Why Anxiety Can Increase During the First Trimester

For many women, the first trimester doesn’t just bring physical symptoms—it brings a noticeable rise in anxiety. Sometimes it’s subtle: a low-level tension in the background that makes you feel less settled than usual. Other times it’s more obvious: racing thoughts, a nervous stomach, or a persistent sense that something could go wrong. And for some women, it’s startling because it arrives before they’ve even fully processed that they’re pregnant.
If this is happening to you, it can feel confusing or discouraging. You might wonder if you’re “overreacting,” whether you should be happier, or whether these feelings mean something is wrong. The reassurance many women need in this moment is simple: increased anxiety in the first trimester is common, and it often has very real, understandable drivers—both biological and situational.
This article explains what first-trimester anxiety can feel like, why it happens in the body and nervous system, how it commonly shows up over time, and when it may be helpful to consider professional support. There’s no diagnosis here, and no pressure to “fix” yourself—just calm context, normalization, and guidance.

For a broader understanding of emotional changes during pregnancy and after birth, visit Pregnancy & Postpartum Mental Wellness.

What this feels like

First-trimester anxiety can look different from woman to woman, but it often has two layers: what your mind is doing and what your body is doing.
In the mind, anxiety may show up as repetitive “what if” thinking. You might find yourself mentally scanning for reassurance: Is this symptom normal? Is the baby okay? Did I eat the wrong thing? What if I miscarry? What if I can’t handle this? Even if you logically know that worry isn’t helping, your brain may keep circling back to the same fears.
In the body, anxiety can feel like restlessness, tightness, or an on-edge sensation that doesn’t fully go away. Some women notice muscle tension in the neck or shoulders, a tight chest, or a fluttery stomach. Others feel a subtle surge of adrenaline—like their system is “revving” when they’d rather be calm.
You may also notice emotional changes that ride alongside anxiety: irritability, tearfulness, or a hair-trigger startle response. Things that normally wouldn’t bother you—noise, clutter, small conflicts—can feel harder to tolerate.
A very common experience is anxiety about anxiety. You might judge yourself for worrying, worry that stress is harmful, or feel scared that you won’t be able to keep it together. This secondary layer can intensify the first one, creating a loop: you feel anxious, then worry about feeling anxious, then feel even more anxious.
And sometimes first-trimester anxiety isn’t “thought-based” at all. Some women describe it as a physical sense of dread or unease that isn’t attached to any specific idea. That can be especially unsettling, because it feels harder to explain or soothe. But it still fits within the range of common early-pregnancy experiences.

Why this happens (body / nervous system)

It can help to think of first-trimester anxiety as the nervous system responding to rapid change—change that is real, internal, and intense, even if it’s invisible from the outside.
Hormonal shifts begin early and accelerate quickly. Estrogen and progesterone rise steeply in the first trimester, and these hormones interact with brain chemistry. They influence neurotransmitters that affect mood stability, emotional sensitivity, and stress response. When these systems are recalibrating, emotional steadiness can feel temporarily less predictable.
At the same time, the body is adjusting its baseline. Blood volume starts increasing, heart rate can rise, and digestion often changes. Sleep may become lighter or more fragmented. Appetite may shift. Nausea can create a constant background stress signal. All of these are normal physiological transitions—and they can also mimic or amplify anxiety sensations. When your body feels unfamiliar, the brain may interpret those signals as “something is off,” which can increase alertness and worry.
Uncertainty is another powerful driver. The first trimester contains many “unknowns” and often fewer moments of external reassurance. You may be waiting for an ultrasound, waiting for tests, waiting to feel better, waiting to tell people. The nervous system tends to treat uncertainty as a reason to stay vigilant. Vigilance can be useful in truly risky situations, but in early pregnancy it can feel like anxious monitoring that never fully turns off.
There is also a meaning-layer to pregnancy that can quietly intensify anxiety. Even when pregnancy is wanted and welcomed, it represents a major life transition. Your identity, priorities, routines, relationships, and future responsibilities may be shifting in the background. The mind often responds to major transitions by running scenarios—trying to “prepare”—and that preparation can feel like anxiety.
Past experiences can make this stronger. If you’ve experienced a prior loss, fertility challenges, complicated medical history, or even a general tendency toward worry, your nervous system may be primed to scan for danger. That doesn’t mean you’re doing anything wrong. It means your body remembers what felt hard before, and it tries to protect you by staying alert.

Patterns & variability

First-trimester anxiety rarely stays the same day to day. Many women experience it in waves. Some days feel manageable and steady, and other days feel emotionally loud—full of worry, physical tension, or an unsettled mind.
Certain moments tend to increase anxiety. Waiting periods are a big one: waiting for a first appointment, waiting for test results, waiting to see if symptoms change. The mind naturally tries to reduce uncertainty, and it can do that by seeking information or imagining outcomes.
Time of day can also matter. Anxiety may feel stronger in the evening when fatigue has accumulated and distractions fade. For other women, mornings are harder because nausea or dizziness is worse, and physical discomfort can set the tone for anxious thoughts.
Information exposure can shape anxiety patterns too. Some women find themselves searching and reading constantly—trying to reassure themselves—but discovering that reassurance only lasts briefly. Others avoid information because it feels too activating. Both patterns are understandable attempts to cope with uncertainty, and both can make anxiety feel more prominent.
It’s also common for first-trimester anxiety to be “triggered” by normal pregnancy sensations. A cramp, a change in discharge, a day with fewer symptoms, a sudden wave of fatigue—these experiences can lead to mental scanning and worry. The challenge is that early pregnancy symptoms are often variable even when everything is progressing normally, so the nervous system can end up reacting repeatedly to ordinary fluctuations.
Finally, it’s important to recognize that anxiety can be present even alongside happiness. Many women feel grateful and anxious at the same time. The presence of anxiety does not cancel out the goodness of the pregnancy, and it doesn’t mean you’re unprepared or unappreciative. It means your mind and body are adjusting to something significant.

When it starts affecting daily life

A certain amount of worry can be part of early pregnancy, but anxiety becomes more burdensome when it begins shaping your day or shrinking your life.
You might notice that it’s harder to concentrate, make decisions, or complete tasks because your attention keeps returning to worry. You may feel emotionally exhausted, like your brain has been “on” all day. Some women describe it as mental noise that won’t quiet down.
Sleep can be affected in multiple ways: difficulty falling asleep because thoughts keep looping, waking early with worry, or feeling physically restless. When sleep is disrupted, the nervous system becomes more reactive, which can intensify anxiety the next day.
Relationships can also be impacted. If anxiety is high, you may feel less patient, less flexible, or more easily overwhelmed by conversation and social interaction. Some women withdraw because they don’t want to “burden” others or because talking about it makes it feel more real. Others seek reassurance repeatedly from a partner, friends, or clinicians and feel briefly calmer—then anxious again.
Another sign anxiety is affecting daily life is avoidance. You may avoid appointments because they feel stressful, avoid discussing the pregnancy because it triggers fear, or avoid making plans because it feels too uncertain. You may also avoid being alone with your thoughts, filling every quiet moment with noise or distraction because silence feels too activating.
None of these signs mean something is wrong with you. They simply indicate that anxiety is taking up more space than you want it to, and you deserve support rather than self-criticism.

When to consider professional support

It can be helpful to consider professional support when anxiety is persistent, escalating, or interfering with your ability to function and feel like yourself. This doesn’t require a crisis. Many women benefit from support simply because pregnancy is a major transition and the first trimester can be emotionally intense.
Consider reaching out if anxiety is present most days, if worry feels difficult to control, or if you find it hard to experience moments of calm. Support can also be helpful if anxiety interferes with sleep, appetite, relationships, or work—or if you feel constantly on edge and unable to recover emotionally.
It may also be time to consider support if you notice that reassurance never lasts. If you’re checking symptoms repeatedly, searching online often, or asking the same questions over and over because relief fades quickly, that’s a sign your nervous system may need steadier support than quick reassurance can provide.
If you have a history of anxiety, panic, trauma, pregnancy loss, or postpartum emotional difficulty, reaching out early can be especially supportive—not because something is guaranteed to happen, but because you deserve a strong foundation.
And if your anxiety ever feels so intense that you feel scared of your own thoughts, unable to cope, or unable to stay present in daily life, that’s a clear sign to seek help promptly. You do not have to carry that alone.

Takeaway

Anxiety often increases in the first trimester because the body and nervous system are adapting to rapid hormonal change, physical symptoms, and uncertainty. These feelings are common, understandable, and not a sign that you’re failing—often they’re simply a sign that your system is working hard to adjust.