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Cited by 99Obsessive-Compulsive Spectrum DisordersMaternal Mental Health During Pregnancy and PostpartumPsychoanalysis and Psychopathology Research

Association of Perinatal Risk Factors With Obsessive-Compulsive Disorder: A Population-Based Birth Cohort, Sibling Control Study

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Brander, Gustaf, Rydell, Mina, Kuja-Halkola, Ralf, Fernández de la Cruz, Lorena, Lichtenstein, Paul, Serlachius, Eva, Rück, Christian, Almqvist, Catarina +3 more·2016·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2016.2095
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Abstract

IMPORTANCE: Perinatal complications may increase the risk of obsessive-compulsive disorder (OCD). Previous reports were based on small, retrospective, specialist clinic-based studies that were unable to rigorously control for unmeasured environmental and genetic confounding. OBJECTIVE: To prospectively investigate a wide range of potential perinatal risk factors for OCD, controlling for unmeasured factors shared between siblings in the analyses. DESIGN, SETTING, AND PARTICIPANTS: This population-based birth cohort study included all 2 421 284 children from singleton births in Sweden from January 1, 1973, to December 31, 1996, who were followed up through December 31, 2013. From the 1 403 651 families in the cohort, differentially exposed siblings from the 743 885 families with siblings were evaluated; of these, 11 592 families included clusters of full siblings that were discordant for OCD. Analysis of the data was conducted from January, 26, 2015, to September, 5, 2016. EXPOSURES: Perinatal data were collected from the Swedish Medical Birth Register and included maternal smoking during pregnancy, labor presentation, obstetric delivery, gestational age (for preterm birth), birth weight, birth weight in relation to gestational age, 5-minute Apgar score, and head circumference. MAIN OUTCOMES AND MEASURES: Previously validated OCD codes (International Statistical Classification of Diseases and Health Related Problems, Tenth Revision, code F42) in the Swedish National Patient Register. RESULTS: Of 2 421 284 individuals included in the cohort, 17 305 persons were diagnosed with OCD. Of these, 7111 were men (41.1%). The mean (SD) age of individuals at first diagnosis of OCD was 23.4 (6.5) years. An increased risk for OCD remained after controlling for shared familial confounders and measured covariates (including sex, year of birth, maternal and paternal age at birth, and parity), for smoking 10 or more cigarettes per day during pregnancy (hazard ratio [HR], 1.27; 95% CI, 1.02-1.58), breech presentation (HR, 1.35; 95% CI, 1.06-1.71), delivery by cesarean section (HR, 1.17; 95% CI, 1.01-1.34), preterm birth (HR, 1.24; 95% CI, 1.07-1.43), birth weight 1501 to 2500 g (HR, 1.30; 95% CI, 1.05-1.62) and 2501 to 3500 g (HR, 1.08; 95% CI, 1.01-1.16), being large for gestational age (HR, 1.23; 95% CI, 1.05-1.45), and Apgar distress scores at 5 minutes (HR, 1.50; 95% CI, 1.07-2.09). Gestational age and birth weight followed inverse dose-response associations, whereby an increasingly higher risk for OCD was noted in children with a shorter gestational age and lower birth weight. We also observed a dose-response association between the number of perinatal events and increased OCD risk, with HRs ranging from 1.11 (95% CI, 1.07-1.15) for 1 event to 1.51 (95% CI, 1.18-1.94) for 5 or more events. CONCLUSIONS AND RELEVANCE: A range of perinatal risk factors is associated with a higher risk for OCD independent of shared familial confounders, suggesting that perinatal risk factors may be in the causal pathway to OCD.

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  • Multiple studies have linked maternal conditions before and during pregnancy, such as maternal smoking and maternal history of autoimmune disease, to the risk of OCD.

    “Indeed, multiple studies have linked maternal conditions before and during pregnancy, such as maternal smoking and maternal history of autoimmune disease, to the risk of OCD (16,25).”

    From Maternal Effects as Causes of Risk for Obsessive-Compulsive Disorder (2020) · cites this paper as [16]

  • The results demonstrate associations between parental factors such as parental age, parental psychiatric history, maternal smoking during pregnancy, and gestational age and risk for OCD.

    “Our results also demonstrate an association between parental factors and risk for OCD such as parental age, parental psychiatric history, maternal smoking during pregnancy, and gestational age, in accordance with previous studies (16).”

    From Maternal Effects as Causes of Risk for Obsessive-Compulsive Disorder (2020) · cites this paper as [16]

  • Both genetic and environmental factors contribute to the risk of developing OCD.

    “However, both genetic and environmental factors contribute to risk of developing OCD (11–17).”

    From Maternal Effects as Causes of Risk for Obsessive-Compulsive Disorder (2020) · cites this paper as [16]

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  1. Geller DA, Wieland N, Carey K, et al. Perinatal factors affecting expression of obsessive compulsive disorder in children and adolescents. J Child Adolesc Psychopharmacol. 2008;18(4): 373-379.

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Authors
Brander, G., Rydell, M., Kuja-Halkola, R., Fernández de la Cruz, L., Lichtenstein, P., Serlachius, E., Rück, C., Almqvist, C., D’Onofrio, B. M., Larsson, H., & Mataix-Cols, D.
Affiliations
  • Karolinska Institutet (SE)
  • Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  • Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  • Region Stockholm (SE)
  • Karolinska University Hospital (SE)
  • Department of Psychological and Brain Sciences, Indiana University, Bloomington
  • Örebro University (SE)
  • Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden3Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
Corresponding author
Brander, Gustaf
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2016-11-01
Volume
73
Issue
11
Pages
1135
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2016.2095
OpenAlex
W2527878013
Cited by
99
References
46
Citations by year
2026: 9 · 2025: 8 · 2024: 5 · 2023: 15 · 2022: 14 · 2021: 13 · 2020: 8 · 2019: 16 · 2018: 7 · 2017: 3 · 2016: 1
FWCI
12.07
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Vetenskapsrådet
  • Forskningsrådet om Hälsa, Arbetsliv och Välfärd (2015-00569, 2015-00075)
  • David och Astrid Hageléns Stiftelse
Topics
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
obsessive-compulsive disorder, perinatal risk factors, smoking during pregnancy, breech presentation, cesarean section, preterm birth, birth weight, Apgar score, head circumference, gestational age, familial confounding, birth cohort, genetic confounding
MeSH terms
Adolescent, Adult, Apgar Score, Birth Weight, Breech Presentation, Cesarean Section, Female, Gestational Age, Humans, Infant, Low Birth Weight, Infant, Newborn, Infant, Premature, Diseases, Male, Obsessive-Compulsive Disorder, Pregnancy, Prenatal Exposure Delayed Effects, Retrospective Studies, Risk Factors, Sweden, Tobacco Smoke Pollution, Cohort Studies, Case-Control Studies, Perinatal Care, Siblings, Epigenesis, Genetic, Young Adult, Gene-Environment Interaction

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