Cryptic pregnancy

Cryptic pregnancy also known as ‘denied pregnancy’ or ‘denial of pregnancy’, is a term used to describe a pregnancy that is not recognized by the person who is pregnant until they are in labor or have given birth ¹. Described in the 1970s ², pregnancy denial occurs as the unconsciousness of being pregnant for several months or throughout the entire period of pregnancy. Usually, body transformations are not clearly noticeable. The prevalence of this symptom is estimated to be 1 case of denied pregnancy in 475 births ³. In contrast, concealed pregnancy is when a woman knows she is pregnant at a very early stage but deliberately does not tell anyone  ⁴. Various factors are thought to contribute to denied and concealed pregnancies, for example, a strict religious upbringing and taboo associated with premarital sex ⁴. The main health concerns accruing to concealed pregnancy are the increased risk of stillbirths, neonatal death, neglect and other forms of harm to the baby and the likelihood of (usually undiagnozed) mental disorder in the mother.

The term cryptic pregnancy is also being used online for a special form of false pregnancy or pseudocyesis or delusion of pregnancy, or phantom pregnancy. False pregnancy is characterized by the typical pregnancy symptoms including weight gain, growing belly, morning sickness, irritability, and backache; all the signs of being pregnant without carrying an actual baby. Contrary to what many people believe, false pregnancy is not only found in women but men as well. When a man suffers a false pregnancy, it is usually called Sympathetic Pregnancy. This is more common when his female partner is pregnant and is dealing with the normal aches and pains that are associated with pregnancy. The medical term when men experience this is called Couvade. False pregnancy or pseudocyesis is extremely rare in both men and women so doctors are still trying to piece together the root cause of the condition. Some believe the cause is physical while others believe it is psychological. Some believe that the cause comes from trauma, either a physical or mental trauma, while others believe it is a chemical imbalance.

There is no consensus concerning the definition of cryptic pregnancy or pregnancy denial ⁵. First, there is no consensus on the threshold date from when the pregnancy is considered denied if unacknowledged. On the one hand, some authors consider that the threshold date is beyond the first trimester: 14 weeks of amenorrhea ⁶, beyond 21 weeks of amenorrhea ⁷ or beyond 20 weeks of pregnancy ³. On the other hand, some authors consider a much longer duration. For example, Friedman proposed the end of the third trimester as threshold date ⁸. Second, besides duration, denial may be incomplete. Two types of pregnancy denial have been proposed: partial denial with late pregnancy discovery (after 5 month of pregnancy) and total denial with pregnancy discovery while delivering ⁹. Third, the encountered terminologies differ from author to another, including pregnancy denial and pregnancy negation ¹⁰. Dayan describes pregnancy negation as “a large range of occurrences, which are the refusal or incapacity of a pregnant woman to admit her condition” ¹¹. These difficulties in properly defining pregnancy denial reflect the clinical heterogeneity of the patients.

The denial of pregnancy calls into question maternal psychological functioning. However, to date, no link between any specific psychiatric disorder and denial of pregnancy has been established ¹². During our clinical meetings, mothers who presented a denial of pregnancy report a difficult personal history with many breaks and events described as traumatic.

In clinical practice, pregnancy sometimes remains unrecognized until the end of the first trimester, especially in primiparous (first time pregnant) women who are unfamiliar with the symptoms ⁴. However, in some cases, bodily symptoms of pregnancy (nausea, abdominal swelling and amenorrhoea) are absent and in many cases pregnancy is often not detected by relatives or by the partner where present ¹³. When pregnancy is denied throughout most of gestation, or even up to unexpected ‘sudden’ delivery, significant risks to mother and fetus may result from inadequate antenatal care, such as poor nutrition, fetal abuse, unattended or precipitous delivery ⁴. There have been some published data on denied pregnancy, of which some have been case reports  ⁴. The most recent figures suggest that the prevalence of denied pregnancy is 1/475 births, which is higher than previously thought ¹⁴. Furthermore, a significantly increased neonatal risk was confirmed for outcome parameters such as prematurity, low birth weight and small for gestational age  ⁴.

What is a high-risk pregnancy?

A high-risk pregnancy is one that threatens the health or life of the mother or her fetus or both are at higher risk for problems during pregnancy or delivery than in a typical pregnancy. A high-risk pregnancy often requires specialized care from specially trained providers.

Some pregnancies become high risk as they progress, while some women are at increased risk for complications even before they get pregnant for a variety of reasons.

Early and regular prenatal care helps many women have healthy pregnancies and deliveries without complications.

Risk factors for a high-risk pregnancy can include:

• Existing health conditions, such as high blood pressure, diabetes, or being HIV-positive ¹⁵.
• Overweight and obesity. Obesity increases the risk for high blood pressure, preeclampsia, gestational diabetes, stillbirth, neural tube defects, and cesarean delivery. Researchers have found that obesity can raise infants’ risk of heart problems at birth by 15% ¹⁶.
• Multiple births. The risk of complications is higher in women carrying more than one fetus (twins and higher-order multiples). Common complications include preeclampsia, premature labor, and preterm birth. More than one-half of all twins and as many as 93% of triplets are born at less than 37 weeks’ gestation ¹⁷.
• Young or old maternal age. Pregnancy in teens and women age 35 or older increases the risk for preeclampsia and gestational high blood pressure ¹⁸.

Women with high-risk pregnancies should receive care from a special team of health care providers to ensure the best possible outcomes.

Can a high-risk pregnancy be prevented?

High-risk pregnancy is not always preventable. Some factors, such as chronic conditions and lifestyle factors, can be treated and controlled before pregnancy to help reduce risk. But some conditions aren’t treatable or, even if well controlled, still mean higher than normal risk. Other problems may start in pregnancy.

Staying healthy before and during pregnancy is a good way to lower the risk of having a difficult pregnancy. Healthcare providers recommend that women who are thinking about becoming pregnant visit a healthcare provider to make sure they are in good pre-pregnancy health.

Before and during pregnancy, a woman can take steps to help reduce her risk of certain problems ¹⁹.

How is high-risk pregnancy treated?

Treatment for high-risk pregnancy depends on the woman’s specific risk factors.

For example, treatment for a woman whose pregnancy is high risk because of a thyroid problem is usually medication to ensure her body has the right levels of thyroid hormones. Treatment for a woman whose pregnancy is high risk because of cigarette smoking is helping her to quit smoking. Treatment for a woman whose pregnancy is high risk because she is HIV positive would involve antiretroviral treatments during pregnancy, possibly a surgical delivery, and additional medications for her and the baby after birth.

In a high-risk pregnancy, healthcare providers will want to keep a close watch on the woman and the pregnancy to detect any potential problems as quickly as possible so that treatment can start before the woman’s or fetus’s health is in danger. This is particularly true of pregnancies that are high risk because of preeclampsia and previous preterm labor or birth. In these situations, treatment could mean additional days in the womb to allow for fetal development to continue.

Consequence of cryptic pregnancy

During pregnancy, a mother is getting prepared to meet her child and build quality interactions through a maturational process leading to a psychological reorganization. The pregnancy and the birth represent, for the woman, an essential phase of her psycho-affective development, comparable to the adolescence in its somatic, hormonal and psychological changes. In the past, many authors have studied these psychological reorganizations and proposed theories ²⁰. These psychological reorganizations enable the mother to adapt to her new role and to create a containing and reassuring environment for her child. For women prone to pregnancy denial, this period of psychological reorganization is almost non-existent. The first part of the pregnancy’s story is lacking. More recently, a study found that perceiving frequent fetal movements was associated with higher scores of prenatal attachment ²¹. Several publications ²² report observations of cases of pregnancy denial. Only one retrospective studies focused on the future of the child ²³.

Cryptic pregnancy signs and symptoms

Pregnancy symptoms vary from woman to woman and pregnancy to pregnancy; however, one of the most significant pregnancy symptoms is a delayed or missing a menstrual period or two or more consecutive periods, but many women experience other symptoms of pregnancy before they miss a period. Understanding the signs of pregnancy is important because each symptom may have causes other than pregnancy. You may experience pregnancy symptoms within a week of conception. Some women report that they did not experience any symptom for a few weeks.

Most common first signs of pregnancy

In a poll on pregnancy symptoms conducted by the American Pregnancy Association ²⁴:

• 29% of women surveyed reported a missed period as their first pregnancy symptom
• 25% indicated that nausea was the first sign of pregnancy
• 17% reported that a change in their breasts was the initial symptom of pregnancy

While implantation bleeding is often considered the first pregnancy symptom, the American Pregnancy Association survey reveals that only 3% of women identify implantation bleeding as their first sign of pregnancy ²⁴.

Missing a period does not always mean a woman is pregnant. Menstrual irregularities are common and can have a variety of causes, including taking birth control pills, conditions such as diabetes and polycystic ovary syndrome, eating disorders, and certain medications. Women who miss a period should see their health care provider to find out whether they are pregnant or whether they have another health problem.

A woman may experience every common symptom, just a few, or none at all. Some signs of early pregnancy include ²⁴:

• Slight bleeding. One study shows as many as 25% of pregnant women experience slight bleeding or spotting that is lighter in color than normal menstrual blood ²⁵. This typically occurs at the time of implantation of the fertilized egg (about 6 to 12 days after conception) but is common in the first 12 weeks of pregnancy ²⁶.
• Tender, swollen breasts or nipples. Women may notice this symptom as early as 1 to 2 weeks after conception. Hormonal changes can make the breasts sore or even tingly. The breasts feel fuller or heavier as well ²⁴.
• Fatigue. Many women feel more tired early in pregnancy because their bodies are producing more of a hormone called progesterone, which helps maintain the pregnancy and encourages the growth of milk-producing glands in the breasts. In addition, during pregnancy the body pumps more blood to carry nutrients to the fetus. Pregnant women may notice fatigue as early as 1 week after conception ²⁷.
• Headaches. The sudden rise of hormones may trigger headaches early in pregnancy ²⁷.
• Nausea and/or vomiting. This symptom can start anywhere from 2 to 8 weeks after conception and can continue throughout pregnancy. Commonly referred to as “morning sickness,” it can actually occur at any time during the day ²⁴.
• Food cravings or aversions. Sudden cravings or developing a dislike of favorite foods are both common throughout pregnancy. A food craving or aversion can last the entire pregnancy or vary throughout this period ²⁴.
• Mood swings. Hormonal changes during pregnancy often cause sharp mood swings. These can occur as early as a few weeks after conception ²⁸.
• Frequent urination. The need to empty the bladder more often is common throughout pregnancy. In the first few weeks of pregnancy, the body produces a hormone called human chorionic gonadotropin, which increases blood flow to the pelvic region, causing women to have to urinate more often ²⁷.

Many of these symptoms can also be signs of other conditions, the result of changing birth control pills, or effects of stress, so they do not always mean that a woman is pregnant. Women should see their health care provider if they suspect they are pregnant.

How do I know if I’m pregnant?

If you have missed one or more menstrual periods or have one or more of the early signs of pregnancy, you may wonder whether you are pregnant.

Home pregnancy tests, which are highly accurate and available without a prescription, can be the first way women determine if they are pregnant. If a home pregnancy test is positive, a woman should call her health care provider to schedule an appointment.

Home pregnancy tests measure the amount of human chorionic gonadotropin (hCG) in a woman’s urine. Small amounts of this hormone are present even before the first missed period, and they increase as pregnancy continues.

References

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