Obsessive-compulsive disorder (OCD) is frequently observed during pregnancy and the postpartum period. A major challenge in the management of OCD is the safety of fetus and breastfed infants. Unfortunately, there are no randomized controlled studies to guide the treatment of OCD in these periods. The present chapter presents the risks of untreated OCD and recommendations for a pharmacological approach regarding the treatment of active symptoms or prophylaxis during the perinatal period.