Strong moods and emotions are very common in pregnancy, but when do they become more than just normal pregnancy changes? We look at what you should look for and when to seek medical advice.

Emotions
During pregnancy, and in the postnatal period, there are significant changes in a woman's hormone levels. This can have an effect on how they may feel or behave. Women are often more emotionally up and down during pregnancy and less able to cope with normal stresses than usual. In some respects, this is hardly surprising- there's a huge amount of change going on in a very short period.

When pregnant, you may find you become upset and anxious more easily. This is probably due to both the hormonal and emotional changes that you are experiencing. Being pregnant can affect your lifestyle (for example, you may have stopped drinking alcohol) and the activities or hobbies you do. This in turn can affect your emotions and behaviours. You may also find you feel anxious about all the upheaval that comes with childbirth and coping with a newborn baby.

Pregnancy is often divided into three sections, or trimesters.

First trimester
The first trimester {up to 12 weeks) can be very overwhelming for some. Women will have just found out that they are pregnant and may be feeling tired, sick, and constipated and have tender breasts. They may well be feeling anxious, excited, exhausted, and delighted all at the same time!
For some women, the first trimester may be accompanied by severe anxiety, especially if they have had problems conceiving or problems in earlier pregnancies. Remember above all, it is natural to feel worried or anxious - the idea of a new baby may require a lot of adjusting to. If, however, your mood changes become severe or unrelenting, please see your doctor for advice.

Second trimester
When you reach the second trimester (from 13 weeks), you may feel more energetic again and feel a little more able to prepare for your baby. You still may have mood swings or feel tearful at times, but often you may feel more positive than in the first trimester and feel more able to undertake gentle physical activity.

Third trimester
The third trimester (from 28 weeks) can be pretty uncomfortable and tiring. As your baby grows, you may struggle to get a good night's sleep due to discomfort or needing the toilet. It's also common to have increasing fears about childbirth, what will happen and whether you will cope. Childbirth classes can be useful in this scenario as they help prepare you and help you meet others in a similar situation.
The third trimester is often a time when 'nesting' occurs. Women may start tidying and planning, sometimes to excessive proportions. Again, the exact cause of this is not known, but it is likely to be hormonal. Be reassured if it is relatively short-lived and not too dramatic
- it is part of a normal pregnancy-related behaviour.

Reactions to body changes
Some women feel uncomfortable with the changes to their body and appearance that occur in pregnancy. This can be very common. For some, however, resentment or anger can form a significant emotion in their pregnancy. Often this is due to the physical symptoms and changes that may be taking place - for example, extreme nausea.

If, however, you or people around you are concerned that these feelings are extreme or worsening, please see your GP, midwife or other health professional.

When pregnancy is not plain sailing
Pregnancy is thought by so many people to be a time of happiness and excitement but the reality for most women is that pregnancy is a mixture of ups, downs and other extreme emotions.
Some women appear to breeze through pregnancy with no problems at all. They love being pregnant and don't appear to have problems adjusting at all. For others, it is a more turbulent journey. Pregnancy and childbirth are a time of significant change, and it is completely normal to feel anxious or worried or more vulnerable than normal.
When a woman's mood in pregnancy becomes down or low for a prolonged period of time, it may be an indication that there may be more than just normal pregnancy worries.
The risk of this is increased in women who have experienced troublesome symptoms during pregnancy- for example, extreme back pain. Also women who have a past history of depression or bipolar disorder are at increased risk of depression and other mental health problems during pregnancy.
If feeling down or anxious is affecting your everyday life, please mention it to your midwife. You don't have to have a particular mental health problem to be offered help dealing with worrying thoughts or feelings. However, if you have developed depression, it is important to get the help you need.

Not feeling your usual self
Occasionally during pregnancy or shortly after childbirth, a woman's mood can become elated or confused rather than low or depressed. This is rare, but if it occurs, it can develop rapidly into postpartum psychosis. Symptoms may include confusion, unpredictable behavior and hallucinations. If someone you know develops these signs, please seek medical help immediately.
Domestic abuse is something rarely talked about or linked with pregnancy. However, the strong ranges of emotions experienced in pregnancy mean that domestic abuse is more likely to happen than at other times. If your relationship is problematic or violent please ask for help.
Pregnancy is an exciting but emotional time for most women, often with changing pregnancy behaviors. It is important to talk your feelings through with someone if you are anxious or low, to ensure you get the support you need.