OCD in Pregnancy
Authored by:
Anna Glezer, M.D.
As we’ve previously learned, pregnancy and the postpartum period can predispose a woman to developing a new mental health condition or worsening of an ongoing diagnosis. This is the case with depression, with anxiety, and also with Obsessive-Compulsive Disorder. This condition is characterized by intrusive, recurrent thoughts, often with a need to alleviate the tension of these thoughts by engaging in certain types of behaviors. This might mean repetitive checking, cleaning, or seeking reassurance.
In general, the lifetime risk for developing OCD is 2-3%.
How common is OCD in Pregnancy?
In pregnancy, OCD intrusive thoughts are often related to cleanliness and the wellbeing of the baby. Worsening of OCD symptoms occurs during pregnancy in 8-16% of women who have previously been diagnosed with OCD. About 15-40% of women experience OCD symptoms during pregnancy (the wide range speaks to the fact that there are few studies and more research is needed to narrow this down). There is also a significant co-occurrence of depression – in about 65% of cases.
Why are pregnant women vulnerable to OCD?
The biological theory
There are hormonal theories about why pregnant women are predisposed to OCD, involving the interaction between serotonin (a neurotransmitter) with steroid hormones (estrogen and progesterone). This interaction relates to the high comorbidity rates between OCD symptoms and depression. Interestingly, some studies have noted this same increase in OCD symptoms occurs premenstrually (when levels of steroid hormones are also elevated), which validates the hormonal implications of this condition.
The environmental stressor – pregnancy
Someone who is vulnerable to the development of OCD – perhaps due to a family history – is also more likely to develop it following a stressful life event. In several surveys, women with children have noted that OCD onset correlates with pregnancy as the most common stressor.
Can OCD lead to worse obstetrical outcomes?
While a smaller study has noted higher rates of worse obstetrical outcomes, one large recent investigation noted no increased risk of poorer obstetrical outcomes (like preterm delivery, smaller babies, rates of complications). While it is hard to make conclusions based on just one set of data, one possible explanation for this is that women with high anxiety and OCD symptoms might be more diligent with medical appointments and follow up.
How can we treat OCD during pregnancy?
The treatment of OCD in pregnancy is adapted from the research on successful OCD treatment outside of pregnancy. This includes psychotherapy as well as medications. For OCD, the types of psychotherapy that have been most effective include Cognitive-Behavioral Therapy and Exposure-Response Prevention. In CBT, women learn to modify certain cognitions and behaviors when they are feeling anxious, while in ERP women present themselves with the intrusive anxiety-provoking thought (the exposure) and work to manage their anxiety without engaging in any compulsive behaviors.
While there can be many questions about taking medications during pregnancy, research also shows that some of the most commonly used medicines for OCD (namely SSRIs) are relatively safe during pregnancy and effective.
It is essential to recognize and treat OCD during pregnancy, in part because early intervention can prevent the worsening of OCD during the vulnerable postpartum period. (see article on postpartum OCD)
Selected References:
House, S.J. et. al. Obsessive-compulsive disorder in pregnancy and the postpartum period: Course of illness and obstetrical outcome. (2016) Archives Women’s Mental Health 19: 3-10.
Forray, A. Onset and exacerbation of obsessive-compulsive disorder in pregnancy and the postpartum period. (2010) Journal of Clinical Psychiatry 71(8): 1061-68.
