While we have now a fair amount of information regarding the course of major depression and bipolar disorder during pregnancy and the postpartum period, we have much less information on the course obsessive-compulsive disorder (OCD). Clinically we often see women with OCD who report recurrence or worsening of their symptoms during the postpartum period, but few studies have systematically studied the impact of various reproductive events, including pregnancy, on the course of OCD.
A recent study examined the course of 542 women (United States, n = 352; Dutch, n = 190) who met DSM-IV criteria for OCD. These women completed self-report questionnaires designed to assess OCD onset and symptom exacerbation associated with reproductive events.
- Onset of OCD symptoms: 13.0% of women experienced OCD onset occurred within 12 months after menarche, 5.1%, during pregnancy, 4.7% in the postpartum period, and 3.7% at menopause.
- Worsening of pre-existing OCD: 37.6% of women experienced OCD worsening during the premenstrual phase of the menstrual cycle, 33.0% during pregnancy, 46.6% during the postpartum period, and 32.7% at menopause.
One of the limitations of this study is that it was a retrospective study, relying upon women’s reports of onset and symptoms, which may be less reliable than prospective assessments. While the onset of OCD appears to be less consistently associated with reproductive events, these findings are consistent with previous studies and indicate that OCD tends to worsen during pregnancy and the postpartum period and during the premenstrual phase of the menstrual cycle.
In order to advise patients planning pregnancy, we still need more information on which women are most vulnerable to exacerbation of symptoms during these reproductive events. This study does tell us, that women who have experienced puerperal exacerbation of their symptoms are more likely to have recurrent symptoms after a subsequent pregnancy. Women who experienced OCD exacerbation in their first pregnancy were ten times as likely to have an exacerbation in a subsequent pregnancy (OR = 10.82, 95% CI 4.48-26.16). Similarly, postpartum OCD exacerbation was highly recurrent (OR = 6.86, 95% CI 3.27-14.36).
Ruta Nonacs, MD PhD
Guglielmi V, Vulink NC, Denys D, Wang Y, Samuels JF, Nestadt G. OBSESSIVE-COMPULSIVE DISORDER AND FEMALE REPRODUCTIVE CYCLE EVENTS: RESULTS FROM THE OCD AND REPRODUCTION COLLABORATIVE STUDY. Depress Anxiety. 2014 Jan 13.
I’m assuming all women in the studies were not taking any meds to treat their OCD? I would be interested in seeing the difference between women who are pharmacologically treated during pregnancy and/or after childbirth with those who are not, and whether this improves their level of functioning at such a vulnerable time for mom and baby.