title: Obsessive-compulsive disorder in pregnancy and the postpartum period: course of illness and obstetrical outcome.
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.
authors.affiliation: Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham, Box 843, Little Rock, AR, 72205, USA. sjhouse@uams.edu.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: House
authors.affiliation: Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham, Box 843, Little Rock, AR, 72205, USA.
authors.forename: Shanti P
authors.initials: SP
authors.lastname: Tripathi
authors.affiliation: Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham, Box 843, Little Rock, AR, 72205, USA.
authors.forename: Bettina T
authors.initials: BT
authors.lastname: Knight
authors.affiliation: Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham, Box 843, Little Rock, AR, 72205, USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Morris
authors.affiliation: Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: D Jeffrey
authors.initials: DJ
authors.lastname: Newport
authors.affiliation: Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham, Box 843, Little Rock, AR, 72205, USA.
authors.forename: Zachary N
authors.initials: ZN
authors.lastname: Stowe
mesh_terms: D000328:Adult; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D036801:Parturition; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
keywords: Course of illness; Neonatal outcomes; Obsessive-compulsive disorder; Obstetrical outcomes