women felt about their changing bodies and their emotional state during pregnancy. "Results suggest that women face sociocultural pressures for thinness and body dissatisfaction even when pregnant, and that engaging in Fat Talk during pregnancy is detrimental to women's mental health, particularly for younger women," the authors wrote.  

Nesting instinct

There is conflicting evidence when it comes to whether a "nesting instinct" is a real occurrence during pregnancy, Kimmel said. 

Research has shown that toward the end of pregnancy, the brain's reward system ramps up in preparation for the baby's arrival, and this helps make parenting a rewarding experience, Kimmel said. This may reinforce a parent's nesting instinct. 

There are also social activities and preparations for motherhood, such as attending a baby shower, baby-proofing the house and decorating the nursery, which can all contribute to the urge to "nest." Some women may feel a strong urge to cook, clean and organize during the third trimester as a way to mentally prepare for the changes a new baby will bring and to feel more in control of the situation. However, a 2020 review published in the journal Women's Studies International Forum, argued that "nesting" is a response to gender stereotypes and is linked to the social pressures a mother faces during pregnancy.

Depression

It was once thought that being pregnant was protective against depression as well as other psychiatric illnesses because of high levels of estrogen, but scientists now know this is not the case. A pregnant woman is more likely to become depressed than a woman who is not having a baby, according to the Canadian Paediatric Society. 

A 2019 study published in the journal Obstetrics & Gynecology found that between 2000 and 2015 the rate of depression in women hospitalized during pregnancy increased seven-fold. Women in low-income countries are at greater risk of developing postnatal depression, according to a 2020 review published in the journal PLOS One. 

Maternal depression, both pre- and postnatal, also has tangible consequences for the baby. A 2016 study published in the journal Translational Psychiatry found that  adults whose mothers were depressed when they were pregnant had noticeably higher levels of C-reactive protein, which is indicative of inflammatory disease. Additionally, a 2018 study published in PLOS One found that babies born to mothers who suffered from depression and loneliness during pregnancy had a greater risk of respiratory infections. 

Depression can occur at any point in pregnancy. Parent and child support charity NCT suggests pregnant women seek help if they are struggling with some or all of these symptoms:

• A sense of hopelessness
• An inability of concentrate
• Unusual and consistent worry about giving birth and parenthood
• Loss of interest in yourself or your pregnancy.
• Feeling emotionally detached, empty, teary, angry or irritable for a sustained period of time
• Chronic anxiety
• No interest in sex

How to manage pregnancy emotions

While these emotions may feel overwhelming, NCT recommends the following ways to manage pregancy's emotional rollercoaster:

To learn more about the emotional impact of pregnancy, see the book "Understanding Your Moods When You're Expecting" (Mariner, 2008), by Dr. Lucy Puryear, a psychiatrist specializing in women's reproductive mental health at Baylor College of Medicine.

Additional resources

• American College of Obstetricians and Gynecologists: Postpartum Depression FAQs
• Womenshealth.gov: Pregnancy and Body Image
• Mayo Clinic: Does 'Baby Brain' Really Exist?

This article was updated on June10, 2021 by Live Science contributor Sarah Wild.