Perinatal factors affecting expression of obsessive compulsive disorder in children and adolescents

Objective: To examine whether adverse perinatal experiences of children are associated with obsessive compulsive disorder (OCD) in youth. Methods: Subjects were 130 children and adolescents with OCD recruited from a family genetic study of pediatric OCD and 49 matched controls from a contemporaneous family case-control study of attention-deficit/hyperactivity disorder (ADHD). Subjects were comprehensively assessed in multiple domains of function. A systematic history of pregnancy, delivery, and infancy complications was obtained. Results: Compared to normal controls, children with OCD had mothers with significantly higher rates of illness during pregnancy requiring medical care (χ² ± 8.61, p ± 0.003) and more birth difficulties (induced labor, forceps delivery, nuchal cord, or prolonged labor) (χ² ± 7.51, p ± 0.006). Among the OCD-affected children, we found several significant associations between adverse perinatal experiences and earlier age at onset, increased OCD severity, and increased risk for comorbid ADHD, chronic tic disorder, anxiety disorder, and major depressive disorder. Conclusion: Although exploratory, our analyses found that children with OCD had higher rates of several adverse perinatal experiences compared with controls. Among OCD-affected children, comorbid psychopathology was predicted by specific perinatal risk factors. Prospective studies of perinatal adverse events that minimize potential recall bias and type I errors are needed.