Maternal OCD and pregnancy outcomes

Maternal OCD and pregnancy outcomes | Image Credit: © JenkoAtaman - © JenkoAtaman - stock.adobe.com.

According to a recent study published in JAMA Network Open, risks of adverse pregnancy, delivery, and neonatal outcomes are increased in women with maternal obsessive-compulsive disorder (OCD).

About 1% to 3% of individuals are impacted by OCD, with incidence rates estimated to be 1.6 times greater in women compared to men. There are multiple health related complications seen more often in individuals with this psychiatric disorder, but there is little data on pregnancy and neonatal outcomes in women with OCD.

To determine how pregnancy, delivery, and neonatal outcomes differ among women with OCD compared to those without OCD, investigators conducted a study with population-based cohorts from British Columbia (BC), Canada, and Sweden. Person-unique identifiers were used to obtain data from different population registers.

Data from the Sweden cohort was recorded in the Swedish Medical Birth Register, which accounted for over 98% of births in Sweden from 1973 onward. Somatic and psychiatric disorder information was reported in the National Patient Register, with diagnoses based on the International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10.

Eligible BC residents were covered by the provincial public health insurance program, with participant data gathered from the BC Perinatal Database Registry. Data on care and outcomes during antenatal, intrapartum, delivery, and postpartum periods was including for about 99% of births in BC from April 1, 2000, onward.

Singleton livebirths and stillbirths from January 1, 1999, in Sweden, and April 1, 2000, in BC, to December 31, 2019, with a gestational age of 22 weeks or more were eligible for participation. Exclusion criteria included having missing IDs or missing sex.

Exposures in mothers included at least 1 ICD-9 or ICD-10 diagnosis of OCD from age 6 years to index childbirth. Maternal use of serotonin reuptake inhibitors (SRIs), a common pharmacologic treatment for OCD, was also recorded. 

Maternal outcomes included preeclampsia, gestational diabetes, infection, premature rupture of membranes, antepartum hemorrhage or placental abruption, mode of delivery,induction of labor, and postpartum hemorrhage.Covariates included parity, age at delivery, educational level, prepregnancy hypertension, prepregnancy diabetes, smoking during pregnancy, year of delivery, and psychiatric comorbidity.

Neonatal outcomes included perinatal death, small for gestational age, preterm birth, low 5-minute Apgar score, low birth weight, neonatal jaundice, neonatal glycemia, neonatal infections, neonatal respiratory distress, and congenital malformations within a year of birth.

Of the Swedish cohort, 8312 of 2,145,660 pregnancies were to women with OCD, compared to 2341 of 824,100 pregnancies in the BC cohort. Higher rates of living alone, having a lower education level, smoking, being obese, and having psychiatric comorbidity were seen in women with OCD compared to those without OCD.

In the Swedish cohort, the risks of gestational diabetes, elective cesarean delivery, induction of labor, emergency cesarean delivery, and postpartum hemorrhage were all significantly greater in women with OCD. However, only significant increases in emergency cesarean delivery and antepartum hemorrhage or placental abruption were observed in the BC cohort with OCD.

Adverse neonatal outcomes were also more likely from mothers with OCD in both cohorts. These outcomes included low Apgar score at 5 minutes, low birth weight, preterm birth, and neonatal respiratory distress. Neonatal hypoglycemia and neonatal infections were also more likely in the Swedish cohort with OCD, and major congenital malformations in the BC cohort with OCD.

When comparing women in the Swedish cohort with OCD taking SRIs compared to those with OCD not taking SRIs, data indicated SRI use was associated with increased risks of emergency cesarean delivery, premature rupture of membranes, and postpartum hemorrhage. In the BC cohort, SRIs were associated with increased risks of emergency cesarean delivery, induction of labor, and instrumental delivery.

Overall, risks of adverse pregnancy, delivery, and birth outcomes were increased in women with OCD, with further risks found in women taking SRIs. Investigators recommended improved collaboration between obstetric and psychiatry services, along with improved maternal and neonatal care in cases of OCD.

Reference

Fernández de la Cruz L, Joseph KS, Wen Q, Stephansson O, Mataix-Cols D, Razaz N. Pregnancy, delivery, and neonatal outcomes associated with maternal obsessive-compulsive disorder: two cohort studies in Sweden and British Columbia, Canada. JAMA Netw Open. 2023;6(6):e2318212. doi:10.1001/jamanetworkopen.2023.18212