Risk of Obsessive-Compulsive Disorder in Pregnant and Postpartum Women: A Meta-Analysis

Abstract

OBJECTIVE: Although pregnant and postpartum women are presumed to be at greater risk of obsessive-compulsive disorder (OCD) than the general population, the evidence has been inconclusive. This meta-analysis provides an estimate of OCD prevalence in pregnant and postpartum women and synthesizes the evidence that pregnant and postpartum women are at greater risk of OCD compared to the general population. DATA SOURCES: An electronic search of Google Scholar, PsycINFO, PsychARTICLES, and PubMed was performed by using the search terms OCD, obsessive-compulsive disorder, pregnancy, postpartum, prevalence, and epidemiology. We supplemented our search with articles referenced in the obtained sources. The search was conducted until August 2012 without date restrictions. STUDY SELECTION: We included English-language studies reporting OCD prevalence (diagnosed according to DSM-III-R, DSM-IV, or ICD-10 criteria) in pregnant (12 studies) or postpartum (up to 12 months; 7 studies) women using structured diagnostic interviews. We also included a sample of regionally matched control studies (10 studies) estimating 12-month prevalence in the general female population for comparison. The control studies were limited to those conducted during the same time frame as the pregnant and postpartum studies. DATA EXTRACTION: We extracted author name, year of publication, diagnostic measure, sample size, diagnostic criteria, country, assessment time, subject population, and the point prevalence of OCD. RESULTS: Mixed- and random-effects models revealed an increase in OCD prevalence across pregnancy and the postpartum period with the lowest prevalence in the general population (mean = 1.08%) followed by pregnant (mean = 2.07%) and postpartum women (mean = 2.43%). An exploratory analysis of regionally matched risk-ratios revealed both pregnant (mean = 1.45) and postpartum (mean = 2.38) women to be at greater risk of experiencing OCD compared to the general female population, with an aggregate risk ratio of 1.79. CONCLUSIONS: Pregnant and postpartum women are more likely to experience OCD compared to the general population.