Obsessive-compulsive disorders (OCD)

Last Update: 04 Nov 2025

Condition

Table of content

1. What is it? 2. Why managing? 3. Non-Medical Options 4. Medications 5. Breastfeeding/ chestfeeding 6. Key Takeaways 7. Limits of Research

Welcome to our Fact Sheet on obsessive-compulsive disorder (OCD) during pregnancy and breastfeeding or chestfeeding. The information is based on current research and may evolve with new scientific knowledge. This content does not replace personalized advice your healthcare professionals.

1. What is obsessive-compulsive disorder (OCD)?

During pregnancy, it’s normal to feel many emotions and to have a lot on your mind. Whether it’s your first or fifth pregnancy, welcoming a new baby means a lot of changes and adjustments. But sometimes, the feelings and worries can become too much.

If you have repeating and intrusive thoughts that you don’t want (called obsessions) or feel like you must do something over and over to feel less worried (like washing your hands or checking things), you might be showing signs of obsessive-compulsive disorder (OCD).

OCD is a condition related to mental health that can start or become more intense during pregnancy. Sometimes, it can be hard to tell the difference between normal pregnancy worries and OCD symptoms, because both often focus on the baby. But with OCD, the fears are much stronger, and they can start to affect your daily life.

If you find it more difficult to sleep, eat, work, or enjoy life because of your unwanted thoughts or actions, avoid places or situations, or feel very anxious or upset all the time, then it’s important to talk to your healthcare team. OCD can take up a lot of time, cause you to feel alone, and lead to emotional distress. The table below shows some warning signs that can help tell the difference between normal worries and possible OCD symptoms.

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Table 1. Signs to help recognize ODC symptoms during pregnancy.

In your body	In your mind	In your actions
Skin damage or irritation from too much washing or picking (red, sore, or cracked skin, infections)	Obsessive, unwanted thoughts or images about: ● Germs, illness, or health risks (for you or baby) ● Accidentally hurting your baby, although you don’t want to ● Needing objects to be ordered, organised and symmetric in a specific way	Compulsions (repeating behaviors to feel less anxious) like: ● Washing or cleaning too much (yourself, home, baby) ● Checking things again and again (locks, stove, baby) ● Counting or repeating actions until they feel “right” ● Ordering or arranging items for symmetry (baby’s clothes, milk storage, etc.)
Sleep problems because of obsessive thoughts or need to complete rituals	Confusion or brain fog	Need for extra control in daily routines
Fatigue, exhaustion, or loss of energy	Anger or irritability (more than usual)	Asking others for reassurance all the time
Anxiety symptoms (muscle tension and aches, headaches, gastrointestinal issues, heart palpitations, short breath, etc.)	Feeling like you’re losing control or panicking	Avoiding situations, people, or places more than usual

Everyone experiences OCD differently, from one person to another, but it’s often time to seek help when your thoughts and behaviors interrupt your daily life or concern people close to you. It can be difficult to talk about mental health, even during pregnancy, but you are not alone. Your healthcare team is there to support you.

2. Why is it important to manage OCD during pregnancy?

About 1 in 50 people (2%) of the general population live with OCD. But during pregnancy and soon after birth (called the perinatal period), that number can double or triple for pregnant persons. New research also shows that fathers may also be more at risk during this period. Pregnancy, giving birth, and postpartum can trigger OCD symptoms.

People who have OCD usually know their thoughts are not real or logical. That’s why they are very unlikely to act on them. Understanding this can help them ask for support and feel better, making it easier to focus on calm and positive parenting.

Asking for help isn’t always easy. Stigma, lack of resources, and cultural barriers can make it harder to get the care you need. But it’s important to get help as early as possible during pregnancy. Early support can limit long-term repercussions and help support your well-being.

Understanding Pregnancy Risks

Research helps us estimate the risks linked to common pregnancy-related conditions. Miscarriages (loss of the baby), congenital malformations (birth defect, malformation present at birth), premature birth (before 37 weeks), and other complications can happen in any pregnancy for many reasons. This is the background risk. Research helps understand if there’s more risks possible during pregnancy when OCD is not managed compared to these background risks.

There is a growing number of studies on this topic, but most are small and focus on a limited group of participants at a time. More research is needed to fully understand the impact of OCD during pregnancy.

The table below summarises what research has found so far. These risks are relatives. Factors like age, genetics, habits, or having other medical conditions can also influence your personal risk.

Table 2. Possible risks of untreated OCD during pregnancy.

Who?	What?	What does research say?
Pregnant person	Fertility (ability to get pregnant)	The stress and anxiety associated with OCD can affect hormones and menstrual cycles, which might make it harder to get pregnant.
	Miscarriages	OCD doesn’t directly increase the risk of miscarriage. But intense stress and obsessive behaviors (like overuse of cleaning products or excessive exercise) could contribute to unhealthy habits that could affect pregnancy.
	Risky Behaviors	Some pregnant people with OCD can have more risky behaviors like skipping doctor appointments, poor eating or sleeping.
	Postpartum mental illness	Having OCD during pregnancy raises the risk of postpartum depression or anxiety.
	Bond with the baby	OCD can make it more difficult to connect emotionally with the baby.
Unborn baby	Congenital malformations	OCD itself is not a risk factor for malformation.
	Premature birth	Some studies found a slightly higher risk of giving birth early (before 37 weeks). But more studies are needed to confirm.
	Low birth weight	Some studies found a slightly higher risk that the baby will have a low birth weight (less than 5 pounds and 8 ounces [2,500 grams]). But more studies are needed to confirm.
Future child	Child development	Some research found a slightly higher risk of developing emotional and behavioral disorders later in life. We need more research to confirm.

3. What can I do to manage my OCD before taking medications?

If you’re planning a pregnancy or are already pregnant, it’s a great idea to take time to make a “mental health plan during pregnancy”, just like you prepare for childbirth. Talk with your partner or support person about how you’re feeling and what to look out for. Also include steps to take care of your mental health ready to use when you’re not feeling well. By clearly recognizing signs like obsessive thoughts, repetitive actions or changes in your mood or energy, you’ll know when and how to ask for help.

There are simple things you can do, other than medication, to reduce the chances of OCD symptoms getting worse:

Mindfulness and relaxation techniques: Practicing mindfulness, deep breathing, or meditation can reduce anxiety helping you manage obsessive thoughts without acting on them.
Keeping a routine: A regular daily schedule (like waking up, eating, resting, and going to bed at the same time) can help lower stress, keep your mind focused, and make it easier to avoid compulsions.
Avoid triggers : Notice what makes you feel more anxious or brings on OCD habits. When you know your triggers and work, you can develop strategies to lower their impact step-by-step like facing situations that cause discomfort, or practicing alternative responses.
Physical activity: Regular exercise can improve your mood and lower stress. Over time, this can also lower the severity of OCD symptoms.
Social support: Talk to family, friends, or support groups. Feeling supported makes a big difference, you don’t have to go through this alone.
Get good sleep: Rest is important. Getting enough sleep can lower your stress and make it easier to face intrusive thoughts and manage OCD symptoms.
Psychotherapy: Even just a few sessions with a mental health professional during pregnancy can help you handle complex emotions and protect both you and your baby from the effects of OCD.

If your symptoms are hard to manage or make daily life difficult, therapy is often the best support. The preferred type is often cognitive behavioral therapy (CBT), especially with a method called exposure and response prevention (ERP). This teaches you how to manage and change obsessive thoughts and compulsive behaviors effectively.

It can be easy to forget yourself during pregnancy, but remember that your mental health is just as important to your child’s health. Taking care of yourself is also a way of taking care of your baby.

Discover You, Me, Baby, a free and virtual program to support your mental health throughout your pregnancy.

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4. Medications prescribed for managing OCD

Since there is no decision that is perfectly risk-free when it comes to taking medication during pregnancy, it’s important to talk with your healthcare team and weigh the risks and benefits of treatment and the risks if the condition isn’t treated.

When OCD symptoms are severe and persistent, medication may be prescribed in combination with psychotherapy like CBT. It is the standard to treat perinatal OCD.

What does research say?

In Canada, there are several medications that can be used to treat OCD during pregnancy or while breastfeeding or chestfeeding. Most of these medications have not been linked to a higher risk of malformations, based on current research. For information about specific medication, consult the associated fact sheet.

The most common group of medications used to treat OCD is called SSRIs (selective serotonin reuptake inhibitors). You may know them as antidepressants, but they also help with OCD, and are the first line of treatment recommended. SSRIs are often preferred because they have been relatively well studied during pregnancy.

SSRIs work by helping the brain use more of a chemical called serotonin, which improves communication between brain cells and helps reduce OCD symptoms. Some people start feeling better quickly, but full effectiveness can take 4 to 6 weeks.

Table 3. Medications that can be prescribed in Canada for OCD

Medication Types	Medication Names	Brand names
Selective Serotonin Reuptake Inhibitors (SSRIs)	Citalopram, escitalopram	e.g. Celexa®, Cipralex®
	Fluoxetine	e.g. Prozac®
	Fluvoxamine	e.g. Luvox®
	Paroxetine	e.g. Paxil^®
	Sertraline	e.g. Zoloft®

How do I know which medication to take?

Each medication has its risks and benefits. Your healthcare team is best equipped to guide you in making an informed decision adapted to your personal needs.

Always discuss any changes in your medication intake with your healthcare team (pharmacist, nurse, doctor).

5. Will I be able to breastfeed or chestfeed?

Most people with OCD can still breastfeed or chestfeed if they want to. Their symptoms should not affect the baby. When you breastfeed or chestfed, your body releases oxytocin, a hormone that helps you feel calm and connected. This is why, when breastfeeding feels manageable, it can help to bond with your baby and reduce anxiety.

If you’re taking medication, breatfeeding or chestfeeding is still possible. Some SSRIs have been studied more than others in people who are breastfeeding. Among SSRIs, sertraline (Zoloft®) is often recommended if you plan to breastfeed or chestfeed. This medication has a lot of research and a reassuring safety profile in both pregnancy and while nursing. However, this medication is not suitable for all persons, and other SSRIs and most antidepressants can be used during breastfeeding as they pass in small amounts into breast milk.

But, if OCD symptoms make breastfeeding or chestfeeding too difficult, that’s okay too. You’re not alone, and there is support available. If you feel unsure or overwhelmed, talk to your healthcare provider or a lactation consultant. They can help you find ways to feel more confident and supported, whether you choose to breastfeed or not. Every time you ask for help, you’re taking a strong step forward for you and your baby.

Key Takeaways

Obsessive-compulsive disorder, also called OCD, is a mental health issue that can start or intensify during pregnancy or postpartum.
If intrusive thoughts and repetitive behaviors don’t go away and start to make daily life more difficult, it may be a sign of OCD.
If OCD is unmanaged, it can make it more difficult to take care of yourself, connect with your baby, and it may increase the risk of postpartum depression and anxiety.
Getting support early can help both the parent and the baby. It can include making a mental health plan, staying active, and seeking therapy.
Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP) is a treatment that works well for OCD.
When symptoms are severe, selective serotonin reuptake inhibitors(SSRIs) like sertraline or paroxetine might be prescribed during pregnancy or while nursing.
Always talk with healthcare professionals before starting, changing, or stopping medications.

Research Is Great, But It Is Not Perfect

Making informed health decisions also means understanding what research knows and what it cannot say. Here’s what our group of experts found about the limits of OCD research during pregnancy:

Few studies and small groups: There aren’t many studies that focus only on OCD during pregnancy, and the ones we have often include small numbers of people. This makes it hard to say if the results work for everyone.
Not much long-term research: We don’t know a lot about how OCD in pregnancy might affect the health of the parent or baby over time.
OCD looks different in everyone: People with OCD may have very different symptoms and levels of stress. This makes it hard to compare cases and find clear answers.
Pregnancy affects symptoms: Hormones, stress, and sleep changes during pregnancy can make OCD symptoms stronger, and it’s hard to know what’s caused by pregnancy and what’s caused by OCD.
Not enough research on treatments: There is still very little research on which treatments for OCD are safe and work well during pregnancy, so we don’t always have clear plans.

These gaps show why more research is needed to better understand OCD during pregnancy and how to treat it safely and effectively.

For more information, feel free to consult our associated resources and additional references:

References

Vigod SN, Frey BN, Clark CT, Grigoriadis S, Barker LC, Brown HK, et al. Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders: Guide de pratique 2024 du Canadian Network for Mood and Anxiety Treatments pour le traitement des troubles de l’humeur, des troubles anxieux et des troubles connexes périnatals. Can J Psychiatry. 2025; 70(6):429-89. doi: 10.1177/07067437241303031.
Shea A, Jumah NA, Forte M, Cantin C, Bayrampour H, Butler K, et al. Identification and Treatment of Perinatal Mood and Anxiety Disorders. J Obstet Gynaecol Can. 2024;46(10):102697. doi: 10.1016/j.jogc.2024.102696. Epub 2024 Oct 16. PMID: 39424138.
Araújo A, Macedo A, Azevedo J, Xavier S, Soares MJ, Cabaços C, et al.. The Prenatal Obsessive-Compulsive Scale: Psychometric and descriptive study in a Portuguese sample. J of Obsessive-Compulsive and Related Disorders, 2021;29, Elsevier BV doi:10.1016/j.jocrd.2021.100638
Buchholz JL., Hellberg SN., and Abramowitz, Jonathan S. Phenomenology of perinatal obsessive–compulsive disorder. Biomarkers of Postpartum Psychiatric Disorders, Elsevier (2020) doi:10.1016/B978-0-12-815508-0.00006-0
Challacombe FL, Bavetta M, DeGiorgio S. Intrusive thoughts in perinatal obsessive-compulsive disorder. BMJ. 2019;367:I6574 doi:10.1136/bmj.I6574
Fernández de la Cruz L, Joseph KS, Wen Q, Stephansson O, Mataix-Cols D, Razaz N. Pregnancy, Delivery, and Neonatal Outcomes Associated With Maternal Obsessive-Compulsive Disorder: Two Cohort Studies in Sweden and British Columbia, Canada. JAMA Netw Open. 2023;6(6):e2318212. doi:10.1001/jamanetworkopen.2023.18212
Lord C, Rieder A, Hall GB, Soares CN, Steiner M. Piloting the Perinatal Obsessive-Compulsive Scale (POCS): development and validation. J Anxiety Disord, 2011;25(8): 1079-84. doi: 10.1016/j.janxdis.2011.07.005
Lord C, Steiner M, Soares CN, Carew CL, Hall GB. Stress response in postpartum women with and without obsessive–compulsive symptoms: an fMRI study. Journal Psychiatry Neurosci. 2012;37(2):78-86. doi:10.1503/jpn.110005
Mattina GF, Slyepchenko A, Steiner M. Obsessive–compulsive and related disorders. Handb Clin Neurol. 2020;175:369-86. doi:10.1016/B978-0-444-64123-6.00025-4
Miller ML, Roche AI, Lemon E, O’Hara MW. (2022). Obsessive–compulsive and related disorder symptoms in the perinatal period: prevalence and associations with postpartum functioning. Arch Womens Ment Health.2022;25(4):771-80. doi:10.1007/s00737-022-01239-3
Sharma V, Mazmanian D. Are we overlooking obsessive-compulsive disorder during and after pregnancy? Some arguments for a peripartum onset specifier. Arch Womens Ment Health. 2021;24(1):165-8.doi:10.1007/s00737-020-01038-8
Starcevic V, Eslick GD, Viswasam K, Berle D. Symptoms of Obsessive-Compulsive Disorder during Pregnancy and the Postpartum Period: a Systematic Review and Meta-Analysis. Psychiatric Q. 2020;91(4):965-81. doi:10.1007/s11126-020-09769-8

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