Denial Of Pregnancy Research Articles

Oncological Disease and Pregnancy Denial: Psychological Support and Interdisciplinary Collaboration

In the following casuistry, a denied advanced pregnancy was discovered during the diagnosis of an oncological disease. Faced with a life-threatening condition, the patient urged late termination of the pregnancy and was introduced to psychological counselling in order to find a viable and ethically justifiable solution. Strategies for crisis intervention and supportive approaches in the patient's care as well as interdisciplinary collaboration are presented and discussed.

Des enjeux psychologiques et sociaux de femmes auteures d’un néonaticide : solitude, déni de grossesse et fragilités de la personnalité

This interview between professors Jean-Pierre Bouchard and Suzanne Léveillée focuses on the psychosocial issues of women who have undergone neonaticide. This type of intrafamilial homicide is particularly difficult to understand and the number of cases is almost impossible to determine. These women give birth in secret, and the people around them had not observed their physical change. A psychosocial portrait is drawn up and some elements of understanding are highlighted in this text. The denial of pregnancy, the extreme loneliness of these women and mental health issues allow us to better understand them. Clinical vignettes are developed to identify some elements of these women's life trajectories as well as to set out some avenues for prevention.

Negación psicótica del embarazo. Reporte de caso

Denial of pregnancy is a rare, potentially dangerous disorder that can be divided into two variants: psychotic and nonpsychotic. Psychotic denial of pregnancy is typically accompanied by a history of mental illness. Negative effects include psychological distress, unsupported births outside of hospital, and a potential rise in mother and newborn morbi-mortality. It is crucial to include a personal and/or family history of psychopathology as part of the anamnesis because this condition should be treated by a psychiatrist. Regarding the management of this disorder during pregnancy or puerperium, there are no specific recommendations. To provide comprehensive care, a multidisciplinary approach is typically required. A case of psychotic denial of pregnancy is presented. Keywords: Psychotic denial of pregnancy, Pregnancy denial, Mental illness, Psychiatry, Mental health.

Ethical challenges in the treatment of psychotic pregnancy denial.

There is a paucity of literature regarding ethical strategies for treating pregnant people with psychosis. While not uncommon, psychotic pregnancy denial is a psychotic illness in which patients have the delusion that they are not pregnant. The authors provide a literature review regarding psychotic pregnancy denial, present an unpublished case and its questions and dilemmas, and offer recommendations for resolving the ethical challenges these cases raise. A 26-year-old, single, unemployed woman of no fixed residence was admitted for suicidal ideation. She had a history of psychosis, had multiple ER visits and at least one previous hospitalization, had minimal contact with psychiatric outpatient clinics, and had been poorly compliant with treatment recommendations. She was discovered to be about 31 weeks pregnant in the emergency room. Ultrasound exams revealed no fetal anomalies. This was the patient's second pregnancy; her previous pregnancy resulted in an abortion. Her sole psychotic symptom was the delusional belief that she was not pregnant. On the rare occasions when the patient acknowledged being pregnant, she requested termination of pregnancy. Despite intensive pharmacological treatment of her psychosis, the patient continued believing that she was not pregnant and repeatedly said she would not participate in the labor and delivery process. She disagreed with the induction of labor or a cesarean section if needed. The patient developed gestational hypertension, an obstetric indication for delivery. Induction of labor was offered to avoid potentially disastrous outcomes for the pregnant woman and the fetus. Psychotic pregnancy denial is potentially life-threatening. Delivery of the fetus requires carefully weighing risks and benefits and thoroughly considering the ethical framework. Treatment of birthing people with psychotic denial of pregnancy is complex; it requires special clinical and ethical skills to determine the patient's level of decision-making impairment and to find a middle ground between the pregnant person's right to autonomy and the physicians' beneficence-based duties. Using a well-coordinated, interdisciplinary approach and a solid ethical framework, the decision to deliver the fetus while engaging the pregnant person, to the extent possible, in the decision-making process is essential.

Navigating antenatal care: The lived experiences of adolescent girls and young women and caregiver perspectives in Zambia.

Adolescent pregnancy remains a global concern, especially in low- and middle-income countries. Sub-Saharan African nations, including Zambia, bear a disproportionate burden of adolescent pregnancies, contributing to high rates of maternal and child mortality. Despite efforts to improve antenatal care (ANC) services, utilization rates remain suboptimal, especially among adolescent girls and young women (AGYW). To explore the barriers and facilitators to ANC services among AGYW and how these factors might differ by age and HIV status. This qualitative study employs a combination of in-depth interviews (IDIs) and focus group discussions (FGDs) to gather comprehensive insights into the experiences of AGYW regarding ANC services. The study design follows a socio-ecological framework (SEF) to identify multiple levels of influence on ANC utilization. We conducted 40 IDIs with AGYW aged 15-24; and 2 FGDs with caregivers of AGYW (n = 16). IDIs explored AGYWs barriers and facilitators to accessing and utilizing healthcare services during pregnancy, as well as social support and HIV treatment and prevention. FGD topics included social support, barriers and facilitators to ANC, and HIV services. We developed a codebook based on the SEF and coded transcripts using Dedoose software. Results showed that early pregnancy knowledge did not always translate to AGYW seeking ANC services right away or within the first trimester. More than half of the AGYW did not initiate ANC until well into the second trimester. Factors including lack of motivation, denial of pregnancy, desires to terminate pregnancies, social norms, policies, clinic environment, and financial constraints contributed to delays in ANC initiation. Social support from family, partners, peers, and the community were crucial motivators for early ANC. Lastly, challenges to ANC continuation included lack of transportation, long clinic waiting times, perceived provider indifference, and stigma at both community and clinic levels. In conclusion, gaining insights from qualitative data is essential for comprehensively understanding the barriers and challenges to accessing ANC among this specific age group. By identifying and addressing these barriers while enhancing facilitators, effective programs can be developed and implemented to improve the health and well-being of young mothers and their children.

Midwives' Voices on Early Initiation of Antenatal Care Following a Positive Gravindex Test: A Qualitative Study.

Early Antenatal Care (ANC) initiation is aimed at improving maternal and perinatal health outcomes through the identification of complications and determining the level of care needed. This study aimed to determine the voices of midwives on the provision of early initiation of ANC following positive gravindex. The phenomenology approach underpinned the study. The participants included midwives providing ANC at health facilities under Tshino-Mutsha local area in May-December 2020. Nonprobability, purposive sampling was used to select four clinics and to sample 20 midwives. Semistructured face-to-face, in-depth interviews were conducted using an interview guide. Data saturation was reached at Participant 15; however, the researcher continued until Participant 20. Trustworthiness was ensured and ethical principles were adhered to. Data analysis was done using Tesch's open coding approach. Two themes and seven subthemes emerged, as challenges related to the provision of midwifery practice and to pregnant women. The seven subthemes were the shortage of resources, poor support of midwives, poor adherence to the available protocol for the provision of ANC, blaming of midwives by management and community, late ANC booking by pregnant women, denial of pregnancy by young women ignorance leading to a general resistance to ANC instructions, hence late booking. It was concluded that shortage of human and material resources hindered the initiation of early ANC to detect, prevent, and manage the existing and potential causes of maternal and newborn mortality and morbidity.

Discovering a pregnancy after 30 weeks: a qualitative study on explanations for unperceived pregnancy

“Unperceived pregnancy” names the phenomenon when a person becomes pregnant unintentionally and is not aware of being pregnant. Scientific explanations are roughly based on two hypotheses: psychological and physiological. We aim to gain a better understanding of unperceived pregnancy by studying the perspectives of people who experienced an unperceived pregnancy and obstetric professionals. Seventeen semi-structured interviews were conducted: eight with women who had experienced an unperceived pregnancy (≥30 weeks’ gestation), six with midwives, and three with gynecologists. Our findings show that women’s explanations for not noticing their pregnancy center around the absence of pregnancy symptoms. The failure to recognize more subtle signs of pregnancy was enforced by inattention, physical distractions, and psychological factors. In contrast, psychological explanations are dominant among obstetric professionals. Our study demonstrates a discrepancy in the explanations provided by women who had experienced an unperceived pregnancy and obstetric professionals. Potentially, this could result in people being unheard and misunderstood. We recommend that future research moves beyond a focus on “denial of pregnancy” to consider both psychological and physiological factors, and how these could potentially interrelate. This broadened approach will enhance our understanding of unperceived pregnancy and can contribute to improved counseling by obstetric professionals.

Clinical management of psychotic pregnancy denial: what do we know? Case report and narrative review.

IntroductionDenial of pregnancy is the lack of awareness of being pregnant. It associates with increased morbidity and mortality of mother and child and can be classified as non-psychotic or psychotic. There is few literature regarding the latter, making it difficult to recognize, let alone to treat, since we do not have robust data on the incidence nor approved interventions.ObjectivesTo get a better understanding on the standard of care for patients with psychotic denial of pregnancy.MethodsWe present a case report alongside a narrative literature review on the topic.ResultsWe report the case of a 39-year-old caucasian woman, foreign, undomiciled, who was admitted to a Psychiatry unit due to psychotic symptoms. Her birthplace and prior medical records were unknown. She did not recognize being pregnant and showed great irritability when asked; her responses ranged from delusional attributions of symptoms related to the pregnancy to partially acknowledging her state but refusing to answer questions. Obstetric ultrasound revealed a low risk 35 weeks pregnancy. Treatment included quetiapine up to 700mg daily and psychological approach. A multidisciplinary team managed the case and arranged a plan for delivery. Eventually, delusional symptoms remitted and she accepted the gestation. She showed full collaboration during delivery, giving birth to a healthy female and presented transient recovery. After being separated from her daughter, her clinical situation worsened.Psychotic denial of pregnancy is rather uncommon. It is usually seen in patients with prior history of major mental illness, most frequently schizophrenia, and important psychosocial vulnerability. It associates with several negative outcomes for mother and baby, including neonaticide. Most studies agree on the need of a multidisciplinary intervention including obstetrics, psychiatry, and others (social agents, ethical consultants…) to generate a plan for mother and baby. Biopsychosocial aspects should always be considered and each case individually formulated. Pregnant women must be given clear and concise information about the process. For some, seeing obstetric ultrasound might help them accept the pregnancy. Some authors propose labour induction prior to 39 weeks and performing a C-section, especially in cases of uncontrolled psychosis or risk of noncompliance. Most studies also recommend antipsychotic treatment. In cases of persistent denial or acute crisis, especially during the third trimester, patients should be admitted to a psychiatry unit with easy access to obstetric care. Supportive psychotherapy and psychosocial intervention should try to identify precipitating stressors for denial, such as prior or anticipated custody loss, which has been linked to psychotic denial.ConclusionsPsychotic denial is a serious illness which requires a multidisciplinary treatment including biopsychosocial and obstetrical aspects.Disclosure of InterestNone Declared

Denial of pregnancy and neonaticide: A historical overview and case report

While denial of pregnancy and neonaticide are rare, they are potentially associated and share some risk factors. Neonaticide has been proposed as the extreme outcome of a denial of pregnancy. However, the process leading to such a possible outcome is not yet fully understood. The primary goal of this essay is to examine the various definitions and ambiguities surrounding the denial of pregnancy. The case of a young woman with a history of two denied pregnancies with diverse characteristics and outcomes, the latest of which resulted in neonaticide, is then reported and examined. A forensic psychiatric evaluation was also performed to reconstruct the woman's mental state at the time of the crime. The forensic pathological analysis of the newborn, abandoned near the sea while still alive, is described. The victim's body showed signs of shaken baby syndrome. We contend that differing levels of awareness during a denial of pregnancy might not be predictive of the potential delivery outcome in terms of threat to the newborn's survival, according to the forensic pathological and psychopathological data of the current case. Early identification of women affected by denial of pregnancy who pose a danger of committing infanticide is hampered by both intrinsic traits (dissimulation, unawareness, low propensity to seek assistance) and environmental factors (isolation, low socioeconomic level, poor education.). A previous history of denial of pregnancy should activate health and support services to reduce the potential risks for the mother and the child.

Maternal-Fetal Pregnancy Complications of in Minors Raped with or without Physical Restraint in Eastern Democratic Republic of Congo

Introduction: Pregnancy resulting from rape is a public health and sexual and reproductive health issue, especially among minors. Rape can be perpetrated with or without physical restraint. The objective of the present study is to highlight the prevalence of physical coercion leading to pregnancy and the associated maternal-fetal complications. Methodology: This was a comparative descriptive and analytical cross-sectional study of complications associated with post-rape pregnancy by physical restraint among minors who were treated at the General Reference Hospital of Panzi over a two-year period from June 2020 to June 2022. A total of 140 minor survivors of violence with pregnancy were included in the study. Data were collected using a questionnaire, coded and analyzed in Excel and XLSTAT version 2014. Results: The prevalence of physical constraints was 65%. After mulltivariate analyses, denial of pregnancy (ORa: 9.64 95% CI: 1.1 - 81.2; p-value: 0.0370), attempted abortion (ORa: 56.1 95% CI: 1.5 - 2027.6; p-value: 0.0278) and agitation during delivery (ORa: 88.7 95% CI: 4.5 - 1715; p-value: 0.0030) were the complications associated with pregnancy in minors who experienced physical restraint rape. In addition, BMI was a factor in reducing the risk of physical restraint rape at the ORa of 0.5054 [0.3; 0.8]; p 0.006). Conclusion: Pregnancy among minors is a reality and occurs in a situation of physical coercion in the eastern Democratic Republic of Congo. These pregnancies are often associated with complications that require an intensive management system since they can jeopardize the maternal-fetal prognosis of minors.

A case report of adolescent pregnancy denial in which an unsuspected labour in a hotel room resulted in a near miss

A case report of adolescent pregnancy denial in which an unsuspected labour in a hotel room resulted in a near miss

Cerveau maternel : Théorie bayésienne de l’intéroception maternelle pendant la grossesse et le postpartum

The perinatal period, including pregnancy and postpartum, causes major morphological, endocrinal, and thermal transitions in women. As the fetus grows, abdominal muscle fibers stretch, internal organs such as the bladder or colon move, and the uterine anatomy changes. Many of these changes involve interoception, the perception of internal body signals such as muscle and visceral sensations. Despite the importance of these interoceptive signals, few studies have explored perinatal interoception. We propose an innovative theory of maternal interoception based on recent findings in neuroscience. We show that interoceptive signals processing during pregnancy is crucial for understanding perinatal phenomenology and psychopathology, such as maternal perception of fetal movements, maternal-infant bonding, denial of pregnancy, phantom fetal movements after childbirth, pseudocyesis or even puerperal delusion. Knowing the importance of these interoceptive mechanisms, clinicians in obstetrics, gynecology and mental health should be particularly vigilant to maternal interoception during the perinatal period.

Denial of pregnancy: a review

IntroductionDenial of pregnancy is a condition that the pregnant woman is not aware that she is pregnant. It appears in one in every five hundred pregnancies, approximately. Women who present denial of pregnancy do not usually present comorbidity with another psychiatric pathology, although dependent personality traits, low self-esteem, loneliness and poor communication with the partner have been described as features among patients.ObjectivesThe objective of this work is to present the current information on the denial of pregnancy.MethodsA review about denial of pregnancy.ResultsDenial of pregnancy can be classified as psychotic denial (the woman may misinterpret the symptoms and physical changes of pregnancy, usually in strange ways. These people do not hide their pregnancy and those around them are often aware of the situation) or non-psychotic (the patient has the judgment of reality preserved). Non-psychotic denial can be affective: (the woman intellectually recognizes that she is pregnant but does not experience the emotional or behavioral changes that usually occur. This type of denial is related to feelings of detachment from the baby) or generalized (occurs when the The woman not only does not suffer the emotional changes of pregnancy, but also does not know the existence of pregnancy itself. Weight gain, amenorrhea and other changes inherent to this state may not be present or be misinterpreted. It may be that neither the family nor the environment realizes the pregnancy and then there is a collective denial of the pregnancy.)ConclusionsResearch and prevention of perinatal pathology should be a priority.DisclosureNo significant relationships.

Characteristics of Perpetrators of Neonaticide

Authors: Klier CM, Amon S, Fernandez Arias P Introduction Denial of pregnancy the most important risk factor for neonaticide and is a frequent pregnancy associated disorders. It occurs more often than placenta previa or uterus rupture. Wessel found that 1 in 475 women deny pregnancy, but a new study by Simermann even found a higher prevalence of 1:300. We studied how women face their reproductive potential before the denied pregnancy occurs. Moreover pregnancy variables in this group were compared to Austrian population data. Methods In total, there were 69 neonaticide victims between 1995 and 2017. We analysed 55 neonaticide cases, committed by 48 perpetrators, whereas 4 of them were repeated perpetrator and responsible for 11 cases. We also included three cases of suspected neonaticides, whereas later the coroner identified a natural cause of death. The datasheet contains 553 variables, all cases were code by one rater SA. Specifically we looked at the following variables: method of contraception, partner’s interest in contraception, abortion, evidence of pregnancy, motives of pregnancy negation, pregnancy symptoms, prenatal care, awareness of environment, living situation during pregnancy and at birth, immediate reaction to birth Results We found a high percentage of women who did not use contraception (53%), specifically when compared to the percentages of the Austrian population data from a recent survey (26%). When the contraceptive methods were looked at, women in the neonaticide group did practically not use any method with a pearl index of <4, in comparison to 20% in the general population. A high adolescent birth rate (47%) could be shown in comparison to the population (3%). Conclusions It needs further research to find out how denial of pregnancy and reproductive potential are connected and if the reasons for denial of pregnancy are the precursors of the reproductive denial also.DisclosureNo significant relationships.

A systematic review of the qualitative literature on barriers to high-quality prenatal and postpartum care among low-income women.

To examine the qualitative literature on low-income women's perspectives on the barriers to high-quality prenatal and postpartum care. We performed searches in PubMed, Web of Science, Embase, SocIndex, and CINAHL for peer-reviewed studies published between 1990 and 2021. A systematic review of qualitative studies with participants who were currently pregnant or had delivered within the past 2 years and identified as low-income at delivery. Two reviewers independently assessed studies for inclusion, evaluated study quality, and extracted information on study design and themes. We identified 34 studies that met inclusion criteria, including 23 focused on prenatal care, 6 on postpartum care, and 5 on both. The most frequently mentioned barriers to prenatal and postpartum care were structural. These included delays in gaining pregnancy-related Medicaid coverage, challenges finding providers who would accept Medicaid, lack of provider continuity, transportation and childcare hurdles, and legal system concerns. Individual-level factors, such as lack of awareness of pregnancy, denial of pregnancy, limited support, conflicting priorities, and indifference to pregnancy, also interfered with the timely use of prenatal and postpartum care. For those who accessed care, experiences of dismissal, discrimination, and disrespect related to race, insurance status, age, substance use, and language were common. Over a period of 30 years, qualitative studies have identified consistent structural and individual barriers to high-quality prenatal and postpartum care. Medicaid policy changes, including expanding presumptive eligibility, increased reimbursement rates for pregnancy services, payment for birth doula support, and extension of postpartum coverage, may help overcome these challenges.

The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States

The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States

Total Denial of Pregnancy: A Case Report

About a case of denial of pregnancy, the authors report that it can recur and that a preventive follow-up should be instituted to avoid its recurrence.

La grossesse invisible : caractéristiques cliniques et perspectives autour du déni de grossesse

Denial of pregnancy is a public health problem due to maternal, fetal, and neonatal morbidity, affecting both physical and mental health. It generally involves an absence of the physical signals associated with pregnancy such as abdominal swelling, amenorrhea, weight gain, or even perception of fetal movements. Despite the potential consequences for mother and child, there is still little data on its clinical features and the neurocognitive mechanisms involved. In this paper, we provide an update on the clinical, socio-demographic, and psychopathological characteristics of pregnancy denial based on contemporary scientific literature. We first define denial of pregnancy by referring to the history of the concept, previous definitions, and nosographic classifications. We then detail the clinic of denial by distinguishing the physical and psychological symptoms of this disorder, then the socio-demographic, gynecological, and psychiatric characteristics. We describe the consequences of denial on the mother, infant, and the dyad, referring to situations of cryptic neonaticide. Finally, we show the importance of perinatal neuroscience research on maternal interoception to understand the mechanisms involved in denial of pregnancy, and improve their medical management in clinical practice.

Pregnancy denial: a complex symptom with life context as a trigger? A prospective case-control study.

ObjectiveTo identify risk factors for a woman to experience pregnancy denial.Design, setting and populationA French multicentric prospective case–control study with 71 mother–infant dyads having experienced a pregnancy denial versus a control group of 71 dyads.MethodsData were collected in the week after delivery using an observational leaflet and two psychiatric scales (MINI and QSSP).Main outcome measuresStatistically significant differences between the two groups regarding social, demographic, medical and psychiatric data.ResultsNot being in a stable relationship (odds ratio [OR] 17.18, 95% CI 3.37–87.60]; P < 0.0001), not having a high school diploma (OR 1.11, 95% CI 1.04–1.38]; P < 0.0001) and having a psychiatric history (OR 6.33, 95% CI 1.62–24.76; P = 0.0002) were risk factors to experience pregnancy denial, whereas being older was a protective factor (OR 0.86, 95% CI 0.79–0.93; P = 0.0054) (logistic regression, Wald 95% CI). Other risk factors included late declarations of pregnancy history and past pregnancy denials (case n = 7, 9.7% versus 0% in controls; P = 0.01), past pregnancy denials in the family (case n = 13, 18% versus control n = 4, 5.6%; P = 0.03), and use of a contraceptive method (75% for cases versus 7% in control; P < 0.0001), primarily an oral contraceptive (75%).ConclusionFamily or personal history of pregnancy denial should be part of the systematic anamnesis during the first visit of a patient of child‐bearing age. Further, our study points out that life context (young age, single status, socio‐economic precarity, pill‐based contraception) could be a trigger for pregnancy denial in certain women.Tweetable abstractLife context can be a trigger for pregnancy denial.

Towards a new understanding of pregnancy denial: the misunderstood dissociative disorder

Pervasive pregnancy denial is a misunderstood reproductive anomaly which compromises the health of both mother and the developing fetus. Because in extreme cases, the death of the neonate at the hands of his/her mother has criminal repercussions, research has attempted to explain the origins of this clinical phenomenon. The purpose of this review is to analyze the evolution of understanding the association between pregnancy denial and neonaticide. This paper identifies the consistent similarities in symptom presentation, particularly dissociation, when a denied pregnancy ends with the death of the newborn. The common thread across the progression of the literature over time serves as a foundation for considering the development of diagnostic criteria for future inclusion in the Diagnostic and Statistical Manual of Mental Disorders. This paper reviews the seminal research from 1969 to current research up to 2020 addressing pregnancy denial and its connection to neonaticide. Peer reviewed and published articles related to key terms around "pregnancy denial," "pregnancy concealment," "neonaticide," and "dissociation" were retrieved from major databases such as PubMed, PsychINFO, JSTOR, ProQEST, ScienceDirect, and Google Scholar. Reference lists of relevant articles were also scanned to search for further papers pertaining to similarities in symptom presentation across demographic profiles. Papers were excluded if they were not available in English, or if they did not contribute to identifying consistencies in clinical presentation when a pregnancy is denied. There are clear repetitive markers that occur across studies which pertain not only to the frequent absence of certain expected indicators of pregnancy, (i.e. no morning sickness, weight gain, or sensations of fetal movement), but also the misattribution of pregnancy-related symptoms, and the consistent experience of a dissociative episode while giving birth that can unintentionally result in neonaticide. This paper concludes that dissociation is a consistently seen symptom in pervasive pregnancy denial. Dissociation, in addition to other commonly seen symptoms across cases, suggests specific diagnostic criteria that lend themselves to inclusion in the Diagnostic and Statistical Manual of Mental Disorders.