Pregnancy denial: A growing problem?
Over the past few years, some friends have asked me if I ever watched the reality television show, “I Didn't Know I Was Pregnant.” I've always dismissed the show as preposterous and phony.
Certainly I can believe there are rare cases out there where a woman did not realize she was pregnant until late in the pregnancy, but I've been skeptical that there are enough of these cases to make an entire show devoted to the idea.
However, in recent months I've seen an increase in women presenting to the emergency room with undiagnosed third trimester pregnancies, many in active labor. Almost all of these women deny any knowledge or even suspicion that they were pregnant.
When questioned about the telltale signs of gestation — fetal movement and weight gain — most of these women say they thought it was caused by something else. Particularly puzzling is the women who already have carried and delivered full-term babies and are versed in the discomforts and sensations of pregnancy.
My colleagues and I remain skeptical. I am not alone in my belief that many of these women are going through a deep level of denial about their pregnancies. They cannot admit, even to themselves, that they are expecting. Adolescent pregnancies, bad or abusive relationships and infidelity are common themes that I've noticed among women with undiagnosed pregnancies.
I recently saw an adolescent patient for her first office visit at 35 weeks gestation. When I asked her why she was late in seeking prenatal care, she stated that she didn't realize she was pregnant until she went to the ER for a urinary tract infection a few days prior to her visit with me.
“You really didn't know you were pregnant?” I looked this patient in the eye and asked. Initially she was silent and seemed startled that I was questioning her. Then her eyes filled with tears, and she said, “I've suspected it for a long time, especially when I felt the baby move. But I didn't want to be pregnant, and no one else wanted me to be pregnant either.”
Obviously, the big problem in these cases is lack of prenatal care. It is very difficult to accurately date a pregnancy in the third trimester by ultrasound. Few of these women remember the date of their last menstrual period and some insist they had their period the entire time.
Some women arrive to the ER in active labor, but also very sick with preeclampsia, placental abruption or uncontrolled gestational diabetes. I am puzzled as to why these women would wait to seek care. Could pregnancy denial truly be caused by lack of family support? Do women simply believe that if they ignore the pregnancy it will go away? And what can we do about it?
If the television show and my recent clinical encounters are any indication, pregnancy denial is a growing problem in obstetrics that only stands to increase neonatal and maternal morbidity and mortality.
Have you encountered patients who didn't know they were pregnant? Tell us about your experiences in the comments section below?