Maternal OCD tied to adverse pregnancy, delivery, neonatal outcomes

Pregnant women with obsessive–compulsive disorder (OCD) are at higher risk of adverse pregnancy, delivery, and neonatal outcomes, including gestational diabetes, pre-eclampsia, caesarean delivery, preterm birth, neonatal respiratory distress, neonatal infections, and major congenital malformations, among others, as reported in a study.

The study included two register-based cohorts in Sweden and British Columbia (BC), Canada. The Swedish cohort consisted of 8,312 pregnancies in women with OCD (mean age at delivery 30.2 years) and 2,137,348 pregnancies in unexposed women (mean age at delivery 30.2 years). The BC cohort consisted of 2,341 pregnancies in women with OCD (mean age at delivery 31.0 years) and 821,759 pregnancies in unexposed women (mean age at delivery 31.3 years).

Maternal OCD was defined as a diagnosis recorded before childbirth and the use of serotonin reuptake inhibitors (SRIs) during pregnancy. Multivariable Poisson log-linear regressions were used to estimate the associations between OCD and adverse pregnancy, delivery, neonatal outcomes. In the Swedish cohort, sister and cousin analyses were conducted to account for familial confounding.

In Sweden, maternal OCD was associated with increased risks of gestational diabetes (adjusted risk ratio [aRR], 1.40) and elective caesarean delivery (aRR, 1.39), as well as pre-eclampsia (aRR, 1.14), induction of labour (aRR, 1.12), emergency caesarean delivery (aRR, 1.16), and postpartum haemorrhage (aRR, 1.13).

In BC, the risk increase associated with OCD was seen only for emergency caesarean delivery (aRR, 1.15) and antepartum haemorrhage or placental abruption (aRR, 1.48).

In both cohorts, neonates born to women with OCD were at higher risk of low Apgar score at 5 minutes (Sweden: aRR, 1.62; BC: aRR, 2.30), as well as preterm birth (Sweden: aRR, 1.33; BC: aRR, 1.58), low birth weight (Sweden: aRR, 1.28; BC: aRR, 1.40), and neonatal respiratory distress (Sweden: aRR, 1.63; BC: aRR, 1.47).

Among women with OCD, those taking SRIs during pregnancy had an overall increased risk of the mentioned outcomes compared with those who were not taking SRIs. However, women who were not taking SRIs still had increased risks compared with women without OCD.

Sister and cousin analyses showed that at least some of the associations were not influenced by familial confounding.