Is maternal obsessive-compulsive disorder associated with adverse pregnancy, delivery, and neonatal outcomes?

In a recent study published in JAMA Network Open, researchers assessed the correlation between maternal obsessive-compulsive disorder (OCD) and pregnancy, neonatal, and delivery outcomes.

Study: Pregnancy, Delivery, and Neonatal Outcomes AssociatedWith Maternal Obsessive-Compulsive Disorder Two Cohort Studies in Sweden and British Columbia, Canada. Image Credit: InkDrop/Shutterstock.com

Background

OCD is a psychiatric disorder that impacts a small percentage of the population. In Sweden, most people with OCD rely on medication to manage their symptoms, typically in the form of serotonin reuptake inhibitors (SRIs).

However, the impact of this medication on perinatal and neonatal outcomes needs extensive investigation since previous studies have linked selective SRIs (SSRIs) with unfavorable outcomes during pregnancy and in newborns.

Furthermore, no studies have utilized sibling comparison analyzes to understand the impact of shared familial factors on the correlation between maternal OCD and pregnancy and neonatal outcomes.

About the study

The study involved population-based groups from the Canadian province of British Columbia (BC) and Sweden. Person-unique identifiers were used to link data from various population registers in each location.

The study analyzed two groups of births, one in Sweden from January 1, 1999, and the other in British Columbia from April 1, 2000, to December 31, 2019, including singleton live births and stillbirths observed at 22 weeks or more of gestation. The study period ended on December 31, 2019.

Based on available dispensation data, the study identified subcohorts of women prescribed an SRI from 30 days before conception until the day of childbirth.

The study analyzed various pregnancy and delivery outcomes, including preeclampsia, mode of delivery, gestational diabetes, placental abruption or antepartum hemorrhage, maternal infection, induction of labor, premature rupture of membranes, and postpartum hemorrhage.

The study examined various neonatal outcomes such as perinatal mortality, preterm birth, low birth weight, small for gestational age, neonatal hypoglycemia, low five-minute Apgar score, neonatal infections, neonatal respiratory distress, neonatal jaundice, and congenital malformations identified within the first year post-birth.

Results

The study analyzed two cohorts, one from Sweden with 2,145,660 pregnancies, including 8,312 to OCD patients, and another from BC with 824,100 pregnancies, including 2,341 to OCD patients.

Women with OCD were linked to having lower education levels, living alone, being obese, smoking, and having higher psychiatric comorbidity rates. In both the Swedish and BC cohorts, a higher number of women with OCD were diagnosed with a psychiatric disorder in comparison to non-OCD women.

The Swedish cohort had 6,009 women with OCD, and 1,184 women with OCD in the BC cohort all had another psychiatric disorder diagnosis. The study found increased maternal OCD rates in both cohorts over time.

Maternal OCD in Sweden was linked with a 40% higher risk of elective cesarean delivery and gestational diabetes. Maternal OCD also had a significant association with preeclampsia, emergency cesarean delivery, induction of labor, and postpartum hemorrhage.

Furthermore, statistically significant associations were only found between emergency cesarean delivery and placental abruption or antepartum hemorrhage in BC.

Mothers with OCD in Sweden and BC faced higher risks of negative neonatal outcomes, such as low birth weight, preterm birth, low Apgar score at five minutes, and neonatal respiratory distress, compared to those without OCD.

Maternal OCD in Sweden was also linked with higher risks of infections and neonatal hypoglycemia. Notably, a significant increase in major congenital malformations was observed only in BC.

Compared to Swedish OCD women who did not take SRIs, Swedish OCD women who did consume SRIs had elevated risks of emergency cesarean delivery, premature rupture of membranes, and postpartum hemorrhage.

On the other hand, BC OCD women who took SRIs had elevated risks of emergency cesarean delivery, induction of labor, and instrumental delivery, along with a lower chance of premature rupture of membranes Compared to BC OCD women who did not consume SRIs.

Newborns of Swedish OCD women who took SRIs had higher risks of low birth weight, preterm birth, low Apgar score, neonatal respiratory distress, neonatal infections, and neonatal hypoglycemia than newborns of OCD women with OCD who did not take SRIs. A low Apgar score was the only statistically significant factor in the BC cohort.

Conclusion

Maternal OCD was found to be linked with higher risks of pregnancy, delivery, and neonatal outcomes in cohort studies. The study found that pregnant women with OCD who took SRIs had increased risks of certain outcomes.

However, the results suggest that medication alone may not be the sole factor contributing to these findings. Enhanced collaboration between obstetric and psychiatry services is needed to provide better maternal and neonatal therapy for women with OCD and their offspring.

Written by

Bhavana Kunkalikar

Bhavana Kunkalikar is a medical writer based in Goa, India. Her academic background is in Pharmaceutical sciences and she holds a Bachelor's degree in Pharmacy. Her educational background allowed her to foster an interest in anatomical and physiological sciences. Her college project work based on ‘The manifestations and causes of sickle cell anemia’ formed the stepping stone to a life-long fascination with human pathophysiology.