title: Obsessive-compulsive disorder and female reproductive cycle events: results from the OCD and reproduction collaborative study.
abstract: BACKGROUND
  Women with obsessive-compulsive disorder (OCD) often report that symptoms first appear or exacerbate during reproductive cycle events; however, little is known about these relationships. The goals of this study were to examine, in a US and a European female OCD sample, onset and exacerbation of OCD in reproductive cycle events, and to investigate the likelihood of repeat exacerbation in subsequent pregnancies and postpartum periods.
  
  
  METHODS
  Five hundred forty-two women (United States, n = 352; Dutch, n = 190) who met DSM-IV criteria for OCD, completed self-report questionnaires designed to assess OCD onset and symptom exacerbation associated with reproductive events.
  
  
  RESULTS
  OCD onset occurred within 12 months after menarche in 13.0%, during pregnancy in 5.1%, at postpartum in 4.7%, and at menopause in 3.7%. Worsening of pre-existing OCD was reported by 37.6% of women at premenstruum, 33.0% during pregnancy, 46.6% postpartum, and 32.7% at menopause. Exacerbation in first pregnancy was significantly associated with exacerbation in second pregnancy (OR = 10.82, 95% CI 4.48-26.16), as was exacerbation in first postpartum with exacerbation in second postpartum (OR = 6.86, 95% CI 3.27-14.36). Results were replicated in both samples.
  
  
  CONCLUSIONS
  Reproductive cycle events are periods of increased risk for onset and exacerbation of OCD in women. The present study is the first to provide significant evidence that exacerbation in or after first pregnancy is a substantial risk factor for exacerbation in or after a subsequent pregnancy. Further research is needed to identify factors related to exacerbation, so that physicians may provide appropriate recommendations to women regarding clinical issues involving OCD and reproductive cycle events.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Valeria
authors.initials: V
authors.lastname: Guglielmi
authors.forename: Nienke C C
authors.initials: NC
authors.lastname: Vulink
authors.forename: Damiaan
authors.initials: D
authors.lastname: Denys
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.forename: Jack F
authors.initials: JF
authors.lastname: Samuels
authors.forename: Gerald
authors.initials: G
authors.lastname: Nestadt
mesh_terms: D000208:Acute Disease; D000328:Adult; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008572:Menarche / Q000523:psychology*; D008593:Menopause / Q000523:psychology*; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D012098:Reproduction; D012307:Risk Factors; D057566:Self Report; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology
keywords: female reproductive cycle events; obsessive-compulsive disorder; obstetrics-gynaecology; reproduction; women