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Abstract

Background: Obsessive-compulsive disorder (OCD) is an anxiety-related mental health condition characterized by unwanted, intrusive thoughts (obsessions), and repetitive behaviours (compulsions). OCD is experienced by as many as 17% of postpartum gestational people, with obsessional content frequently involving distressing thoughts of harm related to one’s newborn. OCD is associated with sleep disturbances in non-perinatal populations. Despite the common occurrence of poor perinatal sleep, there are no published studies of perinatal sleep predicting postpartum OC symptoms. The purpose of this research is to assess reduced perinatal sleep quality as a predictor of postpartum OCD. Methodology: This research utilizes data from a prospective cohort study of pregnant people in the province of British Columbia. Questionnaires and interviews were administered once during pregnancy (33 weeks) and twice postpartum (9 weeks and 20 weeks), and assessed sleep quality, symptoms, and diagnostic status of OCD. Linear regression and mixed-effects models explored the predictive ability of sleep on postpartum OC symptoms. Mann-Whitney U Tests were conducted to analyze differences in concurrent sleep quality based on OCD diagnosis and the experience of thoughts of intentional infant-related harm. Results: In final models, poor prenatal sleep quality remained a moderate predictor of more severe postpartum OC symptoms across regression (β = 0.12, 95% CI [0.03, 0.21], p =.01; β = 0.14, 95% CI [0.01, 0.27], p = .04) and mixed-effects models (β = 0.23, 95% CI [0.03, 0.43], p = .02). Birthing individuals meeting criteria for postpartum OCD experienced significantly poorer concurrent sleep quality at both postpartum timepoints (Z = -2.03, p = .04; Z = -2.09, p = .04), although only participants experiencing UITs of intentional harm in the later postpartum experienced worse concurrent sleep quality (Z = -4.21, p