Psychiatry Research 226 (2015) 396–398
Contents lists available at ScienceDirect
Psychiatry Research journal homepage: www.elsevier.com/locate/psychres
Brief report
Birth weight and gestational age in newborns exposed to maternal obsessive-compulsive disorder Faruk Uguz a,n, Goksen Yuksel b, Cagatay Karsidag b, Hatice Guncu a, Murat Konak c a
Department of Psychiatry, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey Department of Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey c Department of Neonatology, University of Necmettin Erbakan, Faculty of Medicine, Konya, Turkey b
art ic l e i nf o
a b s t r a c t
Article history: Received 21 May 2014 Received in revised form 4 December 2014 Accepted 21 December 2014 Available online 23 January 2015
We examined the impact of maternal obsessive-compulsive disorder (OCD) on gestational age and birth weight of infants. The sample included 63 mothers (28 patient and 35 controls). OCD and other psychiatric diagnoses were determined with a structured clinical interview. Birth weight and gestational age were lower in the newborns exposed to maternal OCD compared to ones who were not exposed. The results suggest that maternal OCD may negatively affect fetal weight growth and gestational duration. & 2015 Elsevier Ireland Ltd. All rights reserved.
Keywords: Obsessive-compulsive disorder Birth weight Pregnancy
1. Introduction Obsessive-compulsive disorder (OCD) is a relatively frequent psychiatric disorder observed in pregnancy with prevalence rates varying from 0.2% to 5.2% (Andersson et al., 2003; Adewuya et al., 2006; Felice et al., 2007; Uguz et al., 2007; Borri et al., 2008). Previous studies have suggested that pregnancy in women may affect the onset or clinical course of OCD. According to a recent meta-analysis, pregnant women have 1.45 times greater risk of OCD compared to the general female population (Russell et al., 2013). It has been demonstrated that OCD symptoms may be aggravated in 8–46% of women during pregnancy (Labad et al., 2005; Vulink et al., 2006; Uguz et al., 2007; Forray et al., 2010; Uguz and Ayhan, 2011). Although OCD is relatively prevalent, its effects on the fetus or on neonatal outcomes are almost unknown. The available studies mostly present epidemiological or clinical findings related to OCD during pregnancy. Indeed, the studies on the influence of psychiatric disturbances on neonatal outcome are primarily focused on depression and not anxiety disorders, which are more frequently observed in pregnant women (Borri et al., 2008; Uguz et al., 2010). However, several studies have suggested that general stress or anxiety and panic disorder are associated with smaller birth weight and preterm birth (Rondo et al., 2003; Warren et al.,
n Correspondence to: Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, Psikiyatri Anabilim Dalı Akyokuş, 42080, Konya, Turkey. Tel.: þ90 332 223 6306. E-mail address: [email protected] (F. Uguz).
http://dx.doi.org/10.1016/j.psychres.2014.12.063 0165-1781/& 2015 Elsevier Ireland Ltd. All rights reserved.
2006; Bánhidy et al., 2006; Uguz et al., 2013). On the other hand, low birth weight and preterm birth are highly associated with increased risk of neonatal mortality, neonatal morbidity and poor neurodevelopmental outcome (Stephens and Vohr, 2009; Yonkers et al., 2014; Malin et al., 2014). Additionally, most of studies examining effects of depression or anxiety on fetus did not exclude comorbidity between depression and anxiety disorders. For this reason, in the present study, we aimed to examine whether there is an effect of maternal OCD without comorbidity with anxiety disorders and depression during pregnancy on gestational age and birth weight.
2. Methods This cross-sectional study was conducted among in the postpartum period up to 12 weeks. The study sample included 28 women with OCD who were admitted to the Psychiatry Clinic of Meram Faculty of Medicine of Necmettin Erbakan University in Konya, Turkey and Perinatal Mental Health Outpatient Clinic of Bakırkoy Mental and Neurological Diseases Research and Training Hospital in Istanbul, Turkey. These patients had obsessive-compulsive symptoms which meet diagnostic criteria for OCD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association, 1994) during pregnancy and postpartum period. The study sample also included 35 healthy women who were admitted to the Neonatology Outpatient Clinics of Meram Faculty of Medicine of Necmettin Erbakan University for routine care of her infants and without any psychiatric diagnosis during their pregnancy. Maternal age of at least 18 years and voluntary participation were the inclusion criteria for the study. Exclusion criteria for the study were as follows: (1) a history of medical illnesses (e.g., endocrine abnormalities, cardiovascular and pulmonary system diseases, neurological disease and metabolic disease) or pregnancy related complications (e.g., gestational hypertension, imminent abortion, placenta previa
F. Uguz et al. / Psychiatry Research 226 (2015) 396–398
and other placental abnormalities, vaginal bleeding, and gestational diabetes), (2) any fetal malformation in the baby, (3) a maternal infection that can negatively affect fetal growth (toxoplasma, rubella, cytomegalovirus, herpes simplex, mycoplasma, chlamydia), (4) a history of bipolar affective disorder, schizophrenia or related psychotic disorders, (5) smoking or alcohol consumption during pregnancy, (6) the existence of comorbidity between depressive and anxiety disorders and (7) to have received any psychiatric treatment during their pregnancy for any psychiatric diagnosis. Initially, the objectives and procedures of the study were explained to all participants, and written informed consent forms were obtained. After the data on the sociodemographic characteristics and obstetrical features were recorded in the outpatient clinics, psychiatric interviews by means of the Structured Clinical Interview for DSM-IV (SCID-I) (First et al., 1997) were carried out. Psychiatric interviews were carried out by investigators blinded to the gestational age at delivery and birthweight of the newborn. Birth weight was obtained from the hospital records and from reports by the mother. The data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 16.0, for Windows. Chi-square test was used to compare categorical and continuous variables between data in the study. For comparisons of continuous variables which exhibit normal and abnormal distribution between the study groups, we carried out t test and Mann–Whitney U test, respectively. All significance levels were 2-tailed and set at the level of 0.05.
3. Results The mean age of the participants (n¼63) was 29.1274.68 years. Almost all of the women (98.4%) were married, 31 (49.2%) had completed primary school and 51 (81.0%) were unemployed. The mean number of children was 1.5271.11, and the mean duration of gestation at delivery was 38.9671.77 weeks. The proportion of primiparous women was 30.2% (n¼19). There was no significant difference between the study groups in terms of age (P¼ 0.238), education (P¼ 0.449), marital status (P¼ 0.444), employment status (P¼ 0.343), economical level (P¼0.711), primiparity (P¼ 0.421), gender of baby (P¼0.804) and delivery type (P¼ 0.612). Two (7.14%) of the patients reported the onset of OCD during the pregnancy whereas the other patients reported the existence of OCD prior to their pregnancy. Of the women with OCD, five (17.9%) gave birth to an infant with low birth weight (o2500 g), and four (14.3%) had preterm delivery (o 37 weeks gestation). These numbers were 1 (2.9%) and 1 (2.9%) in the control group, respectively. The chi-square test did not reveal a significant difference between the study groups (P ¼0.162 and P¼ 0.080). In contrast, the statistical analyses comparing continuous variables between the groups demonstrated that newborns of women with OCD had statistically significant lower birth weight (3077 7466 g vs 3421 7 345 g, t¼ 3.37, P ¼0.001) and shorter gestational age (38.357 1.83 weeks vs 39.46 71.58 weeks, z¼ 2.49, P ¼0.013).
4. Discussion The present study suggests that OCD may lead to unfavorable neonatal outcomes in pregnant women. In this study, the mean gestational age and birth weight of the infants were statistically significantly lower in the mothers with OCD when compared to the mothers without OCD. On the other hand, the prevalence of preterm birth and low birth weight did not reach a statistically significant level despite approximately four-fold difference in these values between patients with OCD and healthy subjects. This could be due to the small sample size of the study groups. Few studies have examined these neonatal outcomes in pregnant women with specific anxiety disorders, and they mostly include panic disorder. Warren et al. (2006) reported lower birth weight in newborns of mothers with panic disorder compared to controls. A population-based study suggests that pregnant women with panic disorder had a shorter gestational age and higher proportion of preterm births (Bánhidy et al., 2006). Most recently, a comparative study has suggested that both major depression and
397
panic disorder in pregnant women are associated with lower birth weight and shorter gestational age compared to control women. However, panic disorder may affect these parameters more negatively compared to major depression (Uguz et al., 2013). The present study suggests that within anxiety disorders not only panic disorder but also OCD has negative influences on gestational length and fetal growth. In addition, we think that the effects of OCD on the fetus may be as important as depression. The results of this study suggest that OCD is related to a negative outcome in birth weight and gestational age. However, the following limitations of the study must be taken into account: (1) the sample size was relatively small and the study has a crosssectional design. However, to obtain patients with treatment-free OCD without comorbid depression, anxiety disorders was difficult. (2) The study design did not allow for the examination of the symptom levels of the psychiatric diagnoses during pregnancy. (3) All women were recruited from a clinical setting rather than the general population. Therefore, the sample might not be representative of the entire community. The present results should be confirmed in studies with larger sample size. Moreover, further studies should also examine whether pharmacotherapy or psychotherapy for OCD during pregnancy can have positive effects in terms of gestational age and birth weight.
Acknowledgments This research has not been supported by any commercial or non-commercial organization. In addition, the authors have no conflict of interest with any commercial or other associations in connection with submitted paper. The authors have no financial funding source supporting the article. References American Psychiatric Association, 1994. Diagnostic and Statistical Manual of Mental Disorders, fourth edition American Psychiatric Press, Washington, DC. Adewuya, A.O., Ola, B.A., Aloba, O.O., Mapayi, B.M., 2006. Anxiety disorders among Nigerian women in late pregnancy: a controlled study. Archives of Womens Mental Health 9, 325–328. Andersson, L., Sundström-Poromaa, I., Bixo, M., Wulff, M., Bondestam, K., Åström, M., 2003. Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. American Journal of Obstetrics and Gynecology 189, 148–154. Bánhidy, F., Ács, N., Puhó, E., Czeizel, A.E., 2006. Association between maternal panic disorders and pregnancy complications and delivery outcomes. Europeran Journal of Obstetrics and Gynecology Reproductive Biology 124, 47–52. Borri, C., Mauri, M., Oppo, A., Banti, S., Rambelli, C., Ramacciotti, D., et al., 2008. Axis I psychopathology and functional impairment at the third month of pregnancy: results from the Perinatal Depression-Research and Screening Unit (PNDReScU) Study. Journal of Clinical Psychiatry 69, 1617–1624. Felice, E., Saliba, J., Grech, V., Cox, J., Calleja, N., 2007. Antenatal psychiatric morbidity in Maltase women. General Hospital Psychiatry 29, 501–505. First, M.B., Spitzer, R.L., Gibbon, M., Williams, J.B.W., 1997. Structured Clinical Interview for DSM-IV Clinical Version (SCID-I/CV), D.C. American Psychiatric Press, Washington. Forray, A., Focseneanu, M., Pittman, B., McDougle, C.J., Epperson, C.N., 2010. Onset and exacerbation of obsessive-compulsive disorder in pregnancy and the postpartum period. Journal of Clinical Psychaitry 71, 1061–1068. Labad, J., Menchón, J.M., Alonso, P., Segalàs, C., Jiménez, S., Vallejo, J., 2005. Female reproductive cycle and obsessive-compulsive disorder. Journal of Clinical Psychiatry 66, 428–435. Malin, G.L., Morris, R.K., Riley, R., Teune, M.J., Khan, K.S., 2014. When is birthweight at term abnormally low? A systematic review and meta-analysis of the association and predictive ability of current birthweight standards for neonatal outcomes. BJOG 121, 515–526. Rondo, P.H., Ferreira, R.F., Nogueira, F., Ribeiro, M.C., Lobert, H., Artes, R., 2003. Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation. European Journal of Clinical Nutrition 57, 266–272. Russell, E.J., Fawcett, J.M., Mazmanian, D., 2013. Risk of obsessive-compulsive disorder in pregnant and postpartum women: a meta-analysis. Journal of Clinical Psychiatry 74, 377–384. Stephens, B.E., Vohr, B.R., 2009. Neurodevelopmental outcome of the premature infant. Pediatric Clinics of North America 56, 631–646.
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F. Uguz et al. / Psychiatry Research 226 (2015) 396–398
Uguz, F., Gezginc, K., Zeytinci, I.E., Karatayli, S., Karatayli, R., Askin, R., et al., 2007. Obsessive-compulsive disorder in pregnant women during the third trimester of pregnancy. Comprehensive Psychiatry 48, 441–445. Uguz, F., Gezginc, K., Kayhan, F., Sarı, S., Büyüköz, D., 2010. Is pregnancy associated with mood and anxiety disorders? A cross-sectional study. General Hospital Psychiatry 32, 213–215. Uguz, F., Ayhan, M.G., 2011. Epidemiology and clinical features of obsessivecompulsive disorder during pregnancy and postpartum period: a review. Journal of Mood Disorder 1, 178–186. Uguz, F., Sahingoz, M., Sonmez, E.O., Karsidag, C., Yuksel, G., Annagur, B.B., Annagur, A., 2013. The effects of maternal major depression, generalized anxiety disorder, and
panic disorder on birth weight and gestational age: a comparative study. Journal of Psycosomatic Research 75, 87–89. Vulink, N.C., Denys, D., Bus, L., Westenberg, H.G., 2006. Female hormones affect symptom severity in obsessive-compulsive disorder. International Clinical Psychopharmacology 21, 171–175. Yonkers, K.A., Blackwell, K.A., Glover, J., Forray, A., 2014. Antidepressant use in pregnancy and postpartum women. Annual Review of Clinical Psychology 10, 369–392. Warren, S.L., Racu, C., Gregg, V., Simmens, S.J., 2006. Maternal panic disorder: infant prematurity and low birth weight. Journal of Anxiety Disorders 20, 342–352.
Contents lists available at ScienceDirect
Psychiatry Research journal homepage: www.elsevier.com/locate/psychres
Brief report
Birth weight and gestational age in newborns exposed to maternal obsessive-compulsive disorder Faruk Uguz a,n, Goksen Yuksel b, Cagatay Karsidag b, Hatice Guncu a, Murat Konak c a
Department of Psychiatry, University of Necmettin Erbakan, Meram Faculty of Medicine, Konya, Turkey Department of Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey c Department of Neonatology, University of Necmettin Erbakan, Faculty of Medicine, Konya, Turkey b
art ic l e i nf o
a b s t r a c t
Article history: Received 21 May 2014 Received in revised form 4 December 2014 Accepted 21 December 2014 Available online 23 January 2015
We examined the impact of maternal obsessive-compulsive disorder (OCD) on gestational age and birth weight of infants. The sample included 63 mothers (28 patient and 35 controls). OCD and other psychiatric diagnoses were determined with a structured clinical interview. Birth weight and gestational age were lower in the newborns exposed to maternal OCD compared to ones who were not exposed. The results suggest that maternal OCD may negatively affect fetal weight growth and gestational duration. & 2015 Elsevier Ireland Ltd. All rights reserved.
Keywords: Obsessive-compulsive disorder Birth weight Pregnancy
1. Introduction Obsessive-compulsive disorder (OCD) is a relatively frequent psychiatric disorder observed in pregnancy with prevalence rates varying from 0.2% to 5.2% (Andersson et al., 2003; Adewuya et al., 2006; Felice et al., 2007; Uguz et al., 2007; Borri et al., 2008). Previous studies have suggested that pregnancy in women may affect the onset or clinical course of OCD. According to a recent meta-analysis, pregnant women have 1.45 times greater risk of OCD compared to the general female population (Russell et al., 2013). It has been demonstrated that OCD symptoms may be aggravated in 8–46% of women during pregnancy (Labad et al., 2005; Vulink et al., 2006; Uguz et al., 2007; Forray et al., 2010; Uguz and Ayhan, 2011). Although OCD is relatively prevalent, its effects on the fetus or on neonatal outcomes are almost unknown. The available studies mostly present epidemiological or clinical findings related to OCD during pregnancy. Indeed, the studies on the influence of psychiatric disturbances on neonatal outcome are primarily focused on depression and not anxiety disorders, which are more frequently observed in pregnant women (Borri et al., 2008; Uguz et al., 2010). However, several studies have suggested that general stress or anxiety and panic disorder are associated with smaller birth weight and preterm birth (Rondo et al., 2003; Warren et al.,
n Correspondence to: Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, Psikiyatri Anabilim Dalı Akyokuş, 42080, Konya, Turkey. Tel.: þ90 332 223 6306. E-mail address: [email protected] (F. Uguz).
http://dx.doi.org/10.1016/j.psychres.2014.12.063 0165-1781/& 2015 Elsevier Ireland Ltd. All rights reserved.
2006; Bánhidy et al., 2006; Uguz et al., 2013). On the other hand, low birth weight and preterm birth are highly associated with increased risk of neonatal mortality, neonatal morbidity and poor neurodevelopmental outcome (Stephens and Vohr, 2009; Yonkers et al., 2014; Malin et al., 2014). Additionally, most of studies examining effects of depression or anxiety on fetus did not exclude comorbidity between depression and anxiety disorders. For this reason, in the present study, we aimed to examine whether there is an effect of maternal OCD without comorbidity with anxiety disorders and depression during pregnancy on gestational age and birth weight.
2. Methods This cross-sectional study was conducted among in the postpartum period up to 12 weeks. The study sample included 28 women with OCD who were admitted to the Psychiatry Clinic of Meram Faculty of Medicine of Necmettin Erbakan University in Konya, Turkey and Perinatal Mental Health Outpatient Clinic of Bakırkoy Mental and Neurological Diseases Research and Training Hospital in Istanbul, Turkey. These patients had obsessive-compulsive symptoms which meet diagnostic criteria for OCD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association, 1994) during pregnancy and postpartum period. The study sample also included 35 healthy women who were admitted to the Neonatology Outpatient Clinics of Meram Faculty of Medicine of Necmettin Erbakan University for routine care of her infants and without any psychiatric diagnosis during their pregnancy. Maternal age of at least 18 years and voluntary participation were the inclusion criteria for the study. Exclusion criteria for the study were as follows: (1) a history of medical illnesses (e.g., endocrine abnormalities, cardiovascular and pulmonary system diseases, neurological disease and metabolic disease) or pregnancy related complications (e.g., gestational hypertension, imminent abortion, placenta previa
F. Uguz et al. / Psychiatry Research 226 (2015) 396–398
and other placental abnormalities, vaginal bleeding, and gestational diabetes), (2) any fetal malformation in the baby, (3) a maternal infection that can negatively affect fetal growth (toxoplasma, rubella, cytomegalovirus, herpes simplex, mycoplasma, chlamydia), (4) a history of bipolar affective disorder, schizophrenia or related psychotic disorders, (5) smoking or alcohol consumption during pregnancy, (6) the existence of comorbidity between depressive and anxiety disorders and (7) to have received any psychiatric treatment during their pregnancy for any psychiatric diagnosis. Initially, the objectives and procedures of the study were explained to all participants, and written informed consent forms were obtained. After the data on the sociodemographic characteristics and obstetrical features were recorded in the outpatient clinics, psychiatric interviews by means of the Structured Clinical Interview for DSM-IV (SCID-I) (First et al., 1997) were carried out. Psychiatric interviews were carried out by investigators blinded to the gestational age at delivery and birthweight of the newborn. Birth weight was obtained from the hospital records and from reports by the mother. The data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 16.0, for Windows. Chi-square test was used to compare categorical and continuous variables between data in the study. For comparisons of continuous variables which exhibit normal and abnormal distribution between the study groups, we carried out t test and Mann–Whitney U test, respectively. All significance levels were 2-tailed and set at the level of 0.05.
3. Results The mean age of the participants (n¼63) was 29.1274.68 years. Almost all of the women (98.4%) were married, 31 (49.2%) had completed primary school and 51 (81.0%) were unemployed. The mean number of children was 1.5271.11, and the mean duration of gestation at delivery was 38.9671.77 weeks. The proportion of primiparous women was 30.2% (n¼19). There was no significant difference between the study groups in terms of age (P¼ 0.238), education (P¼ 0.449), marital status (P¼ 0.444), employment status (P¼ 0.343), economical level (P¼0.711), primiparity (P¼ 0.421), gender of baby (P¼0.804) and delivery type (P¼ 0.612). Two (7.14%) of the patients reported the onset of OCD during the pregnancy whereas the other patients reported the existence of OCD prior to their pregnancy. Of the women with OCD, five (17.9%) gave birth to an infant with low birth weight (o2500 g), and four (14.3%) had preterm delivery (o 37 weeks gestation). These numbers were 1 (2.9%) and 1 (2.9%) in the control group, respectively. The chi-square test did not reveal a significant difference between the study groups (P ¼0.162 and P¼ 0.080). In contrast, the statistical analyses comparing continuous variables between the groups demonstrated that newborns of women with OCD had statistically significant lower birth weight (3077 7466 g vs 3421 7 345 g, t¼ 3.37, P ¼0.001) and shorter gestational age (38.357 1.83 weeks vs 39.46 71.58 weeks, z¼ 2.49, P ¼0.013).
4. Discussion The present study suggests that OCD may lead to unfavorable neonatal outcomes in pregnant women. In this study, the mean gestational age and birth weight of the infants were statistically significantly lower in the mothers with OCD when compared to the mothers without OCD. On the other hand, the prevalence of preterm birth and low birth weight did not reach a statistically significant level despite approximately four-fold difference in these values between patients with OCD and healthy subjects. This could be due to the small sample size of the study groups. Few studies have examined these neonatal outcomes in pregnant women with specific anxiety disorders, and they mostly include panic disorder. Warren et al. (2006) reported lower birth weight in newborns of mothers with panic disorder compared to controls. A population-based study suggests that pregnant women with panic disorder had a shorter gestational age and higher proportion of preterm births (Bánhidy et al., 2006). Most recently, a comparative study has suggested that both major depression and
397
panic disorder in pregnant women are associated with lower birth weight and shorter gestational age compared to control women. However, panic disorder may affect these parameters more negatively compared to major depression (Uguz et al., 2013). The present study suggests that within anxiety disorders not only panic disorder but also OCD has negative influences on gestational length and fetal growth. In addition, we think that the effects of OCD on the fetus may be as important as depression. The results of this study suggest that OCD is related to a negative outcome in birth weight and gestational age. However, the following limitations of the study must be taken into account: (1) the sample size was relatively small and the study has a crosssectional design. However, to obtain patients with treatment-free OCD without comorbid depression, anxiety disorders was difficult. (2) The study design did not allow for the examination of the symptom levels of the psychiatric diagnoses during pregnancy. (3) All women were recruited from a clinical setting rather than the general population. Therefore, the sample might not be representative of the entire community. The present results should be confirmed in studies with larger sample size. Moreover, further studies should also examine whether pharmacotherapy or psychotherapy for OCD during pregnancy can have positive effects in terms of gestational age and birth weight.
Acknowledgments This research has not been supported by any commercial or non-commercial organization. In addition, the authors have no conflict of interest with any commercial or other associations in connection with submitted paper. The authors have no financial funding source supporting the article. References American Psychiatric Association, 1994. Diagnostic and Statistical Manual of Mental Disorders, fourth edition American Psychiatric Press, Washington, DC. Adewuya, A.O., Ola, B.A., Aloba, O.O., Mapayi, B.M., 2006. Anxiety disorders among Nigerian women in late pregnancy: a controlled study. Archives of Womens Mental Health 9, 325–328. Andersson, L., Sundström-Poromaa, I., Bixo, M., Wulff, M., Bondestam, K., Åström, M., 2003. Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. American Journal of Obstetrics and Gynecology 189, 148–154. Bánhidy, F., Ács, N., Puhó, E., Czeizel, A.E., 2006. Association between maternal panic disorders and pregnancy complications and delivery outcomes. Europeran Journal of Obstetrics and Gynecology Reproductive Biology 124, 47–52. Borri, C., Mauri, M., Oppo, A., Banti, S., Rambelli, C., Ramacciotti, D., et al., 2008. Axis I psychopathology and functional impairment at the third month of pregnancy: results from the Perinatal Depression-Research and Screening Unit (PNDReScU) Study. Journal of Clinical Psychiatry 69, 1617–1624. Felice, E., Saliba, J., Grech, V., Cox, J., Calleja, N., 2007. Antenatal psychiatric morbidity in Maltase women. General Hospital Psychiatry 29, 501–505. First, M.B., Spitzer, R.L., Gibbon, M., Williams, J.B.W., 1997. Structured Clinical Interview for DSM-IV Clinical Version (SCID-I/CV), D.C. American Psychiatric Press, Washington. Forray, A., Focseneanu, M., Pittman, B., McDougle, C.J., Epperson, C.N., 2010. Onset and exacerbation of obsessive-compulsive disorder in pregnancy and the postpartum period. Journal of Clinical Psychaitry 71, 1061–1068. Labad, J., Menchón, J.M., Alonso, P., Segalàs, C., Jiménez, S., Vallejo, J., 2005. Female reproductive cycle and obsessive-compulsive disorder. Journal of Clinical Psychiatry 66, 428–435. Malin, G.L., Morris, R.K., Riley, R., Teune, M.J., Khan, K.S., 2014. When is birthweight at term abnormally low? A systematic review and meta-analysis of the association and predictive ability of current birthweight standards for neonatal outcomes. BJOG 121, 515–526. Rondo, P.H., Ferreira, R.F., Nogueira, F., Ribeiro, M.C., Lobert, H., Artes, R., 2003. Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation. European Journal of Clinical Nutrition 57, 266–272. Russell, E.J., Fawcett, J.M., Mazmanian, D., 2013. Risk of obsessive-compulsive disorder in pregnant and postpartum women: a meta-analysis. Journal of Clinical Psychiatry 74, 377–384. Stephens, B.E., Vohr, B.R., 2009. Neurodevelopmental outcome of the premature infant. Pediatric Clinics of North America 56, 631–646.
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F. Uguz et al. / Psychiatry Research 226 (2015) 396–398
Uguz, F., Gezginc, K., Zeytinci, I.E., Karatayli, S., Karatayli, R., Askin, R., et al., 2007. Obsessive-compulsive disorder in pregnant women during the third trimester of pregnancy. Comprehensive Psychiatry 48, 441–445. Uguz, F., Gezginc, K., Kayhan, F., Sarı, S., Büyüköz, D., 2010. Is pregnancy associated with mood and anxiety disorders? A cross-sectional study. General Hospital Psychiatry 32, 213–215. Uguz, F., Ayhan, M.G., 2011. Epidemiology and clinical features of obsessivecompulsive disorder during pregnancy and postpartum period: a review. Journal of Mood Disorder 1, 178–186. Uguz, F., Sahingoz, M., Sonmez, E.O., Karsidag, C., Yuksel, G., Annagur, B.B., Annagur, A., 2013. The effects of maternal major depression, generalized anxiety disorder, and
panic disorder on birth weight and gestational age: a comparative study. Journal of Psycosomatic Research 75, 87–89. Vulink, N.C., Denys, D., Bus, L., Westenberg, H.G., 2006. Female hormones affect symptom severity in obsessive-compulsive disorder. International Clinical Psychopharmacology 21, 171–175. Yonkers, K.A., Blackwell, K.A., Glover, J., Forray, A., 2014. Antidepressant use in pregnancy and postpartum women. Annual Review of Clinical Psychology 10, 369–392. Warren, S.L., Racu, C., Gregg, V., Simmens, S.J., 2006. Maternal panic disorder: infant prematurity and low birth weight. Journal of Anxiety Disorders 20, 342–352.
