{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:47:39Z","timestamp":1791208059634,"version":"4.1.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Obsessive-compulsive disorder (OCD) is associated with adverse health-related outcomes. However, pregnancy and neonatal outcomes among women with OCD have been sparsely studied.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate associations of maternal OCD with pregnancy, delivery, and neonatal outcomes.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>Two register-based cohort studies in Sweden and British Columbia (BC), Canada, included all singleton births at 22 weeks or more of gestation between January 1, 1999 (Sweden), or April 1, 2000 (BC), and December 31, 2019. Statistical analyses were conducted between August 1, 2022, and February 14, 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Maternal OCD diagnosis recorded before childbirth and use of serotonin reuptake inhibitors (SRIs) during pregnancy.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Pregnancy and delivery outcomes examined were gestational diabetes, preeclampsia, maternal infection, antepartum hemorrhage or placental abruption, premature rupture of membranes, induction of labor, mode of delivery, and postpartum hemorrhage. Neonatal outcomes included perinatal death, preterm birth, small for gestational age, low birth weight (&amp;lt;2500 g), low 5-minute Apgar score, neonatal hypoglycemia, neonatal jaundice, neonatal respiratory distress, neonatal infections, and congenital malformations. Multivariable Poisson log-linear regressions estimated crude and adjusted risk ratios (aRRs). In the Swedish cohort, sister and cousin analyses were performed to account for familial confounding.<\/jats:p><\/jats:sec>Results<\/jats:title>In the Swedish cohort, 8312 pregnancies in women with OCD (mean [SD] age at delivery, 30.2 [5.1] years) were compared with 2\u202f137\u202f348 pregnancies in unexposed women (mean [SD] age at delivery, 30.2 [5.1] years). In the BC cohort, 2341 pregnancies in women with OCD (mean [SD] age at delivery, 31.0 [5.4] years) were compared with 821\u202f759 pregnancies in unexposed women (mean [SD] age at delivery, 31.3 [5.5] years). In Sweden, maternal OCD was associated with increased risks of gestational diabetes (aRR, 1.40; 95% CI, 1.19-1.65) and elective cesarean delivery (aRR, 1.39; 95% CI, 1.30-1.49), as well as preeclampsia (aRR, 1.14; 95% CI, 1.01-1.29), induction of labor (aRR, 1.12; 95% CI, 1.06-1.18), emergency cesarean delivery (aRR, 1.16; 95% CI, 1.08-1.25), and postpartum hemorrhage (aRR, 1.13; 95% CI, 1.04-1.22). In BC, only emergency cesarean delivery (aRR, 1.15; 95% CI, 1.01-1.31) and antepartum hemorrhage or placental abruption (aRR, 1.48; 95% CI, 1.03-2.14) were associated with significantly higher risk. In both cohorts, offspring of women with OCD were at elevated risk of low Apgar score at 5 minutes (Sweden: aRR, 1.62; 95% CI, 1.42-1.85; BC: aRR, 2.30; 95% CI, 1.74-3.04), as well as preterm birth (Sweden: aRR, 1.33; 95% CI, 1.21-1.45; BC: aRR, 1.58; 95% CI, 1.32-1.87), low birth weight (Sweden: aRR, 1.28; 95% CI, 1.14-1.44; BC: aRR, 1.40; 95% CI, 1.07-1.82), and neonatal respiratory distress (Sweden: aRR, 1.63; 95% CI, 1.49-1.79; BC: aRR, 1.47; 95% CI, 1.20-1.80). Women with OCD taking SRIs during pregnancy had an overall increased risk of these outcomes, compared with those not taking SRIs. However, women with OCD not taking SRIs still had increased risks compared with women without OCD. Sister and cousin analyses showed that at least some of the associations were not influenced by familial confounding.<\/jats:p><\/jats:sec>Conclusion and Relevance<\/jats:title>These cohort studies suggest that maternal OCD was associated with an increased risk of adverse pregnancy, delivery, and neonatal outcomes. Improved collaboration between psychiatry and obstetric services and improved maternal and neonatal care for women with OCD and their children is warranted.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.18212","type":"journal-article","created":{"date-parts":[[2023,6,14]],"date-time":"2023-06-14T15:01:14Z","timestamp":1686754874000},"page":"e2318212","source":"Crossref","is-referenced-by-count":15,"title":["Pregnancy, Delivery, and Neonatal Outcomes Associated With Maternal Obsessive-Compulsive Disorder"],"prefix":"10.1001","volume":"6","author":[{"given":"Lorena","family":"Fern\u00e1ndez de la Cruz","sequence":"first","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. S.","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of British Columbia and the Children\u2019s and Women\u2019s Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada"},{"name":"School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of British Columbia and the Children\u2019s and Women\u2019s Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olof","family":"Stephansson","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s Health, Karolinska University Hospital, Stockholm, Sweden"},{"name":"Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Mataix-Cols","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden"},{"name":"Department of Clinical Sciences, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neda","family":"Razaz","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,6,14]]},"reference":[{"issue":"1","key":"zoi230556r1","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1038\/mp.2008.94","article-title":"The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication.","volume":"15","author":"Ruscio","year":"2010","journal-title":"Mol Psychiatry"},{"issue":"4","key":"zoi230556r2","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.19r13085","article-title":"Women are at greater risk of OCD than men: a meta-analytic review of OCD prevalence worldwide.","volume":"81","author":"Fawcett","year":"2020","journal-title":"J Clin Psychiatry"},{"key":"zoi230556r3","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2022.104602","article-title":"Morbidity and mortality in obsessive-compulsive disorder: a narrative review.","volume":"136","author":"Fern\u00e1ndez de la Cruz","year":"2022","journal-title":"Neurosci Biobehav Rev"},{"issue":"4","key":"zoi230556r4","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1016\/j.comppsych.2013.12.018","article-title":"Neuroinflammation in the fetus exposed to maternal obsessive-compulsive disorder during pregnancy: a comparative study on cord blood tumor necrosis factor-alpha levels.","volume":"55","author":"Uguz","year":"2014","journal-title":"Compr Psychiatry"},{"issue":"1","key":"zoi230556r5","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1016\/j.psychres.2014.12.063","article-title":"Birth weight and gestational age in newborns exposed to maternal obsessive-compulsive disorder.","volume":"226","author":"Uguz","year":"2015","journal-title":"Psychiatry Res"},{"issue":"1","key":"zoi230556r6","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s00737-015-0542-z","article-title":"Obsessive-compulsive disorder in pregnancy and the postpartum period: course of illness and obstetrical outcome.","volume":"19","author":"House","year":"2016","journal-title":"Arch Womens Ment Health"},{"key":"zoi230556r7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocrd.2021.100641","article-title":"Peripartum complications associated with obsessive compulsive disorder exacerbation during pregnancy.","volume":"29","author":"Holingue","year":"2021","journal-title":"J Obsessive Compuls Relat Disord"},{"issue":"6","key":"zoi230556r8","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1007\/s00737-021-01140-5","article-title":"Association between obsessive-compulsive disorder and obstetrical and neonatal outcomes in the USA: a population-based cohort study.","volume":"24","author":"Nasiri","year":"2021","journal-title":"Arch Womens Ment Health"},{"issue":"4","key":"zoi230556r9","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1016\/j.euroneuro.2016.02.004","article-title":"Pharmacoepidemiology of obsessive-compulsive disorder: a Swedish nationwide cohort study.","volume":"26","author":"Isomura","year":"2016","journal-title":"Eur Neuropsychopharmacol"},{"issue":"11","key":"zoi230556r10","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1007\/s11920-022-01372-x","article-title":"Selective serotonin reuptake inhibitors (SSRIs) in pregnancy: an updated review on risks to mother, fetus, and child.","volume":"24","author":"Lebin","year":"2022","journal-title":"Curr Psychiatry Rep"},{"key":"zoi230556r11","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.jpsychires.2020.02.023","article-title":"Use of antidepressants during pregnancy and neonatal outcomes: an umbrella review of meta-analyses of observational studies.","volume":"124","author":"Biffi","year":"2020","journal-title":"J Psychiatr Res"},{"issue":"11","key":"zoi230556r12","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s10654-009-9350-y","article-title":"The Swedish Personal Identity Number: possibilities and pitfalls in healthcare and medical research.","volume":"24","author":"Ludvigsson","year":"2009","journal-title":"Eur J Epidemiol"},{"issue":"1","key":"zoi230556r14","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/s10654-022-00947-5","article-title":"The Swedish Medical Birth Register during five decades: documentation of the content and quality of the register.","volume":"38","author":"Cnattingius","year":"2023","journal-title":"Eur J Epidemiol"},{"key":"zoi230556r15","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1186\/1471-2458-11-450","article-title":"External review and validation of the Swedish National Inpatient Register.","volume":"11","author":"Ludvigsson","year":"2011","journal-title":"BMC Public Health"},{"issue":"7","key":"zoi230556r16","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1002\/(ISSN)1099-1557","article-title":"The new Swedish Prescribed Drug Register\u2014opportunities for pharmacoepidemiological research and experience from the first six months.","volume":"16","author":"Wettermark","year":"2007","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"zoi230556r17","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/978-1-59745-423-0","article-title":"The Swedish Multi-generation Register.","volume":"675","author":"Ekbom","year":"2011","journal-title":"Methods Mol Biol"},{"issue":"4","key":"zoi230556r18","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1007\/BF03403934","article-title":"Creating a population-based linked health database: a new resource for health services research.","volume":"89","author":"Chamberlayne","year":"1998","journal-title":"Can J Public Health"},{"issue":"1","key":"zoi230556r20","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1186\/s12884-015-0563-7","article-title":"Validating the British Columbia Perinatal Data Registry: a chart re-abstraction study.","volume":"15","author":"Frosst","year":"2015","journal-title":"BMC Pregnancy Childbirth"},{"issue":"5","key":"zoi230556r25","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1016\/j.biopsych.2017.12.003","article-title":"Metabolic and cardiovascular complications in obsessive-compulsive disorder: a total population, sibling comparison study with long-term follow-up.","volume":"84","author":"Isomura","year":"2018","journal-title":"Biol Psychiatry"},{"issue":"9","key":"zoi230556r26","doi-asserted-by":"publisher","first-page":"1817","DOI":"10.1007\/s00127-021-02182-x","article-title":"Hit-and-run: a Swedish nationwide cohort study of serious transport accidents and convictions due to traffic offenses in obsessive-compulsive disorder.","volume":"57","author":"Mataix-Cols","year":"2022","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"6","key":"zoi230556r27","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-007520","article-title":"Validity and reliability of chronic tic disorder and obsessive-compulsive disorder diagnoses in the Swedish National Patient Register.","volume":"5","author":"R\u00fcck","year":"2015","journal-title":"BMJ Open"},{"issue":"5","key":"zoi230556r28","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1177\/0269881114525674","article-title":"Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology.","volume":"28","author":"Baldwin","year":"2014","journal-title":"J Psychopharmacol"},{"issue":"18","key":"zoi230556r30","doi-asserted-by":"publisher","first-page":"3067","DOI":"10.1002\/sim.5767","article-title":"Between-within models for survival analysis.","volume":"32","author":"Sj\u00f6lander","year":"2013","journal-title":"Stat Med"},{"issue":"2","key":"zoi230556r31","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1002\/(ISSN)1097-0258","article-title":"The need for randomization in the study of intended effects.","volume":"2","author":"Miettinen","year":"1983","journal-title":"Stat Med"},{"key":"zoi230556r32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s40471-013-0004-y","article-title":"Confounding by indication and related concepts.","volume":"1","author":"Joseph","year":"2014","journal-title":"Curr Epidemiol Rep"},{"issue":"11","key":"zoi230556r33","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1001\/jamapsychiatry.2016.2095","article-title":"Association of perinatal risk factors with obsessive-compulsive disorder: a population-based birth cohort, sibling control study.","volume":"73","author":"Brander","year":"2016","journal-title":"JAMA Psychiatry"},{"key":"zoi230556r34","doi-asserted-by":"publisher","first-page":"S46","DOI":"10.2105\/AJPH.2013.301252","article-title":"Critical need for family-based, quasi-experimental designs in integrating genetic and social science research.","volume":"103","author":"D\u2019Onofrio","year":"2013","journal-title":"Am J Public Health"},{"key":"zoi230556r29","volume-title":"Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder","author":"National Institute for Health and Clinical Excellence","year":"2005"},{"key":"zoi230556r13","unstructured":"Population Data BC. The data linkage process. Accessed December 30, 2022. https:\/\/www.popdata.bc.ca\/datalinkage\/process"},{"key":"zoi230556r19","unstructured":"Perinatal Services BC. British Columbia Perinatal Data Registry: Years Provided: 2000 to 2019: Resource Data: Data Extract. Data Provided on: 2021. Accessed December 30, 2022. http:\/\/www.perinatalservicesbc.ca\/health-professionals\/data-surveillance\/perinatal-data-registry"},{"key":"zoi230556r21","unstructured":"Population Data BC. Discharge Abstracts Database (Hospital Separations) data set. Accessed December 30, 2022. https:\/\/www.popdata.bc.ca\/data\/health\/dad"},{"key":"zoi230556r22","unstructured":"Population Data BC. Medical Services Plan (MSP) Payment Information File (PopData). Accessed December 30, 2022. https:\/\/www.popdata.bc.ca\/node\/677"},{"key":"zoi230556r23","unstructured":"Population Data BC. PharmaNet data set. Accessed December 30, 2022. https:\/\/www.popdata.bc.ca\/data\/health\/pharmanet"},{"key":"zoi230556r24","unstructured":"Population Data BC. Central demographics file (MSP registration and premium billings, client roster and census geodata)\/consolidation file (MSP registration and premium billing) data set. Accessed December 30, 2022. https:\/\/www.popdata.bc.ca\/data\/demographic\/consolidation_file"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2806014\/fernndez_de_la_cruz_2023_oi_230556_1689016634.81083.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T15:00:36Z","timestamp":1689606036000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2806014"}},"subtitle":["Two Cohort Studies in Sweden and British Columbia, Canada"],"short-title":[],"issued":{"date-parts":[[2023,6,14]]},"references-count":34,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,6,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.18212","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,14]]}}}