Frequently Asked Questions

Obsessive-compulsive disorder was more common after delivery than during pregnancy. The estimated average point prevalence was 2.9% (95% CI, 2.7%–3.2%) during pregnancy and 7.0% (95% CI, 6.9%–7.2%) during the postpartum period. Weighted period prevalence was 7.8% (95% CI, 5.1%–12.0%) during pregnancy and 16.9% (95% CI, 14.0%–20.2%) across the postpartum period.

Postpartum obsessive-compulsive disorder peaked at approximately 8 weeks postpartum, with an estimated point prevalence of 8.7% (95% CI, 5.6%–11.7%). The model estimated point prevalence at 8.3% (95% CI, 5.4%–11.2%) at 10 weeks postpartum, after which the probability of OCD diagnoses declined and then leveled out.

The incidence of new postpartum OCD diagnoses was 4.7 new cases per 1,000 women per week postpartum (95% CI, 3.2–6.1) among women who had not met full OCD criteria during pregnancy. There were 49 new postpartum cases over 9,612 total person-weeks of follow-up, and the highest rate of new diagnoses occurred within the first 10 weeks postpartum.

New postpartum OCD cases accumulated early and continued to rise across the first several postpartum months. Cumulative incidence was 5% (95% CI, 3%–6%) at 4 weeks, 6% (95% CI, 4%–8%) at 8 weeks, 7% (95% CI, 5%–10%) at 12 weeks, 8% (95% CI, 6%–11%) at 16 weeks, and 9% (95% CI, 6%–12%) by 6 months postpartum.

No. Among the 100 women who met criteria for obsessive-compulsive disorder at some point during the perinatal period, 60 had clinical-level OCD that began during the index pregnancy or postpartum period. The remaining women reported symptom onset or diagnosis before the most recent pregnancy.

The authors attributed the higher estimates mainly to two features of the study: a more comprehensive assessment of perinatal-specific obsessive-compulsive symptoms and the use of DSM-5 rather than DSM-IV diagnostic criteria. They noted that detailed questions about infant-related harm thoughts and related compulsions likely increased detection, and that DSM-5 is less stringent than DSM-IV for diagnosing OCD.

It is important because standard obsessive-compulsive disorder questions may miss perinatal-specific symptoms, especially infant-related harm obsessions. The authors reported that perinatal women often do not recognize standard questions about intrusive thoughts as referring to thoughts about their infant, so assessments that do not ask directly about infant-related obsessions, compulsions, and effects on parenting may underestimate maternal perinatal OCD prevalence.

No. The article states that although harming obsessions are common among women with postpartum obsessive-compulsive disorder, they are not associated with a risk of behaving violently. The authors also note that clinicians may struggle to distinguish perinatal OCD from psychosis, which can lead to the mistaken assumption that all infant-related harming ideation represents a risk to infant safety.

OCD was assessed with the Structured Clinical Interview for DSM-5 (SCID-5) in a longitudinal design. Women completed telephone diagnostic interviews in late pregnancy and twice postpartum, with mean assessment times at 36.89 weeks' gestation, 9.09 weeks postpartum, and 21.27 weeks postpartum; participants were followed from late pregnancy to a maximum of 38 weeks postpartum. In addition to standard OCD questions, the postpartum interviews included detailed questions about infant-related harm thoughts and associated behaviors, and these symptoms were incorporated into OCD diagnostic ratings.

The main limitations were related to recruitment, prior OCD history data, and generalizability. Some participants joined after childbirth and may have been drawn to the study because of postpartum intrusive thoughts; prior OCD history was collected only for participants with subclinical or clinical OCD symptoms, so the investigators could not report postpartum incidence separately for women with and without a previous OCD history; and because the study was conducted in one Canadian province, generalizability to other cultures is limited.