Obsessive-compulsive disorder in pregnant and postpartum women
- Murray B Stein, MD, MPH
Murray B Stein, MD, MPH
- Editor-in-Chief — Psychiatry
- Section Editor — Anxiety Disorders
- Professor of Psychiatry and Family Medicine & Public Health
- University of California San Diego
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 . 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".)
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 . 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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