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Perinatal complications associated with increased risk for OCD

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.

“Complications in the perinatal period, including delivery by cesarean section, delivery using vacuum extraction, preterm birth, and low birthweight, have been associated with a range of psychiatric disorders, such as schizophrenia, bipolar disorder, autism spectrum disorder, and attention deficit/ hyperactivity disorder. Few studies, most of which were retrospective, indicate that perinatal complications may also play a role in OCD, but the methodologic weaknesses of those studies preclude firm conclusions,” Gustaf Brander, MSc, of Karolinska Institutet, Stockholm, and colleagues wrote.

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 (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 between 1,501 g to 2,500 g (HR = 1.3; 95% CI, 1.05-1.62) and 2,501 g to 3,500 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 = 1.5; 95% CI, 1.07-2.09). 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 (HR = 1.61; 95% CI, 1.35-1.91) and lower birth weight (HR = 1.1; 95% CI, 1-1.21) 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.

“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,” Thomas V. Fernandez, MD, and James F. Leckman, MD, PhD, of Yale University School of Medicine, New Haven, Connecticut, wrote in an accompanying editorial. “Further studies are required to replicate these findings, and much more work will need to be done, for example, in animal and cell models, to dissect the mechanisms underlying the reported associations. Ultimately, this work will continue to increase our understanding of the etiology of OCD and inform novel interventions to alleviate and potentially prevent the debilitating effects of this common disorder.” – by Amanda Oldt

Disclosure: Brander reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.