Pregnancy complicated by obsessive-compulsive disorder

Abstract

Obsessive-compulsive disorder (OCD) is a well-recognized psychiatric disorder often beginning in reproductive age. A case of OCD in pregnancy is presented and its management discussed. A 28-year-old G3P2 woman presented at 8 weeks' gestation for prenatal care. She had been diagnosed with OCD following her prior pregnancy. Her symptoms primarily involved obsessions about infectious disease and compulsive cleaning and organization of household items, both of which greatly distressed her and interfered with caring for her children. She had been managed with clomipramine between pregnancies and was beginning a clinical trial of fluvoxamine when pregnancy was diagnosed. She discontinued medication when she realized she was pregnant. Her symptoms were managed during the pregnancy with frequent appointments with her obstetrician and her psychiatrist. She used a behavioral technique, "thought-stopping", as well. Her symptoms worsened in the last month of pregnancy and immediately after delivery; she delivered a normal infant. The clomipramine was restarted postpartum. She has done well since then, with minimal psychiatric symptoms. OCD is a disabling psychiatric disorder that occurs in women of reproductive age. With careful management, pregnancy without disabling psychiatric symptoms can occur.