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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References
Abramowitz J, Schwartz S, Moore K et al (2003) Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature. J Anxiety Disord 17:461–478
Abramowitz J, Nelson C, Rygwall R et al (2007) The cognitive mediation of obsessive-compulsive symptoms: a longitudinal study. J Anxiety Disord 21:91–104
American Congress of Obstetricians and Gynecologists (2009) ACOG issues new guidelines on managing stillbirths. https://www.acog.org/About_ACOG/News_Room/News_Releases/2009/ACOG_Issues_New_Guidelines_on_Managing_Stillbirths#.UycmmeSUOAo.email. Accessed 17 March 2014
Black DW, Gaffney GR, Schlosser S et al (2003) Children of parents with obsessive-compulsive disorder - a 2-year follow-up study. Acta Psychiatr Scand 107:305–313
Brandes M, Soares C, Cohen L (2004) Postpartum onset obsessive-compulsive disorder: Diagnosis and management. Arch Women Ment Health 7:99–110
Cassin S, Richter M, Zhang K et al (2009) Quality of life in treatment-seeking patients with obsessive-compulsive disorder with and without major depressive disorder. Can J Psychiatry 54:460–467
Catapano F, Perris F, Masella M et al (2006) Obsessive-compulsive disorder: a 3-year prospective follow-up study of patients treated with serotonin reuptake inhibitors OCD follow-up study. J Psychiatr Res 40:502–510
Chambers CD, Johnson KA, Dick LM et al (1996) Birth outcomes in pregnant women taking fluoxetine. New Engl J Med 335:1010–1015
Chung T, Lau T, Yip A et al (2001) Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosom Med 63:830–834
Diav-Citrin O, Shechtman S, Weinbaun D et al (2002) Pregnancy outcome after gestational exposure to paroxetine: a prospective cohort study. Teratology 65:298
Eisen J, Goodman W, Keller M et al (1999) Patterns of remission and relapse in obsessive-compulsive disorder: a 2-year prospective study. J Clin Psychiatry 60:346–351
Eisen J, Pinto A, Mancebo M et al (2010) A 2-year prospective follow-up study of the course of obsessive-compulsive disorder. J Clin Psychiatry 78:1033–1039
Fairbrother N, Abramowitz J (2007) New parenthood as a risk factor for the development of obsessional problems. Behav Res Ther 45:2155–2163
Farrell L, Barrett P, Piacentini J (2006) Obsessive-compulsive disorder across the developmental trajectory: clinical correlates in children, adolescents, and adults. Behav Change 23:103–120
Field T (2011) Prenatal depression effects on early development: a review. Infant Behav Dev 34:1–14
Fineberg N, Gale T (2005) Evidence-based pharmacotherapy of obsessive-compulsive disorder. Int J Neuropsychopharmacol 8:107–129
First M, Spitzer R, Gibbon M, et al. (2002) Structured clinical interview for DSM-IV axis I disorders - patient edition (SCID-I/P, version 2.0). Biometrics Research Department, New York State Psychiatric Institute
Forray A, Focseneanu M, Pittman B et al (2010) Onset and exacerbation of obsessive-compulsive disorder in pregnancy and the postpartum period. J Clin Psychiatry 71:1061–1068
Goodman W, Price L, Rasmussen S et al (1989) The Yale-Brown obsessive compulsive scale. Arch Gen Psychiatry 46:1006–1011
Kulin N, Pastuszak A, Sage S et al (1998) Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study. JAMA 279:609–610
Maina G, Albert U, Bogetto F et al (1999) Recent life events and obsessive-compulsive disorder (OCD): The role of pregnancy/delivery. Psychiatry Res 89:49–58
Mataix-Cols D, Rauch S, Baer L et al (2002) Symptom stability in adult obsessive-compulsive disorder: data from a naturalistic two-year follow-up study. Am J Psychiatry 159:263–268
Miller ES, Chu C, Gollan J et al (2013) Obsessive-compulsive symptoms during the postpartum period: a prospective cohort. J Reprod Med 58:115–122
Misri S, Oberlander TF, Fairbrother N et al (2004) Relation between prenatal maternal mood and anxiety and neonatal health. Can J Psychiatry 49:684–689
Newport DJ, Brennan PA, Green P et al (2007) Maternal depression and medication exposure during pregnancy: comparison of maternal retrospective recall to prospective documentation. Br J Obstet Gynaecol 115:681–688
Neziroglu F, Anemone R, Yaryura-Tobias J (1992) Onset of obsessive-compulsive disorder in pregnancy. Am J Psychiatry 149:947–950
Pastuszak A, Schick-Boschetto B, Zuber C et al (1993) Pregnancy outcome following first-trimester exposure to fluoxetine (Prozac). JAMA 269:2246–2248
Paykel E, Prusoff B, Uhlenhuth E (1971) Scaling of life events. Arch Gen Psychiatry 25:340–347
Ruscio A, Stein D, Chiu W et al (2010) The epidemiology of obsessive-compulsive disorder in the national comorbidity survey replication. Mol Psychiatry 15:53–63
Sichel DA, Cohen LS, Dimmock JA et al (1993) Postpartum obsessive compulsive disorder: a case series. J Clin Psychiatry 54:156–159
Sivojelezova A, Shuhaiber S, Sarkissian L et al (2005) Citalopram use in pregnancy and fetal outcome. Am J Obstet Gynecol 193:2004–2009
Skoog G, Skoog I (1999) A 40-year follow-up of patients with obsessive-compulsive disorder. Arch Gen Psychiatry 56:121–127
Uguz F, Akman C, Kaya N, Cilli A (2007) Postpartum-onset obsessive-compulsive disorder: Incidence, clinical features, and related factors. J Clin Psychiatry 68:132
Uguz F, Yuksel G, Karsidag C et al (2015) Birth weight and gestational age newborns exposed to maternal obsessive-compulsive disorder. Psychiatric Res 226:396–398
Wadhwa PD (2005) Psychoneuroendocrine processes in human pregnancy influence fetal development and health. Psychoneuroendocrinology 30:724–743
Wang X, Chen C, Wang L et al (2003) Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. Fertil Steril 79:577–584
Williams K, Koran L (1997) Obsessive-compulsive disorder in pregnancy, the puerperium, and the premenstruum. J Clin Psychiatry 58:330–334
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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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