Obsessive-compulsive symptom trajectories from pregnancy through the postpartum: examining longitudinal course and risk factors during the COVID-19 pandemic

The peripartum is a time of increased risk for the development or worsening of obsessive-compulsive (OC) symptoms. Existing evidence suggests that OC symptoms commonly surge immediately postpartum followed by a gradual recovery. Yet how societal conditions, such as a widespread public health crisis, may affect this pattern remains unknown. Increased OC symptom prevalence in the general population during the COVID-19 pandemic coupled with the pre-existing vulnerability of peripartum women suggests they may have been at particularly high risk for sustained symptoms. Thus, the aim of the current study was to examine trajectories in OC symptoms, particularly contamination concerns, in women who gave birth during the COVID-19 pandemic, and to look at risk and resiliency factors that may influence symptom course

A sample of 164 US pregnant women were recruited during the COVID-19 pandemic. They reported OC symptoms at 3 timepoints: April/May, 2020, July, 2020, and February, 2022. We used a growth mixture modeling approach to examine OC symptom trajectories from pregnancy through the postpartum across these timepoints, comparing the goodness of fit of models with 1–5 trajectory classes for overall OC symptoms and for contamination-related OC symptoms.

For total OC symptoms, two classes of trajectories were identified: recovering (29.27%) versus stable low (70.73%) symptoms; for contamination symptoms alone, a subset of total symptoms, three trajectories were identified: recovering (8.54%), stable low symptoms (68.29%), and stable high symptoms (23.17%). Peripartum stress, but not sociodemographic or obstetric factors, predicted class membership.

These findings suggest that peripartum OC symptoms, particularly related to contamination, may persist beyond the postpartum period in some women, particularly for women exposed to elevated stress in pregnancy and the postpartum.