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Obsessive-compulsive disorder in pregnant and postpartum women

Author
Murray B Stein, MD, MPH
Section Editor
Peter P Roy-Byrne, MD
Deputy Editor
Richard Hermann, MD

INTRODUCTION

While the significance of depression and psychosis during pregnancy or postpartum have been widely recognized, obsessive-compulsive disorder (OCD) has not received as much attention. OCD may also occur during these periods and poses unique clinical challenges. Rigorous epidemiologic studies are not available, but women may be at an increased risk for OCD during or following pregnancy, including new-onset OCD, recurrence, or exacerbation of a chronic disorder illness.

The mother's obsessional thoughts often focus on the baby, and the associated compulsive behaviors may suggest the potential for harm to the mother or child. Though relatively rare, the risk for harm should be carefully monitored. In some cases, intervention (eg hospitalization) may be required to ensure safety.

OCD is an often-disabling illness that is frequently difficult to treat. Partial responses to treatment are common as are subsequent relapses [1]. Presentations during pregnancy and postpartum frequently go undetected and untreated.

This topic reviews OCD during pregnancy and postpartum. The presentation, assessment, and treatment of OCD in the general population are discussed elsewhere. (See "Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis".)

EPIDEMIOLOGY

A meta-analysis of 19 retrospective studies with 6922 participants in 12 countries compared the prevalence of obsessive-compulsive disorder (OCD) among pregnant (12 studies) or postpartum women (7 studies) with the prevalence of OCD in 10 regionally matched studies of 17,955 women drawn from the general population of eight countries [2]. Estimates of the prevalence of OCD in pregnant and postpartum women were found to be greater than the estimated prevalence in the general population (2.07 and 2.43 versus 1.08 percent). Further research is needed to determine the significance of the difference in rates observed in pregnancy and postpartum, and on whether OCD prevalence differs by trimester.

             

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Literature review current through: Nov 2016. | This topic last updated: Mon Oct 27 00:00:00 GMT+00:00 2014.
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References
Top
  1. Skoog G, Skoog I. A 40-year follow-up of patients with obsessive-compulsive disorder [see commetns]. Arch Gen Psychiatry 1999; 56:121.
  2. Russell EJ, Fawcett JM, Mazmanian D. Risk of obsessive-compulsive disorder in pregnant and postpartum women: a meta-analysis. J Clin Psychiatry 2013; 74:377.
  3. Wenzel A, Haugen EN, Jackson LC, Brendle JR. Anxiety symptoms and disorders at eight weeks postpartum. J Anxiety Disord 2005; 19:295.
  4. Wenzel, A, et al. The occurrence of panic and obsessive compulsive symptoms in women with postpartum dysphoria: A prospective study. Arch Women Ment Health 2001; 4:5.
  5. Abramowitz JS, Schwartz SA, Moore KM, Luenzmann KR. Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature. J Anxiety Disord 2003; 17:461.
  6. Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:593.
  7. Karno M, Golding JM, Sorenson SB, Burnam MA. The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry 1988; 45:1094.
  8. Sutter-Dallay AL, Giaconne-Marcesche V, Glatigny-Dallay E, Verdoux H. Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: a prospective survey of the MATQUID cohort. Eur Psychiatry 2004; 19:459.
  9. Neziroglu F, Anemone R, Yaryura-Tobias JA. Onset of obsessive-compulsive disorder in pregnancy. Am J Psychiatry 1992; 149:947.
  10. Williams KE, Koran LM. Obsessive-compulsive disorder in pregnancy, the puerperium, and the premenstruum. J Clin Psychiatry 1997; 58:330.
  11. Uguz F, Akman C, Kaya N, Cilli AS. Postpartum-onset obsessive-compulsive disorder: incidence, clinical features, and related factors. J Clin Psychiatry 2007; 68:132.
  12. Wisner KL, Peindl KS, Gigliotti T, Hanusa BH. Obsessions and compulsions in women with postpartum depression. J Clin Psychiatry 1999; 60:176.
  13. Misri S, Reebye P, Corral M, Milis L. The use of paroxetine and cognitive-behavioral therapy in postpartum depression and anxiety: a randomized controlled trial. J Clin Psychiatry 2004; 65:1236.
  14. Abramowitz J, Moore K, Carmin C, et al. Acute onset of obsessive-compulsive disorder in males following childbirth. Psychosomatics 2001; 42:429.
  15. Barr LC, Goodman WK, Price LH. The serotonin hypothesis of obsessive compulsive disorder. Int Clin Psychopharmacol 1993; 8 Suppl 2:79.
  16. Labad J, Menchón JM, Alonso P, et al. Female reproductive cycle and obsessive-compulsive disorder. J Clin Psychiatry 2005; 66:428.
  17. Vulink NC, Denys D, Bus L, Westenberg HG. Female hormones affect symptom severity in obsessive-compulsive disorder. Int Clin Psychopharmacol 2006; 21:171.
  18. Leckman JF, Goodman WK, North WG, et al. The role of central oxytocin in obsessive compulsive disorder and related normal behavior. Psychoneuroendocrinology 1994; 19:723.
  19. Fairbrother N, Abramowitz JS. New parenthood as a risk factor for the development of obsessional problems. Behav Res Ther 2007; 45:2155.
  20. Uguz F, Gezginc K, Zeytinci IE, et al. Course of obsessive-compulsive disorder during early postpartum period: a prospective analysis of 16 cases. Compr Psychiatry 2007; 48:558.
  21. Brockington IF, Macdonald E, Wainscott G. Anxiety, obsessions and morbid preoccupations in pregnancy and the puerperium. Arch Womens Ment Health 2006; 9:253.
  22. Sichel DA, Cohen LS, Dimmock JA, Rosenbaum JF. Postpartum obsessive compulsive disorder: a case series. J Clin Psychiatry 1993; 54:156.
  23. Jennings KD, Ross S, Popper S, Elmore M. Thoughts of harming infants in depressed and nondepressed mothers. J Affect Disord 1999; 54:21.
  24. Abramowitz JS, Nelson CA, Rygwall R, Khandker M. The cognitive mediation of obsessive-compulsive symptoms: a longitudinal study. J Anxiety Disord 2007; 21:91.
  25. Buttolph, M. Obsessive-compulsive disorders in pregnancy and childbirth, in Obsessive Compulsive Disorders, Theory and Management, 2nd Ed, Jenike, M, Baer, L, Minichiello, WE (Eds), Yearbook Medical Publishers, Chicago 1990.
  26. Sichel DA, Cohen LS, Rosenbaum JF, Driscoll J. Postpartum onset of obsessive-compulsive disorder. Psychosomatics 1993; 34:277.
  27. Uguz F, Kaya N, Sahingoz M, et al. One year follow-up of postpartum-onset obsessive-compulsive disorder: a case series. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1091.
  28. Brandes M, Soares CN, Cohen LS. Postpartum onset obsessive-compulsive disorder: diagnosis and management. Arch Womens Ment Health 2004; 7:99.
  29. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  30. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
  31. Misri S, Milis L. Obsessive-compulsive disorder in the postpartum: open-label trial of quetiapine augmentation. J Clin Psychopharmacol 2004; 24:624.
  32. Rennie, R, Landreth, G. Effects of filial therapy on parent and child behaviors. International Journal of Play Therapy 2000; 9:19.
  33. Lee HK. The effects of infant massage on weight, height, and mother-infant interaction. Taehan Kanho Hakhoe Chi 2006; 36:1331.