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

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Abstract

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.

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Acknowledgments

The original study was funded by NIH grants TRCBS P50 MH 77928 and SCOR P50 MH 68036.

Conflict of interest

Dr., Ms., Ms., and Mr. have no conflicts of interest to disclose. Dr. has received research support from and consulted to GlaxoSmithKline, Pfizer, and Wyeth Corporations and received speakers’ honoraria from the companies plus from Eli Lilly and Forest Corporations, with no funds received since 2008. Dr. has received research support from NARSAD and the National Institutes of Health (NIH), as well as Eli Lilly, GlaxoSmithKline (GSK), Janssen, and Wyeth Corporations, and speaker’s honoraria from Astra-Zeneca Pharmaceuticals (AZP), Eli Lilly, GSK, and Pfizer Corporations, with no funds received since 2008.

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Correspondence to Samuel J. House.

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House, S.J., Tripathi, S.P., Knight, B.T. et al. Obsessive-compulsive disorder in pregnancy and the postpartum period: course of illness and obstetrical outcome. Arch Womens Ment Health 19, 3–10 (2016). https://doi.org/10.1007/s00737-015-0542-z

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  • DOI: https://doi.org/10.1007/s00737-015-0542-z

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