Some women do not realise, or cannot accept, that they are pregnant until late in pregnancy or even until they go into labour. Pregnancy denial can be frightening and confusing for mothers and carries risks for babies who miss out on antenatal care. Yet little is known about which women are most vulnerable, and a new French study offers some clues.
Researchers at Reims University Hospital and nine other hospitals across France compared mothers who had experienced pregnancy denial with mothers who had not. The findings appear in BMC Psychology. The study recruited 71 women whose pregnancy was discovered after 20 weeks and 71 women without denial between 2013 and 2019, and 70 of them were assessed again about eight weeks after giving birth.
At that visit, mothers completed questionnaires on depression and anxiety, a screening interview for personality traits and a storytelling task that reveals attachment style. Attachment style describes the mental model a person forms in childhood about whether others can be relied on for comfort, and it tends to shape close relationships in adult life. People with a secure style generally trust that help will come when they need it.
Mothers who had denied their pregnancy scored lower on the attachment task, with a median score of 2.50 compared with 3.38 in the comparison group. This points to a more insecure pattern, both in stories about couples and in stories about parents and children. When the team adjusted for other factors, however, this link was no longer significant, which the researchers put down to the small number of mothers.
Social circumstances also differed. Mothers in the denial group were much less likely to live in their own home, often staying with parents or in temporary housing such as hostels. They were also far more likely to be separated from the baby’s father.
Surprisingly, the two groups did not differ in postnatal depression, general depression or anxiety scores. The personality screening did find more borderline and paranoid traits among mothers who had denied their pregnancy. These traits are often linked with difficult early relationships and fears of being abandoned.
The findings suggest that pregnancy denial is not usually a sign of severe mental illness, but may be rooted in insecure early relationships and an unstable social situation. Identifying these mothers early could help maternity and social services offer extra support to them and their babies after birth.
The study has important limits. Many women dropped out between the first and second visits, leaving only 24 mothers with pregnancy denial at eight weeks, so the results have limited statistical power. The attachment task also cannot distinguish between different types of insecure attachment.
Pregnancy denial is thought to occur in roughly one in 300 to one in 475 births, and complete denial until birth is rarer still. This is believed to be the first study to look directly at maternal attachment style in women who have experienced it.
