Obsessive Compulsive Disorder

Perinatal complications associated with increased risk for OCD
(Source: Brander G, et al. JAMA Psychiatry, 05.10.2016)
Recent findings showed smoking 10 or more cigarettes per day during pregnancy, breech presentation, delivery by cesarean section, preterm birth and other perinatal factors were associated with increased risk for obsessive-compulsive disorder.

According to Gustaf Brander, MSc, of Karolinska Institutet, Stockholm, and colleagues, complications in the perinatal period, including delivery by cesarean section, delivery using vacuum extraction, preterm birth, and low birth weight, have been associated with a range of psychiatric disorders, such as schizophrenia, bipolar disorder, autism spectrum disorder, and attention deficit/ hyperactivity disorder.

To assess potential perinatal risk factors for OCD, researchers conducted a population-based birth cohort study of 2,421,284 children born in Sweden between 1973 and 1996. Study participants were followed through 2013. Overall, 17,305 participants were diagnosed with OCD. Mean age at first diagnosis was 23.4 years. Increased risk for OCD was associated with smoking 10 or more cigarettes per day during pregnancy, breech presentation, delivery by cesarean section, preterm birth, birth weight between 1,501 g to 2,500 g and 2,501 g to 3,500 g, being large for gestational age and Apgar distress scores at 5 minutes. These remained when controlling for shared familial confounders and measure covariates, including sex, birth year, maternal and paternal age at birth and parity.

Children with a shorter gestational age and lower birth weight had an increasingly higher risk for OCD.

Researchers found a dose-response association between the number of perinatal events and increased risk for OCD, with hazard ratios ranging from 1.11 (95% CI, 1.07-1.15) for one event to 1.51 (95% CI, 1.18-1.94) for five or more events.

According to Thomas V. Fernandez, MD, and James F. Leckman, MD, PhD, of Yale University School of Medicine, New Haven, Connecticut, the findings presented in this issue of JAMA Psychiatry are certainly intriguing and have great public health significance. In addition, they bring us one step further in our understanding of OCD risk and underlying biological mechanisms and are likely to influence the design of future genetic, epigenetic, and environmental investigations. The findings of the study will continue to increase our understanding of the etiology of OCD and inform novel interventions to alleviate and potentially prevent the debilitating effects of OCD.