Pregnancy requires adaptation in all areas of life and is accompanied by doubts and uncertainty that can be highly stressful for the woman.(1,2) Spielberger et al.(1,3) define anxiety as an immediate, transitory, and time-varying emotional state involving physiological and cognitive changes characterized by feelings of tension, apprehension, and nervousness.

It is a very unpleasant sensation that is frequently experienced and sometimes undiagnosed, manifesting itself with one or more physical symptoms such as a feeling of emptiness and difficulty breathing.(4,5)

It has been shown that anxiety constitutes a risk factor for pregnancy development and is associated with a higher risk of miscarriage, reduced intrauterine growth, lower Apgar scores, preterm birth, fetal disorders of the hypothalamic-pituitary-adrenal axis, low birth weight, increased risk of neurological and mental diseases in the child throughout their life, as well as affective disorders in the woman (pre- and postpartum depression), which can have lasting effects on the offspring.(1,4)

It is estimated that more than 25% of women suffer from prenatal stress. When prenatal stress occurs at high and persistent levels, an anxiety disorder may be triggered.(1) During gestation, anxiety is a frequent mental health problem, observed in 15.2% of the pregnant population.(6)

Pregnant women are biologically vulnerable to psychopathological disorders, due to both hormonal and psychosocial changes. A meta-analysis conducted in developed countries estimates that 7.4%, 12.8%, and 12% are affected during the first, second, and third trimesters, respectively, and up to 16% postpartum.(7)

Although not all pregnant women develop clinical anxiety, many experience moments of worry that, if not adequately addressed, can affect their well-being and the development of the pregnancy.(8)

From a practical perspective, nursing plays a key role in the detection, prevention, and management of these emotional states. Nursing staff not only perform clinical assessments but also establish trusting bonds with patients, which makes it possible to identify early signs of anxiety. Through active listening, empathetic support, and education about the gestational process, nurses can reduce the negative emotional impact and foster a safer and more positive experience.

Nursing can implement support strategies such as relaxation techniques, guidance on healthy habits, and timely referral to specialized professionals when persistent symptoms are detected. In community or resource-limited contexts, the nurse's role is expanded, serving as a link between the pregnant woman and the health system, especially in areas where access to psychologists or psychiatrists is scarce.

In accordance with the above, the present study was conducted with the aim of characterizing anxiety during pregnancy and childbirth from the perspective of the nursing professional.

A narrative literature review was conducted in January 2023 on parameters for anxiety management from the perspective of the nursing professional's role during gestation and childbirth. Data were collected from various bibliographic sources related to the topic.

The inclusion criteria were:

Research of any type on the topic, prioritizing research published in the last 5 years, in English, Spanish, or Portuguese, and available in highly reliable databases and scientific journals.

That the content explicitly address anxiety, and not solely other mental health entities in this population group.

Articles from websites, news blogs, or social media that were non-academic were not selected, nor were those whose content was unavailable.

The search was conducted in the following databases: PubMed, ProQuest, Dialnet, SciELO, Medline.

The process was conducted gradually, applying the criteria provided in each database and progressing through the sampling until the final sample was obtained. The following keywords were used in the corresponding language:

Pregnancy, gestation, gestational anxiety, psychosocial factors, mental disorders, comorbidity, education, nursing practice, labor pain, mental health, and nursing care.

Pregnancy, gestation, gestational anxiety, psychosocial factors, mental disorders, comorbidity, education, nursing practice, labor pain, mental health, and nursing care.

Pregnancy, gestation, gestational anxiety, psychosocial factors, mental disorders, comorbidity, education, nursing practice, labor pain, mental health, and nursing care.

To select the documents included in the work, the title and abstract were first read to conduct an initial selection aligned with the topic in question; subsequently, the full text was read to definitively establish those most relevant to the research.

An initial search of 653 articles formed the universe; of these, 16 were selected after applying the inclusion and exclusion criteria, as shown in Figure 1.

The documents analyzed are available on the internet and are open access; the authors' intention and central idea were respected at all times when analyzing the information.

Figure 1. Flowchart of the search and selection of articles.

Table 1 presents various findings on the psychological changes that women face during pregnancy, highlighting anxiety as a central component. Its association with underlying disorders and perinatal complications is evident, as is its exacerbation during the COVID-19 pandemic. Among the main findings is that the absence of support, especially from the partner, and emotional instability in pregnant adolescents are associated with anxiety and depression. Factors such as gestational loss and the postpartum adaptation process are identified as additional triggers of psychological distress.

Table 1. Pathophysiology of pregnancy and its effect on anxiety

Table 2 presents the main results on psychological changes during gestation, highlighting the presence of anxiety associated with underlying disorders, perinatal diseases, and factors such as the COVID-19 pandemic, lack of support, adolescent pregnancy, gestational loss, and the postpartum period. Symptoms such as stress, insomnia, depression, and social dysfunction are reported, with variations according to the context and stage of pregnancy.

Table 2. Findings on the impact of anxiety among pregnant women

Table 3 presents nursing staff actions in the management of anxiety in pregnant women. The reviewed literature documented that dignified and empathetic treatment by health personnel, especially nurses, reduces insecurity and strengthens emotional confidence. The usefulness of relaxation methods such as deep breathing and music was also reported, as was the positive impact of floral therapy during labor on physiological and hormonal parameters.

Table 3. Role of the nursing professional in the management of anxiety in pregnant women

The results indicate that anxiety during pregnancy is a frequent, multicausal phenomenon with relevant obstetric and psychosocial repercussions, including its association with pregnancy loss, intrauterine growth restriction, and increased symptoms of depression and insomnia, in addition to worsening during the COVID-19 pandemic.(9,11,13) These findings confirm that perinatal anxiety is not an isolated problem but rather is integrated with biological, psychosocial, and healthcare determinants that require a systematic response from the first level of care.

The relationship between gestational anxiety and adverse perinatal outcomes found in the study is consistent with meta-analyses and reviews,(9) which show an association between anxiety and outcomes such as preeclampsia, preterm birth, and low birth weight, reinforcing the clinical plausibility of the observed link. The increase in symptomatology during the pandemic is consistent with reports of increased prenatal stress in health crisis contexts.(10)

The authors concur with other studies on the importance of support, especially from the partner, in reducing anxiety; however, some quantitative studies(12,19) report variations according to socioeconomic or cultural factors that may modulate this effect. Therefore, the relative influence of social support may differ across contexts and requires local assessment before interventions are generalized.

Although evidence of positive effects of floral therapy was found, it should be used with caution, since robust comparative evidence on its efficacy and mechanisms remains limited and heterogeneous.

The findings regarding the frequency of anxiety, even at mild levels, should not be minimized because of its clinical significance and impact on neonatal outcomes; clinical practice should prioritize screening and continuous follow-up.(6,9)

The reported finding that adolescents, women with a history of abortion, and ethnic minorities have a greater anxiety burden,(14,18,19) suggests that interventions should be differentiated and culturally sensitive. Broader and more heterogeneous studies in other contexts are necessary.

Relaxation techniques, prenatal education, and empathetic support have significant evidence as first-line treatment measures; this study reports complementary therapies with hormonal effects,(4,22) but these require controlled research before their generalized recommendation as a standard of care.

The described interventions (preparation classes, support groups, teaching of breathing and relaxation techniques)(4,22,23) are practices aligned with nursing competencies and can reduce anxiety in early phases, improving adherence and the childbirth experience.

The authors agree that, in resource-limited contexts, community nursing can offer home visits and group workshops and mobilize family networks to counteract the lack of support identified as a risk factor, integrating culturally adapted strategies for adolescents or ethnic minorities.

However, as argued by Peñalba and Posada,(16,21,24) for the aforementioned functions to be effective, nursing requires specific training in perinatal mental health screening, brief intervention techniques, and empathetic communication.

As this is a narrative review with a final selection of 16 studies, the synthesized findings offer a useful overview but with limitations for establishing causality or precise effect estimates; therefore, convergence with more rigorous studies (meta-analyses, trials) strengthens the interpretation, whereas the identified differences call for more controlled local studies that consider unmeasured contextual variables, such as availability of psychological services and technological barriers.

Anxiety during pregnancy is a complex phenomenon that intertwines with biological, psychosocial, and healthcare-related aspects, in which the nursing professional emerges as a relevant axis by being a central actor in identifying, accompanying, and offering emotional and educational support to the pregnant woman, in addition to acting as a bridge to other resources of the health system, especially in contexts with limited access.