By MGH Center for Women's Mental Health | May 6th, 2021
"While we have relatively limited information regarding the prevalence of obsessive-compulsive disorder (OC) during pregnancy and the postpartum period. Previous studies have indicated that women may be more vulnerable to the onset of OCD during the postpartum period. Other studies indicate that women with OCD may experience worsening of OCD symptoms during pregnancy and the postpartum period.
A recent study published in the Journal of Clinical Psychiatry looks at the prevalence of OCD symptoms during pregnancy and the postpartum period. They speculate that using standardized instruments for the diagnosis of OCD may fail to capture perinatal OCD, and their study incorporates a detailed assessment of obsessions of infant-related harm and corresponding compulsions.
In this study, 763 English-speaking women living in the Canadian province of British Columbia were recruited into this longitudinal study following women from the third trimester of pregnancy until 9 months postpartum. The Structured Clinical Interview for DSM-5 (SCID-5) was used to confirm DSM-5 diagnoses of OCD.
The weighted prevalence of OCD during pregnancy was 7.8%, and the weighted prevalence increased to 16.9% across the postpartum period. The estimated point prevalence of OCD diagnosis was 2.6% during pregnancy (6 weeks prior to delivery) and increased to 8.7% at 8 weeks postpartum. The point prevalence of OCD remained high (6.1%) at 20 weeks postpartum.
The incidence of new OCD cases was estimated to be 4.7 new cases per 1000 women each week during the postpartum period. By six months postpartum, the cumulative incidence of new cases of OCD was 9.0%. Most cases emerged during the first 10 weeks postpartum.
In total, the researchers observed that 100 women reported symptoms consistent with a diagnosis of OCD at some point during pregnancy or the postpartum period. In this group, 60 of the women reported onset of OCD symptoms during pregnancy or the postpartum period. The remaining 40 women reported that their OCD symptoms preceded the pregnancy.
High Prevalence of OCD During Pregnancy and the Postpartum Period
The lifetime prevalence rate of obsessive-compulsive disorder (OCD) has been consistently estimated to be 2%-3% in the general adult population in the United States. The current study indicates that the weighted prevalence of OCD during pregnancy was 7.8% and increased to 16.9% across the postpartum period. Consistent with previous studies, Fairbrother and colleagues conclude that pregnancy and the postpartum period is a time of increased vulnerability to OCD. In addition, new onset of OCD is relatively common during pregnancy and the postpartum period, with 9% of women reporting postpartum onset of OCD in this study.
These estimates of prevalence are higher than those reported in previous studies, a finding that the researchers attribute to using a more comprehensive evaluation of perinatal-specific OC symptoms, including intrusive thoughts of infant-related harm. However, the authors note that some women joined the study after childbirth and may have been attracted to the study because of their experience of postpartum intrusive thoughts. Nonetheless, this is one of the largest studies we have regarding the incidence of OCD during pregnancy and the postpartum period and is noteworthy in that it used the SCID to confirm OCD diagnoses.
Current guidelines for screening perinatal women do not specifically recommend screening for OCD. This study indicates that perinatal OCD is relatively common and the authors recommend more careful screening for perinatal-specific OC symptoms. They note that standardized assessments for OCD include questions about obsessions involving dirt, germs, arranging and ordering; however, perinatal OCD is more often characterized by intrusive thoughts related to harming the infant (e.g., unwanted thoughts or images of harming the infant on purpose, harm to the infant stemming from parental distraction or neglect, being sexually inappropriate with the infant). Furthermore, given the shameful and horrifying nature of these thoughts, many women are hesitant to share these thoughts with others."
-Ruta Nonacs, MD PhD