The lifetime prevalence rate of obsessive-compulsive disorder (OCD) has been consistently estimated to be 2%-3% in the general adult population throughout the world, making OCD one of more common psychiatric diagnoses; however research on OCD in pregnancy and peurperium has been limited.

Although most studies have not been designed to estimate the prevalence of pregnancy-related OCD in the general population, Ugoz and colleagues examined the prevalence rate and clinical characteristics of OCD in 434 consecutive pregnant women who presented to the obstetrical outpatient clinics during the third trimester of pregnancy.  They compared these women to 58 consecutive non-pregnant women diagnosed with OCD who presented to the psychiatric outpatient clinic of the same center.

3.5% of the women in the third trimester of pregnancy met criteria for OCD.  Two women developed symptoms in the second trimester.  The most common obsessions were contamination (80%), and symmetry/exactness (60%), whereas the most common compulsions were cleaning/washing (86.7%) and checking (60%).  The authors concluded that OCD is present relatively frequently among pregnant women during the third trimester of pregnancy, and it has similar clinical features in both pregnant and non-pregnant women.

Earlier studies estimated that between 13% and 44% of woman with OCD identified pregnancy or the postpartum period as the significant event which may have precipitated the onset or worsening of their OCD (Abramowitz 2005).  However, these studies have all relied on retrospective self report, and did not differentiate pregnancy and the postpartum period as two distinct reproductive periods.

A more recent study aimed to describe the relationship between reproductive cycle events and the initiation or change in symptom severity of OCD (Labad 2005).  In a sample of 46 female outpatients meeting DSM-IV criteria for OCD, the authors found that OCD onset occurred in the same year as menarche in 22% of women, at pregnancy in 2%, at postpartum in 7%, and at menopause in 2%.  Worsening of preexisting OCD was reported by 20% of patients premenstrually, 8% at pregnancy, 50% at postpartum, and 8% at menopause.  Patients with onset or worsening of OCD during the postpartum period more frequently reported premenstrual worsening of OCD symptoms and were more likely to have a previous history of MDD, including postpartum depression.

The authors of this study suggest that certain women with OCD seem to be vulnerable to worsening of OCD during times of hormonal fluctuations, as occur during the premenstrual phase of the menstrual cycle and the postpartum period.  Therefore, they call for increased monitoring during these periods of increased risk.

There have been at least two additional studies that provide evidence that OCD symptoms are especially common (40-50%) in women with postpartum-onset depression and these symptoms are characterized by particularly intrusive harm-related obsessional thoughts (Abramowitz 2003, Wisner 1999).

Obsessional thoughts are experienced as unwanted and inconsistent with one’s typical personality or behavior, and patients often express fears of even thinking these thoughts, particularly when they involve thoughts of harm.   Patients with OCD, and postpartum women with OCD especially, can have a great deal of shame regarding their symptoms and may delay psychiatric treatment for this reason.  It is thus important to specifically ask about intrusive obsessional thoughts in all patients, particularly in postpartum women.

April Hirschberg, MD

Uguz F, Gezginc K, Zeytinci IE, Karatayli S, Askin R, Guler O, Kir Sahin, F, Emul HM, Ozbulut O, Gecici O. Obsessive-compulsive disorder in pregnant women during the third trimester of pregnancy. Compr Psychiatry. 2007 Sep-Oct;48(5):441-5. Epub 2007 Jul 5.

Abramowitz, JS, Schwartz SA, Moore KM, Luenzmann KR.  Obsessive-compulsive symptoms in pregnancy and the puerperium: A review of the literature. J Anxiety Disorders 2003;17: 461-478.

Labad J, Menchon J, Alonso P, Segalas C, Jimenez S, Vallejo J. Female Reproductive Cycle and Obsessive-Compulsive Disorder. J Clin Psychiatry 2005; 66:428-435.

Vulink NC, Denys D, Bus L, Westenberg HG. Female hormones affect symptom severity in obsessive-compulsive disorder. Int Clin Psychopharmacol 2006; 21(3):171-175.

Wisner, K. L., K. S. Peindl, et al. (1999). Obsessions and compulsions in women with postpartum depression. J Clin Psychiatry 60(3): 176-80.