Prenatal obsessive beliefs predict postpartum obsessive-compulsive symptoms: a prospective study

Jonathan S Abramowitz; Samantha N Hellberg; Janice Krasnow; Joseph B Friedman; Nicholas S Myers; Paul S Nestadt; Heidi J Ojalehto; Emily K Juel; Jack Samuels; Mary E Kimmel; Lauren M Osborne; Eric A Storch; Gerald Nestadt; Rashelle J Musci

doi:10.1016/j.psychres.2025.116620

Prenatal obsessive beliefs predict postpartum obsessive-compulsive symptoms: a prospective study

Psychiatry Res. 2025 Jun 30:351:116620. doi: 10.1016/j.psychres.2025.116620. Online ahead of print.

Affiliations

¹ Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: jabramowitz@unc.edu.
² Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
⁵ Department of Obstetrics and Gynecology and Department of Psychiatry, Weil Cornell Medical College, NY, NY, USA.
⁶ Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
⁷ Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.

PMID: 40628003
DOI: 10.1016/j.psychres.2025.116620

Abstract

This longitudinal study examined whether specific cognitive patterns during pregnancy predict postpartum obsessive-compulsive (OC) symptoms. A diverse sample of 256 women was assessed at 20 weeks of pregnancy (Time 1), 6 weeks postpartum (Time 2; n = 233), and 6 months postpartum (Time 3; n = 231). At each point, participants completed interview and/or self-report measures of OC symptoms, psychological distress, and obsessive beliefs (i.e., cognitive patterns related to OC symptoms). Postpartum OC symptoms were common, reported by 87.1 % at Time 2 and 74.5 % at Time 3. Stronger prenatal obsessive beliefs during pregnancy predicted greater postpartum OC symptom severity and higher likelihood of an OCD diagnosis at Time 3, even after controlling for baseline OC symptoms and distress. Findings highlight the clinical importance of prenatal cognitive risk factors and support cognitive-behavioral models of postpartum OCD.

Keywords: Cognitive-behavioral model; Intrusive thoughts; Longitudinal study; Obsessive beliefs; Postpartum OCD.