OBSESSIVE-COMPULSIVE DISORDER IN PREGNANCY, THE PUERPERIUM, AND THE PREMENSTRUUM

Background: Recent reports suggest that pregnancy and the puerperium m ay precipitate or exacerbate obsessive-compulsive disorder (OCD). The influence of this illness on other reproductive events. such as the pr emenstruum, is unknown. We examined retrospectively the relationships of pregnancy, the puerperium, and premenstruum to the course of OCD in 57 women. Method: Women outpatients with OCD meeting DSM-III-R criter ia completed a standardized telephone interview administered by a psyc hiatric resident. They were asked retrospectively about the clinical c ourse of their illness premenstrually and during and after pregnancy. Results: Of 72 women eligible for the study, 79% (N = 57) completed th e interview. Premenstrual worsening of OCD was described by 24 !(42%) of the 57 women, and 12 (21%) described premenstrual dysphoria. Of the 57 women, 38 (67%) had been pregnant at least once; 31 (54%) had deli vered at least one child. Pregnancy was associated with the onset of O CD in only 5 (13%) of the 38 women. Of the 29 women with preexisting O CD who became pregnant, 20 (69%) described no change in symptoms durin g pregnancy, 5 (17%) described worsening, and 4 (14%) described improv ement. Postpartum exacerbation of OCD symptoms was reported by 7 (29%) of the 24 women with preexisting OCD who completed full-term pregnanc ies. Nine (37%) of the 24 women with both preexisting OCD and complete d pregnancies also reported postpartum depression. Conclusion: The pre menstrual and postpartum exacerbation of OCD symptoms in some women su ggests that the course of this disorder may, in some cases, be influen ced by changes in gonadal hormones. Our finding that women with OCD ma y be at increased risk far postpartum depression underscores the impor tance of careful postpartum evaluation of women with OCD to prevent ma ternal and infant morbidity.