The Anxious Pregnancy Across Three Trimesters: A Primary-Care Case Series of Non-Pharmacological, CBT-Based Multidisciplinary Management of Antenatal Anxiety

Abstract

Introduction. Antenatal anxiety is among the most common yet most overlooked complications of pregnancy and, left unrecognized, is associated with preterm birth, low birth weight, impaired bonding, and adverse child neurodevelopment. Evidence for first-line, non-pharmacological management within primary care—where most women in low-resource settings receive care—remains sparse.

Case presentation. We describe three pregnant women managed at an Indonesian community health center (UPTD Puskesmas Susut I, Bali), spanning all three trimesters. Case 1 was a 20-year-old primigravida at 9 weeks with a generalized anxiety presentation driven by an absent seafaring husband and unfiltered online health information (Beck Anxiety Inventory [BAI] 28, Perinatal Anxiety Screening Scale [PASS] 25, Edinburgh Postnatal Depression Scale [EPDS] 14). Case 2 was a 29-year-old multigravida at 20 weeks with anxiety and mild anemia rooted in a previous traumatic low-birth-weight delivery and in-law pressure (BAI 24, PASS 22, EPDS 14). Case 3 was a 22-year-old primigravida at 35 weeks with panic-like symptoms and fear of childbirth (BAI 24, PASS 22, EPDS 14). All three were managed without psychotropic medication using CBT, family psychoeducation, and obstetric monitoring, with serial screening documenting improvement across every instrument within one to four weeks.

Conclusion. A spectrum of antenatal anxiety can be recognized at the primary-care level using serial validated screening; in these three women, CBT-based multidisciplinary care without psychotropic exposure was followed by rapid improvement. As an uncontrolled series these observations are hypothesis-generating, but they support integrating perinatal mental-health care into routine antenatal services.