She walked into my consultation room at 11 weeks pregnant. By every external measure, things were going well. She and her husband had been trying for two years, and when the test turned positive, there was relief, even joy.
But for the past month, she had been waking up with a sense of unease she could not explain. It was not dramatic and nothing about it would have been visible to anyone else.
She had also been crying every morning for a month and have been asking herself, ‘What is wrong with me?’
Pregnancy anxiety in Malaysia is far more common than most women realise. Malaysian research puts the overall prevalence of antepartum anxiety symptoms at around 28%. More recent work shows that anxiety peaks in the first trimester, at 25.5%.
That is roughly one in four pregnant Malaysian women, sitting in the earliest weeks of pregnancy and carrying a level of psychological distress that meets clinical threshold.
We often talk about postnatal depression. The six-week postpartum check-in built around confinement is the point at which our system finally turns to a mother and asks how she is feeling.
By that point, we have already missed the window when her anxiety was at its loudest.
Emotional and physical signs
What many women and couples experience during early pregnancy is not simply worry. It is a convergence of biological, psychological and social changes happening all at once.
Biologically, early pregnancy is a period of rapid internal recalibration. Hormones such as progesterone, oestrogen and human chorionic gonadotropin (hCG) rise quickly to sustain the pregnancy. At the same time, they influence mood regulation, sleep patterns, appetite and stress sensitivity.
For some women, this can feel like a loss of emotional baseline; becoming more easily overwhelmed, more alert to uncertainty or more reactive than usual.
Physical symptoms such as fatigue, headache, nausea and changes in bladder control are often described as normal. But when not explained, they can feel unsettling and difficult to manage.
Socially, early pregnancy is often kept private. Later, it is treated as a blessing and most antenatal advice from elders focuses on the physical well-being of the baby.
There is very little cultural language for what to do when you are pregnant and frightened. Many of my patients tell me they felt unable to mention their anxiety to anyone in the family because it felt like complaining about a gift, especially after fertility struggles or pregnancy loss.
Mother-in-law dynamics, expectations of the dutiful pregnant daughter and the convention of waiting until the second trimester to share the news all combine to make the first trimester one of the loneliest periods in a woman’s life.
This becomes more complex for women who are working. Workplace support tends to focus on later pregnancy; adjustments to physical demands, shift work and maternity leave.
These are important. But they come after a phase that is often more biologically and psychologically unstable. In the first trimester, expectations remain unchanged. Disclosure is often not yet possible. Support is minimal. So the adjustment is carried quietly between meetings, deadlines and responsibilities.
Seek help
The cost of leaving early pregnancy anxiety untreated is well documented.
Untreated antenatal anxiety is one of the strongest predictors of postnatal depression.
Early pregnancy anxiety is significantly associated with adverse outcomes, including a 41% higher risk of preterm birth and increased risks of miscarriage and stillbirth which further complicate the motherhood experience.
Women who experience this should know what they are experiencing is not weakness, ingratitude, being dramatic or a personal failing.
Antenatal depression is treatable and understanding what is happening can bring relief. Talking therapy could help. Cognitive behavioural therapy works well too.
Most importantly, you do not have to wait. If you are not okay, seek help today.
It can be requesting a referral from your obstetrician to a clinical psychologist or psychiatrist with perinatal experience, booking an appointment at a mental health clinic that offers perinatal care consultation, or simply telling a trusted person that you are struggling.
Our country has made progress in recognising postnatal depression. The next step is earlier, where the need already exists.
Dr Siti Nordiana Dollah is a consultant psychiatrist at The Kuaya. The views expressed here are the writer’s own.
