Purpose <p>Anxiety-related disorders (ARD), including posttraumatic stress disorder (PTSD) and obsessive–compulsive disorder (OCD), are highly prevalent mental health conditions. The peak prevalence of ARD in women coincides with the critical period of family planning, pregnancy, and child-rearing, affecting 1 in 5 women. This poses several challenges, including fears of passing anxiety on to children, worsening of symptoms during pregnancy or postpartum, and concerns about how therapy affects pregnancy outcomes. Clinicians frequently lack the expertise to adequately address these concerns. This may result in clinicians being cautious about starting treatment. This narrative review provides insights from the literature along with practical recommendations to facilitate decision-making with these challenges.</p> Methods <p>This narrative review provides a review of existing literature on ARD and pregnancy, synthesizing key findings from relevant theoretical and empirical studies.</p> Results <p>Results show that ARD tend to cluster within families, driven by both genetic and environmental factors. During pregnancy and postpartum, ARD are particularly prevalent, and maternal anxiety is associated with an increased risk of preterm birth and low birth weight. Psychotherapy, including exposure therapy, is effective and is overall beneficial for pregnant women, although in specific cases, it can also worsen the anxiety, with no known adverse effects on pregnancy outcomes. SSRI use requires consideration of risks and benefits. Preventive strategies to reduce anxiety vulnerability in offspring are scarce.</p> Conclusion <p>In conclusion, addressing ARD in (prospective) parents is essential, given the potential negative impact on both parents and children. Clinical awareness is needed to optimize care for this population.</p>