title: Perinatal factors affecting expression of obsessive compulsive disorder in children and adolescents.
abstract: OBJECTIVE
  To examine whether adverse perinatal experiences of children are associated with obsessive compulsive disorder (OCD) in youth.
  
  
  METHODS
  Subjects were 130 children and adolescents with OCD recruited from a family genetic study of pediatric OCD and 49 matched controls from a contemporaneous family case-control study of attention-deficit/hyperactivity disorder (ADHD). Subjects were comprehensively assessed in multiple domains of function. A systematic history of pregnancy, delivery, and infancy complications was obtained.
  
  
  RESULTS
  Compared to normal controls, children with OCD had mothers with significantly higher rates of illness during pregnancy requiring medical care (chi(2) +/- 8.61, p +/- 0.003) and more birth difficulties (induced labor, forceps delivery, nuchal cord, or prolonged labor) (chi(2) +/- 7.51, p +/- 0.006). Among the OCD-affected children, we found several significant associations between adverse perinatal experiences and earlier age at onset, increased OCD severity, and increased risk for comorbid ADHD, chronic tic disorder, anxiety disorder, and major depressive disorder.
  
  
  CONCLUSIONS
  Although exploratory, our analyses found that children with OCD had higher rates of several adverse perinatal experiences compared with controls. Among OCD-affected children, comorbid psychopathology was predicted by specific perinatal risk factors. Prospective studies of perinatal adverse events that minimize potential recall bias and type I errors are needed.
authors.affiliation: Clinical and Research Program in Pediatric Psychopharmacology, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02318, USA. dageller@partners.org
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Geller
authors.forename: Natalie
authors.initials: N
authors.lastname: Wieland
authors.forename: Kathleen
authors.initials: K
authors.lastname: Carey
authors.forename: Fé
authors.initials: F
authors.lastname: Vivas
authors.forename: Carter R
authors.initials: CR
authors.lastname: Petty
authors.forename: Jessica
authors.initials: J
authors.lastname: Johnson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Reichert
authors.forename: David
authors.initials: D
authors.lastname: Pauls
authors.forename: Joseph
authors.initials: J
authors.lastname: Biederman