Clinical Summary
Clinical Summary: High Prevalence and Incidence of Obsessive-Compulsive Disorder Among Women Across Pregnancy and the Postpartum
Obsessive-compulsive disorder in the perinatal period is easy to miss, especially when obsessions involve infant-related harm that clinicians may mistake for psychosis or fail to ask about directly. This study shows that obsessive-compulsive disorder is substantially more common across pregnancy and the postpartum than prior estimates suggested, with the highest burden after delivery.
Design
this longitudinal study
N
580
Population
English-speaking women living in the Province of British Columbia, Canada (BC)
Duration
from late pregnancy to a maximum of 38 weeks postpartum
Key Findings
- Estimated point prevalence of OCD diagnosis rose from 2.6% (95% CI 0.4–4.8) at 6 weeks prior to delivery to 8.3% (95% CI 5.4–11.2) at 10 weeks postpartum, peaking at approximately 8 weeks postpartum at 8.7% (95% CI 5.6–11.7).
- Average point prevalence was 2.9% (95% CI 2.7– 3.2) during the prenatal period and 7.0% (95% CI 6.9–7.2) during the postpartum period.
- Weighted period prevalence during pregnancy was 7.8% (95% CI 5.1–12.0), while postpartum period prevalence was 16.9% (95% CI 14.0–20.2).
- Postpartum incidence was 4.7 (95% CI 3.2–6.1) new cases per 1,000 women per week postpartum, with 49 new cases of OCD diagnosed during the postpartum period.
- Cumulative incidence of new postpartum OCD was 5% (95% CI 3–6) at 4 weeks, 8% (6–11) at 16 weeks, and 9% (95% CI 6–12) by 6 months postpartum.
Clinical Bottom Line
Obsessive-compulsive disorder is common across the perinatal period and is especially frequent after delivery, with new cases clustering in the first 10 weeks postpartum. Perinatal assessment should explicitly ask about infant-related harm obsessions and related compulsions rather than relying on standard obsessive-compulsive disorder questions alone.
Practice Implications
- Screen more than once across the postpartum period, because point prevalence peaked at approximately 8 weeks postpartum at 8.7% (95% CI 5.6–11.7) and the highest rate of new diagnoses occurred within the first 10 weeks postpartum.
- Ask directly about infant-related harm thoughts and associated checking or reassurance-seeking behaviors, since the diagnostic interview in this study included detailed postpartum questions about infant-related harm thoughts and associated behaviors.
- Do not assume intrusive infant-harm obsessions indicate psychosis; in this cohort, broader perinatal-specific obsessive-compulsive disorder assessment identified substantial postpartum burden, with period prevalence of 16.9% (95% CI 14.0–20.2).
- Continue monitoring beyond the early postpartum visit, because cumulative incidence increased from 5% (95% CI 3–6) at 4 weeks postpartum to 9% (95% CI 6–12) by 6 months postpartum.
