Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. C URRENT O PINION Reducing maternal anxiety and stress in pregnancy: what is the best approach? Yvonne Fontein-Kuipers Purpose of review To briefly review results of the latest research on approaching antenatal maternal anxiety and stress as distinct constructs within a broad spectrum of maternal antenatal distress and the preventive strategic role of the maternal healthcare practitioner. Recent findings Maternal antenatal anxiety and stress are predominant contributors to short and long-term ill health and reduction of these psychological constructs is evident. Anxiety and stress belong to a broad spectrum of different psychological constructs. Various psychometric instruments are available to measure different individual constructs of antenatal maternal emotional health. Using multiple measures within antenatal care would imply a one-dimensional approach of individual constructs, resulting in inadequate management of care and inefficient use of knowledge and skills of maternity healthcare practitioners. A case-finding approach with slight emphasis on antenatal anxiety with subsequent selection of at-risk women and women suffering from maternal distress are shown to be effective preventive strategies and are consistent with the update of the National Institute for Health and Care Excellence guideline ‘Antenatal and postnatal mental health’. Educational aspects of this approach are related to screening and assessment. Summary A shift in perception and attitude towards a broad theoretical and practical approach of antenatal maternal mental health and well-being is required. Case finding with subsequent selective and indicated preventive strategies during pregnancy would conform to this approach and are evidence based. Keywords antenatal mental health, anxiety, maternal distress, pregnancy, stress INTRODUCTION Antenatal maternal anxiety and stress belong to the spectrum of maternal distress, which refers to a wide range of women’s affected emotional well-being during pregnancy. Depression, stress, and anxiety are the most common mentioned constructs of maternal distress and they often co-occur [1]. Recently, attention has been drawn to pregnancy anxiety as a distinct concept, and it has been empha- sized that distinguishable forms of stress during pregnancy exist. Both psychological constructs are identified to be most potent maternal risk factors for adverse maternal and child outcomes compared with other mental health disturbances and disorders [1]. There is scarce epidemiological information of the incidence of antenatal anxiety, but studies indicate that experiencing anxiety is common: it has been suggested that between about one in ten and one in three people will have an anxiety dis- order at some point in their life [1]. In a small-sized study among Dutch pregnant women [2], anxiety in pregnancy occurred between 30 and 35%. It is known that there is a high comorbidity between antenatal depression and anxiety and that antenatal anxiety is a predictor for the development of post- natal mental health complications [3]. Antenatal stress was found to be rather common among a population of ethnically and economically diverse pregnant women attending a university- based antenatal clinic [4], with slightly higher mean levels in the second trimester of pregnancy than in Department of Midwifery Science, Midwifery Education and Studies Maastricht-ZUYD, Maastricht, The Netherlands Correspondence to Yvonne Fontein-Kuipers, RM, MSc, PgDHE, PhD student, Department Midwifery Science, Midwifery Education and Studies Maastricht-ZUYD, PO Box 1256, Maastricht 6201 BG, The Netherlands. Tel: +31 33 2584656; fax: +031 43 3885400; e-mail: y.fontein@AV-M.nl Curr Opin Obstet Gynecol 2015, 27:128–132 DOI:10.1097/GCO.0000000000000155 www.co-obgyn.com Volume 27  Number 2  April 2015 REVIEW