Obsessive-compulsive disorder in pregnancy and the postpartum period: course of illness and obstetrical outcome

• Published in: Archives of women's mental health 2016-02, Vol.19 (1), p.3-10
• Main Authors: House, Samuel J., Tripathi, Shanti P., Knight, Bettina T., Morris, Natalie, Newport, D. Jeffrey, Stowe, Zachary N.
• Format: Article
• Language: English
• Subjects: Adult; Care and treatment; Complications and side effects; Development and progression; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Medicine; Medicine & Public Health; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - diagnosis; Obsessive-Compulsive Disorder - epidemiology; Obsessive-Compulsive Disorder - psychology; Obstetrics; Original Article; Parturition; Postpartum Period - psychology; Pregnancy; Pregnancy Complications - diagnosis; Pregnancy Complications - epidemiology; Pregnancy Complications - psychology; Pregnancy Outcome; Pregnancy Trimester, Second; Pregnant women; Prospective Studies; Psychiatric Status Rating Scales; Psychiatry; Psychological aspects; Psychotherapy; Risk Factors; Severity of Illness Index; Socioeconomic Factors; Studies; United States - epidemiology
• ISSN: 1434-1816; 1435-1102
• DOI: 10.1007/s00737-015-0542-z

The study aimed to examine the course of obsessive-compulsive disorder (OCD) across pregnancy and its impact on obstetric and neonatal outcomes. Women enrolled prior to 20-week gestation in a prospective, observational study. The Structured Clinical Interview for DSM-IV was completed to obtain lifetime Axis I diagnoses. A total of 56 women with OCD were followed at 1 to 3-month intervals through 52 weeks postpartum. Each visit, the Yale-Brown Obsessive Compulsive Scale (YBOCS), clinical assessment, and medication/exposure tracking were performed. Obstetric and neonatal data were abstracted from the medical record. In subjects with OCD, associations between perinatal obsessive-compulsive symptoms (OCSs) and outcomes were examined. Additionally, outcomes were compared to 156 matched psychiatric patients without OCD. Maternal age inversely correlated with the YBOCS scores across the study period ( β  = −0.5161, p  = .0378). Cesarean section was associated with increased OCSs in the postpartum period compared to vaginal delivery ( β  = 5.3632, p  = 0.043). No associations were found between severity of perinatal obsessions or compulsions and any specific obstetric or neonatal complications. Subjects without OCD had higher frequency of fetal loss compared to mothers with OCD ( χ 2  = 4.03, p  = 0.043). These novel prospective data fail to identify an association of OCSs with adverse outcomes. In contrast, there is an association of delivery method and younger maternal age with increased postnatal symptoms of OCD. Psychiatric subjects without OCD may have a higher risk of miscarriage and intrauterine fetal demise compared to subjects with OCD.