title: Obsessive-compulsive disorder in pregnancy, the puerperium, and the premenstruum.
abstract: BACKGROUND
  Recent reports suggest that pregnancy and the puerperium may precipitate or exacerbate obsessive-compulsive disorder (OCD). The influence of this illness on other reproductive events, such as the premenstruum, is unknown. We examined retrospectively the relationships of pregnancy, the puerperium, and premenstruum to the course of OCD in 57 women.
  
  
  METHODS
  Women outpatients with OCD meeting DSM-III-R criteria completed a standardized telephone interview administered by a psychiatric resident. They were asked retrospectively about the clinical course of their illness premenstrually and during and after pregnancy.
  
  
  RESULTS
  Of 72 women eligible for the study, 79% (N = 57) completed the interview. Premenstrual worsening of OCD was described by 24 (42%) of the 57 women, and 12 (21%) described premenstrual dysphoria. Of the 57 women, 38 (67%) had been pregnant at least once; 31 (54%) had delivered at least one child. Pregnancy was associated with the onset of OCD in only 5 (13%) of the 38 women. Of the 29 women with preexisting OCD who became pregnant, 20 (69%) described no change in symptoms during pregnancy, 5 (17%) described worsening, and 4 (14%) described improvement. Postpartum exacerbation of OCD symptoms was reported by 7 (29%) of the 24 women with preexisting OCD who completed full-term pregnancies. Nine (37%) of the 24 women with both preexisting OCD and completed pregnancies also reported postpartum depression.
  
  
  CONCLUSIONS
  The premenstrual and postpartum exacerbation of OCD symptoms in some women suggests that the course of this disorder may, in some cases, be influenced by changes in gonadal hormones. Our finding that women with OCD may be at increased risk for postpartum depression underscores the importance of careful postpartum evaluation of women with OCD to prevent maternal and infant morbidity.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Calif 94305, USA.
authors.forename: K E
authors.initials: KE
authors.lastname: Williams
authors.forename: L M
authors.initials: LM
authors.lastname: Koran
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D005260:Female; D006753:Hospital Records; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D011293:Premenstrual Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D013689:Telephone