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Cryptic pregnancy

Cryptic pregnancy, also known as pregnancy denial, occurs when the pregnant person is unaware of their pregnant state and discovers this late in pregnancy or when labour starts. Although, historically, the term ‘concealed pregnancy’ has been used synonymously, in a concealed pregnancy the patient is fully aware of their pregnancy but chooses to hide it from their family and the public. Described as early as the 17th century, a population study carried out over 1 year in Berlin reported the incidence of pregnancy denial as 1 in 475 pregnancies at 20 weeks and 1 in nearly 2500 pregnancies at term, similar to the incidence of eclampsia [ 1 ] and equivalent to 1600 surprise births in the USA and 325 in the UK every year. Such births can make for dramatic headlines [ 2 ], sensationalist TV programmes (4 seasons of “I Didn't Know I Was Pregnant” started in 2009) and surprise events in your A&E department or ER [ 3 ].

Cryptic pregnancies can be divided into psychotic or non-psychotic types and the non-psychotic types can be divided further into affective, pervasive or persistent [ 4 ]. The psychotic type is associated with a psychotic disorder and is much less common. In affective denial, the patient intellectually acknowledges the pregnancy, but cannot declare the pregnancy. In pervasive and persistent denial, the expectant person doesn't know that they are pregnant. There is no weight gain or morning sickness. Periods may or may not stop, and no one recognizes the pregnancy. A dissociative episode may occur at delivery, especially in rare cases occurring with abandonment of the newborn or neonaticide. Kenner and Nicholson [ 5 ] report how, in many cases, pregnancy denial is associated with either significant early-life trauma or trauma at conception such as rape, assault or incest.

Concerns with cryptic pregnancies include late or non-existent antenatal care resulting in non-detection of pre-eclampsia, SGA babies and other pregnancy problems that would benefit from interventions, continuance of unwanted behaviours in pregnancy such as smoking, alcohol and drug use, and the possible dangers of unassisted delivery alone [ 6 ]. This is aside from the psychological consequences of a surprise birth with possible impaired parent/child interactions and infant development and rare instances of neonaticide [ [7] , [8] , [9] ].

Is there a typical presentation of cryptic pregnancy? In one of the largest, prospective, case control studies in this area, Delong et al. [ 10 ] published a study of 71 mother/infant dyads with pregnancy denial after 20 weeks of pregnancy and compared them with 71 temporal and parity matched dyads to try and determine pertinent risk factors. At least ten of the cases did not discover their pregnancy until labour started. Cases were more likely to be younger (24 years vs 30 years), less well educated, single or not with the father of the pregnancy at birth, lower down the career ladder and more likely to have a psychiatric history, especially of major depressive order or persistent depressive disorder. Cases had more previous pregnancy denials and more pregnancy denials in the family. There were no differences between the groups with regard to BMI before pregnancy, parity, gestational age at delivery, obstetric history or past medical/surgical history. 75% of case pregnancies occurred whilst using contraception (with 75% using oral contraceptives) compared with 7% in the control group. There was less change in weight and breast size in the cryptic pregnancies and 86% of cases continued to have periods compared with 4.5% of controls. Cases also perceived less fetal movement during the pregnancy. Interestingly, of the 126 newborns that had analysable data, only the median pregnancy term (38 vs 39 weeks) and median height (49 vs 50.5 cm) of the newborns were significantly different.

Management will depend on gestation at diagnosis. However, given that a small proportion of cryptic pregnancies can be associated with neonaticide or a co-existing psychiatric disorder, patients presenting in late pregnancy or labour should be evaluated by a psychiatrist whilst still in hospital, although most people will go on to take full responsibility for their babies. It has been suggested that psychiatric referral in these pregnancies is under-requested or not made at all [ 8 ].

With a clinical picture known for so long, it is surprising how little objective information on prediction, management and the possible consequences is available. There are no official guidelines on how to manage the condition and care for those involved in the long term. The psychological and developmental impact of pregnancy denial on children and mothers is still unknown. Despite Delong's study, people who deny pregnancy are, in general, a heterogeneous group and health care professionals should have a low threshold for thinking of and testing for pregnancy in people of reproductive age with symptoms compatible with pregnancy such as nausea, weight gain or abdominal symptoms, with or without amenorrhoea. It is worth noting that in one cohort study, 38% of patients had visited their doctor during the pregnancy without receiving a pregnancy diagnosis [ 11 ]. It has been pointed out that without a DSM or ICD code for this condition, research and comparisons are difficult [ 11 ]. The absence of consistent diagnostic recognition and terminology for cryptic pregnancies or pregnancy denial has led to a lack of awareness. Such obliviousness continues to put patients and their babies at risk.

Contributors

Kirsten Duckitt is the sole author of this editorial.

No funding from an external source supported the publication of this editorial.

Provenance and peer review

This editorial was commissioned and not externally peer reviewed.

Conflict of interest statement

The author has no conflict of interest regarding the publication of this editorial.

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Hidden Pregnancy: Signs You’re Pregnant But Don’t Know It

Medically referred to as a cryptic pregnancy

A hidden pregnancy, also called a cryptic or stealth pregnancy, is when a pregnancy goes undetected until about halfway through (or even up until labor or birth).

Hidden pregnancy signs may include typical pregnancy symptoms , such as spotting, nausea , cramping, swollen breasts, and fatigue . You may not notice these symptoms because you don't think you could be pregnant, or you may think your symptoms are caused by something else. It's also possible to have no symptoms at all.

Mental health or medical conditions, as well as trauma, can increase the risk of experiencing an undetected pregnancy.

This article goes over the causes and symptoms of a cryptic pregnancy. It also covers associated concerns and how to cope if you experience a hidden or undetected pregnancy.

Verywell / Jessica Olah

Symptoms: What Are “Hidden” Pregnancy Signs?

Symptoms of a hidden pregnancy can sometimes be attributed to factors like birth control use, recent travel, work exhaustion, and/or diet or exercise changes. Early pregnancy symptoms may include:

• Slight weight gain
• Experiencing fatigue
• Constipation
• Spotting or light bleeding, but no periods
• Swollen, tender breasts
• Frequent urination

Some people say their vivid dreams are an early sign of pregnancy. This may be because hormonal balances and body changes can alter the way you sleep, making you more likely to remember your dreams.

How Far Along Can You Be With an Undetected Pregnancy?

As many as 1 in 475 pregnancies go undetected or unnoticed until the 20-week, or five-month, mark. That's roughly half of someone's pregnancy. One in 2,455 pregnancies goes unrecognized until a person  goes into labor .

What Causes Hidden (Cryptic) Pregnancy?

Research is still limited when it comes to hidden pregnancies. However, experts think some of the following factors contribute to a person not realizing they are pregnant:

• Assumptions , meaning individuals don't believe they could become pregnant
• Unexpected symptom experience , meaning individuals don't experience what is generally expected when it comes to pregnancy symptoms
• Life circumstances , such as age, family history, and/or past or ongoing trauma
• Conditions , including mental, developmental, and medical conditions

While it may be difficult to understand how someone could be pregnant and not know it, limited discussion and research on the topic continue to contribute to the lack of awareness around this uncommon, but real problem.

Assumptions

Assumptions that can increase the risk of a hidden pregnancy include:

• Intermittent spotting: Bleeding and spotting that can occur during pregnancy can easily be mistaken for a light period.
• Inaccurate pregnancy test results: Pregnancy tests are usually very accurate, but errors do happen—especially if a person does not test the right way or at the best time. It is possible for a pregnancy test to be negative even when a person is actually pregnant.
• Early menopause: Pregnancy symptoms can be similar to early menopause symptoms. If you're between the ages of 45 and 55, which is the range menopause typically begins, you may attribute the symptoms to menopause, instead of pregnancy.
• Fertility : If you've struggled with getting pregnant in the past, you may find it hard to believe that you could be pregnant.
• Birth control use: Even when used correctly, it's possible to become pregnant when using birth control . People using contraception may not think they could be pregnant and might ignore the signs.
• Recent pregnancy: Ovulation can occur sooner than you'd think after you've had a baby. That said, the early signs of pregnancy may not be as clear in someone who recently gave birth and signs may be associated with the previous pregnancy and recovery.

Symptom-Related

Symptom-related factors that can increase the risk of a cryptic pregnancy include:

• Lack of pregnancy symptoms: Common pregnancy symptoms like nausea, vomiting, pelvic cramping , lower back pain, fatigue, missed periods, and abdominal swelling can show up at different times and intensity levels, or may not show up at all depending on the individual.
• Not realizing symptoms: In some cases, symptoms can be mild or attributed to other causes. For example, an individual may believe morning sickness is an upset stomach or not getting their period may be an irregular menstrual cycle .
• No prominent “baby bump:” A pregnant belly might not be obvious on someone who carries more weight in their abdomen. Some people do not gain much weight or start to "show" until later in pregnancy.
• Not feeling the fetus move: The location of the fetus and placenta can sometimes make it hard to feel movement. For example, with anterior placenta placement , the placenta is in the front of the uterus. When this happens, it may take longer to feel fetal movements and they can be trickier to recognize.
• Not feeling any changes in the cervix : Some people may try inserting a finger into the vagina to feel the cervix, which may feel softer in early pregnancy. The finger test is not a reliable or recommended method of checking for pregnancy. Contact your healthcare provider or try at-home tests instead.

Keep in mind that pregnancy in most people isn't detected by what it feels like in the stomach (abdomen). A "baby bump" isn't noticeable until well into the second trimester and you can't feel a fetus move before then, either.

Life Circumstances

Certain life circumstances increase your risk of experiencing a hidden pregnancy. These may include:

• Young age: Research suggests that being young in age is a risk factor for a denied pregnancy in certain individuals.
• Family history: Research suggests that individuals with a family member who has experienced a cryptic pregnancy were more at risk for also experiencing one.
• Trauma: About one third of individuals who experience a rape-related pregnancy have cryptic pregnancies and don't know they're pregnant until the second trimester. In many cases, the perpetrator was someone the survivor knew.

Survivors of sexual violence and intimate partner violence are at an increased risk of developing associated mental health conditions, as well as increased alcohol and drug use.

Conditions that can increase the risk of a cryptic pregnancy include:

• Irregular menstrual cycle: Irregular periods can make it hard to know whether you've missed a period. This is especially true if your menstrual cycle is longer than the average 28 days. For someone who may not experience as many periods per year, the absence of a period may not be an immediate red flag for pregnancy.
• Polycystic ovary syndrome (PCOS): PCOS can cause hormonal imbalances that throw off ovulation. This can lead to an unexpected pregnancy that may go unnoticed.
• Mental health and developmental conditions: Some research suggests that people with certain mental health conditions , including depressive disorders , schizophrenia , and certain personality disorders, as well as certain developmental conditions, such as an intellectual disability , are more at risk of experiencing a hidden pregnancy.

Symptoms of a hidden pregnancy are the same symptoms associated with pregnancy in general. However, with a cryptic pregnancy, these symptoms may be mild, denied, or attributed to some other cause.

A Word From Verywell

A hidden pregnancy is more likely to occur in someone who does not have regular, predictable menstrual cycles. For someone who is used to going several months without a period, it may take longer to realize that the lack of a period is due to pregnancy. In addition, many early pregnancy signs can be very similar to common everyday symptoms, such as bloating, fatigue, or headaches. If you are sexually active and not using reliable contraception, it's important to get any irregular bleeding pattern evaluated.

Cryptic Pregnancy Concerns

Not recognizing pregnancy—even just for a short time—can be dangerous for both the fetus and the pregnant person. The reasons include:

• If a person does not realize they're pregnant, they won't get the prenatal care that is necessary for a safe and healthy pregnancy.
• Without prenatal testing, serious complications—such as high blood pressure , gestational diabetes , and preeclampsia —could go unnoticed.
• If a hidden pregnancy lasts up until the time of birth, a person may not realize that they are in labor. If they don't get to a hospital, they may have to deliver on their own without any help.
• Research has shown that babies born after a cryptic pregnancy might be more likely to be underweight and born prematurely , or born before week 37 of pregnancy.
• If a person who did not know they were pregnant consumed substances like alcohol, tobacco, or certain medications, damage to the fetus could lead to structural or functional abnormalities.
• Abortions for pregnancies past the first trimester mark involve a medical procedure. While these procedures are generally considered safe, the longer the pregnancy goes on, the higher the chances of experiencing associated risks.

Coping With a Cryptic Pregnancy

Not knowing you are pregnant until the 20-week mark or later can be incredibly stressful. You may feel confused, overwhelmed, trapped, angry, shocked, worried, as well as upset about being pregnant or missing out on the full pregnancy experience.

Know that any way you feel is valid and it's totally normal to feel a complex mix of emotions that may change as you continue to process the pregnancy.

If your hidden pregnancy is diagnosed before you go into labor, you still have time to talk to your provider about prenatal care and pregnancy choices. They can offer support, resources, and guidance concerning:

• What to expect as the pregnancy progresses
• How to best prepare for labor and delivery
• Abortion, along with associated risks depending on your specific circumstance
• Adoption services
• Parenting and new baby care
• Mental health services

While it can be challenging, it's possible to have a healthy pregnancy and birth even if you didn't learn that you were pregnant until later.

Coping After Pregnancy

Giving birth and becoming a parent are major events that can be stressful, especially when you have a very short time to plan for them. Anxiety, doubt, and exhaustion after having a baby are normal.

If you had an abortion, experienced a miscarriage, or chose adoption for the baby, know that you may go through a wide range of emotions. In addition to the hormonal shifts, processing the outcome of a hidden pregnancy can feel incredibly intense and exhausting.

It's important to prioritize your self-care during this time:

• Speak with your healthcare provider about additional resources.
• Contact a mental health professional who specializes in pregnancy-related concerns.
• Join a support group for your specific concern.
• Connect with trusted friends and family members who will support you during this time.
• Don't ignore intense, persistent feelings of sadness, irritability , disconnection, or thoughts of harming yourself or others. Know that you are not alone and help is available.

Suicide Prevention Hotline

If you are having suicidal thoughts, contact the  National Suicide Prevention Lifeline  at  988  for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call  911 .

For more mental health resources, see our  National Helpline Database .

A cryptic (hidden) pregnancy when a person is not aware that they are pregnant until they are at least five months along.

Hidden pregnancies can occur if a person doesn't have or notice any pregnancy symptoms, thinks they are due to another cause, or experiences denial about the pregnancy. Certain factors such as medical, developmental, or mental health conditions, as well as certain life circumstances can increase the risk of experiencing a cryptic pregnancy.

Cryptic pregnancies are associated with concerns for both the pregnant individual and the fetus. It's important to seek appropriate care as soon as possible.

Delong H, Eutrope J, Thierry A, et al. Pregnancy denial: a complex symptom with life context as a trigger? A prospective case–control study* .  BJOG . 2022;129(3):485-492. doi:10.1111/1471-0528.16853

Scarpelli S, D’Atri A, Bartolacci C, et al.  Dream recall upon awakening from non-rapid eye movement sleep in older adults: electrophysiological pattern and qualitative features.   Brain Sciences . 2020;10(6):343. doi:10.3390/brainsci10060343

Van Brouwershaven A, Dijkstra C, Bolt S, Werdmuller A. Discovering a pregnancy after 30 weeks: a qualitative study on explanations for unperceived pregnancy . J Psychosom Obstet Gynaecol . 2023;44(1):2197139. doi:10.1080/0167482X.2023.2197139

Villavicencio J, Allen RH.  Unscheduled bleeding and contraceptive choice: Increasing satisfaction and continuation rates .  Open Access J Contracept . 2016;7:43-52. doi:10.2147/OAJC.S85565

Griffey RT, Trent CJ, Bavolek RA, Keeperman JB, Sampson C, Poirier RF.  “Hook-like effect” causes false-negative point-of-care urine pregnancy testing in emergency patients .  J Emerg Med.  2013;44(1):155-160. doi:10.1016/j.jemermed.2011.05.032

National Institutes of Health. What is menopause?

Berens P, Labbok M; Academy of Breastfeeding Medicine. ABM clinical protocol #13: Contraception during breastfeeding .  Breastfeed Med . 2015;10(1):3-12. doi:10.1089/bfm.2015.9999

Goldstein et al. Association of gestational weight gain with maternal and infant outcomes: A systemic review and meta-analysis . JAMA . 2017;317(21):2207-2225. doi:10.1001/jama.2017.3635

Food and Drug Administration.  Pregnancy .

Basile KC, Smith SG, Liu Y, et al. Rape-related pregnancy and association with reproductive coercion in the U.S .  Am J Prev Med . 2018;55(6):770-776. doi:10.1016/j.amepre.2018.07.028

Planned Parenthood. How safe is an in-clinic abortion?

By Cristina Mutchler Cristina Mutchler is an award-winning journalist with more than a decade of experience in national media, specializing in health and wellness content. 

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Pregnant Without Knowing It: What Is a Cryptic Pregnancy?

Wendy Wisner is freelance journalist and international board certified lactation consultant (IBCLC). She has written about all things pregnancy, maternal/child health, parenting, and general health and wellness.

Alexandra Dubinskaya, MD is a board-certified urogynecologist specializing in menopause and sexual health.

• How It Can Happen

Risk Factors

• How Common It Is
• Complications
• Confirming the Pregnancy

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Cryptic pregnancy is when someone is pregnant but doesn’t know it. Sometimes people are unaware of their pregnancy for several months into a pregnancy. Other times, people don’t know they’re pregnant until they go into labor. Cryptic pregnancies are not common, but they happen more frequently than you might realize.

Although researchers started describing cryptic pregnancies in literature as far back as the 17th century, it’s still something that isn’t fully understood. Experts don’t have a formal definition for it, such as how far into a pregnancy someone discovers they're pregnant for it to be considered a cryptic pregnancy. Cryptic pregnancies are also not yet classified in the Diagnostic and Statistical Manuals, Fifth Edition , used by psychiatrists, or the International Classification of Diseases-10, used by physicians.

Cryptic pregnancy is sometimes referred to as unperceived pregnancy, pregnancy denial, or stealth pregnancy.

Cryptic Pregnancy Symptoms

There are a range of possibilities for what you might experience with a cryptic pregnancy.

Pregnancy symptoms like missed periods, nausea, sore breasts , weight gain, and growing belly may be present. However, the symptoms are often less noticeable. These pregnancy symptoms might even be mostly absent for people with cryptic pregnancies.

While some people with cryptic pregnancy might miss a period, others might experience vaginal bleeding or spotting.

How Does Cryptic Pregnancy Happen?

There is no consensus on why exactly cryptic pregnancies happen, and it’s likely that the reasons are different from one person to another. Here are some possible explanations:

Psychological Factors

There may be psychological factors at play. For example, someone may unconsciously convince themselves that they aren’t pregnant because the idea of being pregnant would cause too much anxiety .

A history of trauma might also cause a person to unconsciously block out the idea of pregnancy, even if symptoms are present.

Having a history of mental health conditions may contribute to the development of cryptic pregnancies. In particular, a history of depression has been linked to cryptic pregnancy.

Often, people with cryptic pregnancies don’t believe they are pregnant and are usually surrounded by others, like family and friends, who don’t believe it either.

Physical Factors

Research has found that people who have cryptic pregnancies have few, if any, pregnancy symptoms.

Some researchers have suspected that people with cryptic pregnancies are more likely to have lower levels of human chorionic gonadotropin, or hCG, the hormone released in high amounts in early pregnancy that causes symptoms like nausea , morning sickness , and exhaustion.

If symptoms of pregnancy are present, the pregnant person might not relate them to pregnancy. For instance, someone with nausea might think they have a stomachache while someone who's gained weight might think it's just normal weight fluctuation.

People who are in perimenopause might not believe it’s possible to be pregnant, so brush aside symptoms and believe a lack of a menstrual period means they are in menopause .

Some people who have a cryptic pregnancy take a pregnancy tests which gives them false negative results (meaning they are pregnant, but the test incorrectly says they are not).

Anyone can experience a cryptic pregnancy, but it’s possible that certain individuals may be at higher risk.

Research from 2021 found that cryptic pregnancy was more common among younger people who were single and did not have a high school diploma. People experiencing cryptic pregnancies are also more likely to have a history of mental health issues.

People who have recently given birth might also be more likely to have a cryptic pregnancy. They might assume they can't become pregnant because their period hasn't yet returned.

Cryptic pregnancy might also be more common among people who have irregular periods , who take birth control pills, and who are in perimenopause (the transitionary time to menopause).

How Common Is Cryptic Pregnancy?

Research from Germany has shown that one out of every 475 pregnancies is not known of until the 20th week or later. That means that just .2% of pregnancies are cryptic pregnancies. So cryptic pregnancies aren't too common. Still, for comparison, they are more common than rare diseases, which are defined as diseases that affect one out of every 200,000 people in the U.S.

Usually, people with a cryptic pregnancy find out they're pregnant before labor. Less often, they find out they're pregnant only when they go into labor. It's estimated that one out of 2,455 births (just .04%) come from a cryptic pregnancy.

Potential Complications of a Cryptic Pregnancy

When a pregnancy unfolds without the pregnant person’s knowledge, it puts the pregnancy at risk. For instance, the person who's pregnant misses out on most if not all of their prenatal care, including necessary prenatal testing, and counseling on appropriate nutrition and activity.

In addition, the pregnant person likely hasn’t made the lifestyle changes people who know they are pregnant usually make, such as refraining from smoking or drinking alcohol, which can affect the health of the parent and child.

Research has found that cryptic pregnancy comes with an increased risk of premature birth, low birth weight, and the diagnosis of small for gestational size.

Cryptic pregnancies also put the pregnant individual at risk for delivering their baby without medical assistance.

Once a person learns they have a cryptic pregnancy, they are at increased risk for emotional distress.

How to Confirm a Cryptic Pregnancy

If you suspect you are pregnant, even if you think you may have missed confirming your pregnancy by several weeks or months, you should visit a healthcare provider.

Your provider will confirm your pregnancy using testing methods used for all pregnancies including:

• Urine test to detect the presence of the hCG hormone in your urine
• Blood tests to detect pregnancy hormones in your blood, if necessary
• Ultrasounds , which give a view of your fetus and placenta

How to Cope With a Cryptic Pregnancy

The first step to take if you are experiencing a cryptic pregnancy is to visit with a healthcare provider to ensure that you and your fetus are healthy. Then, you should do what’s necessary to support your pregnancy, including taking prenatal vitamins , visiting your provider regularly, and getting any necessary prenatal testing. If you are in a time in your pregnancy where termination is possible, you can discuss that with your healthcare provider, if that is how you wish to proceed and the care is accessible to you .

It's important to take into consideration the emotional effects of experiencing a cryptic pregnancy. It’s typical to feel distress and shame. People in this situation are often stigmatized by others. It’s also common to feel guilt about not realizing you were pregnant and potentially putting your fetus at risk. If you didn’t realize you were pregnant until you were giving birth, you might feel unsure if you will be able to adequately care for your baby or bond with them.

If you are experiencing mental health challenges in relation to your cryptic pregnancy, know you aren’t alone and that help is out there for you. Don’t hesitate to reach out to a mental health professional for help and support. Your physician can give you a recommendation if you need one.

If you are having thoughts of self-harm, suicide, or are thinking of harming your baby, call 911 or seek emergency medical care. You can also call the National Suicide hotline at 988, which is free and confidential, or visit the 988 website to chat with a trained helper.

A Quick Review

A cryptic pregnancy is when you are pregnant without knowing it. People may not know they are pregnant for several weeks, months, or even the entire duration of their pregnancy. People might not know their pregnant for a variety of factors, which include both psychological and physical factors. In many cases, people who experience cryptic pregnancy have less pronounced or no pregnancy symptoms. Cryptic pregnancies present risks, including putting you at risk for preterm labor and increased psychological distress and the fetus at risk for a low birth weight. If you realize you are experiencing a cryptic pregnancy, you should visit a healthcare provider and, if needed, seek mental health support.

van Brouwershaven AC, Dijkstra CI, Bolt SH, et al. Discovering a pregnancy after 30 weeks: a qualitative study on explanations for unperceived pregnancy . J Psychosom Obstet Gynaecol . 2023;44(1). doi:10.1080/0167482X.2023.2197139

Delong H, Eutrope J, Thierry A, et al. Pregnancy denial: a complex symptom with life context as a trigger? A prospective case–control study . BJOG . 2022;129(3):485-492. doi:10.1111/1471-0528.16853

American Pregnancy Association. What is a cryptic pregnancy?

Chechko N, Losse E, Stickel S. A case report involving the experience of pervasive pregnancy denial: detailed observation of the first 12 postpartum weeks . BMC Psychiatry . 2022;22:774. doi:10.1186/s12888-022-04377-1

Stammers K, Long N. Not your average birth: considering the possibility of denied or concealed pregnancy . BMJ Case Rep . 2014;2014:bcr2014204800. doi:10.1136/bcr-2014-204800

National Organization for Rare Disorders. Rare Disease Database .

MedlinePlus. Pregnancy test .

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Cryptic pregnancies: ‘I didn’t know I was having a baby until I saw its head’

Klara Dollan spent nine months totally unaware that she was pregnant. The possibility only crossed her mind as she gave birth in her bathroom. But cryptic pregnancies like hers are far from unusual

W hen Klara Dollan, then 22, woke up at 4am on the day she was due to start her new job, she thought her agonising stomach cramps signalled her period being “back with a vengeance”. She had been taking the pill with no break for more than six months, but had stopped about two weeks before. The waves of pain left her pale and shaking, but she didn’t feel she could call in sick on her first day – so she took some paracetamol on her mother’s advice, and caught the bus then the tube from the home they shared in Cricklewood in north-west London into the city.

Hours later, Dollan was in Hampstead’s Royal Free hospital, cradling a newborn baby girl: completely healthy and carried to term. Dollan had given birth by herself in the bathroom of her flat, after being sent home sick from work; a neighbour had heard her screams of labour and called an ambulance. When Dollan rang her mother and told her to come to the maternity ward, the reply was: “But you weren’t pregnant this morning!”

Amelia, now three, was a “complete surprise”, says Dollan, which many struggle to believe. How could she not have known she was pregnant? But the more pertinent question may be: why would she have thought she was?

Dollan had broken up with her boyfriend (Amelia’s father) five months before her daughter was born, and she was used to not getting periods. She had gained a little weight, but chalked that up to the breakup. A mirror selfie she took betrays no trace of her being seven and a half months pregnant. “There was nothing showing. I wasn’t feeling it. I had no symptoms, no cravings, no nausea – nothing. I was out of the loop of my pregnancy.”

In fact, the first time the thought she might be pregnant crossed her mind was as she was giving birth. By this point, it was clear this was no period. “My body was just telling me to push the pain away. Then I saw a head coming out.” What was she thinking? “I couldn’t tell you, honestly. I was in absolute shock.”

Last week, there were reports around the world of an extreme case of a woman being surprised by her own full-term pregnancy: a Bangladeshi woman gave birth to a healthy and expected baby boy, only to learn nearly a month later that she was carrying twins in a second uterus (they were also born healthy, 26 days after her first child). The physical circumstances in that case, and the fact that the woman knew she was pregnant with one child – but not three – clearly make it highly unusual. But the phenomenon of a woman carrying a baby to term without knowing she is pregnant is more common than one might think; as Dollan found out after giving birth to Amelia, this is known as “cryptic pregnancy”. A 2002 paper published in the British Medical Journal estimated that it occurs in about one in every 2,500 pregnancies, suggesting about 320 cases in the UK every year.

“This is not a particularly unusual phenomenon,” says Helen Cheyne, a professor of midwifery at the University of Stirling’s Nursing, Midwifery and Allied Health Professions Research Unit in Glasgow. “It’s rare – but it’s not that rare.” In midwifery and obstetrics and gynaecology circles, she says, if you haven’t come across a cryptic pregnancy yourself, it is not unusual to know someone – or know someone who knows someone – who has.

Early in Cheyne’s career as a clinical midwife, in 1982 or 1983, she remembers caring for a woman in the postnatal ward of the Princess Royal maternity hospital in Glasgow who had not known she was pregnant until she went into labour. She had given birth before – by then her children were teenagers – and she had chalked up her irregular periods and weight gain to age. Cheyne remembers her and her husband being in total shock. “I’ve never forgotten that. She was completely credible.”

And yet, she adds, it is “very, very hard to get your head around”. “The feeling of a baby moving inside you – if you’ve had children, it’s very hard to imagine how you might not recognise that for what it is. Having an 8lb baby inside you …” She laughs. She also adds that it is not only possible for significantly overweight women, as is commonly assumed.

Although the research is sparse – as one might expect, given the fundamental element of surprise – Cheyne says cryptic pregnancies have been recorded around the world, dating back centuries. In fact, it was more understandable when pregnancy diagnoses were dependent on indicators such as the loss of periods and nausea. With highly accurate modern tests, says Cheyne: “It’s very easy to diagnose pregnancy – if you expect to be pregnant.”

But the phenomenon cannot be explained away as women simply not feeling or noticing the signs of pregnancy, variable though they are. “Many people who are not expecting to get pregnant do get pregnant, and recognise that they are,” says Cheyne, adding that that is true even of women in war zones, refugee camps and other challenging situations where there may not be access to tests or healthcare. “If pregnancy symptoms were generally nebulous and not easily detected, [cryptic pregnancies] would happen all the time – so I think it must be something more particular to the symptoms experienced by these particular women.”

Cryptic pregnancy has been reported as a “psychological phenomenon”, says Cheyne, but she does not believe that applies to all cases. “Pregnancy is obviously a physical thing, but becoming a mother is social and psychological as well – maybe pregnancy is also.”

Understandably, when cases make headlines (a representative example: “Woman had no idea she was pregnant – until she gave birth in the toilet”), they tend to be received with incredulity, scepticism and lurid interest, as the stuff of soap operas and low-rent documentary series. Fifteen-year-old Sonia’s “surprise baby” on EastEnders in 2000 made a vivid impression on a generation of young women, while the US television series I Didn’t Know I Was Pregnant ran for four seasons. (In 2015, it was reprised for special episodes about women who had not one but two cryptic pregnancies, titled I Still Didn’t Know I Was Pregnant.)

That a woman could undergo so transformative a physiological experience as pregnancy without having any awareness of it seems to trigger deep-seated disbelief, especially among those who have experienced pregnancy. Dollan says people have questioned her common sense, her connection to her own body, and even the truthfulness of her story. She has found some mothers to be especially judgmental.

“When I tell them I didn’t have any cravings or morning sickness, that I didn’t have too bad a labour – that I just walked through pregnancy, if you will – they are like: ‘How could you not know?’ And almost: ‘How could you live with yourself not knowing?’” she says. “There’s a huge stigma, not only being a young woman who’s pregnant, but a young woman not knowing she’s pregnant.”

What about the reaction from men? “I don’t think they grasp it at all. Any man I’ve told has been like, ‘yeah, cool’, and seemed to have forgotten instantly.”

After she went public about her story on This Morning four and a half months after giving birth, Dollan says she was contacted by many women who had not spoken out about their own cryptic pregnancies out of embarrassment. For her, the proof of her cryptic pregnancy is self-evident. “All I can say to anyone who thinks I was hiding it is: why would I? Not only would I be putting my health at risk, I would be putting my child’s health at risk.”

That Amelia was carried to term and born healthy, without assistance, was a “miracle”, says Dollan, given that she had been working 12-hour days, 60-hour weeks in her hospitality job for her entire pregnancy. “I’d not lived the life of a pregnant woman for the past eight months. I was a bar manager, for Christ’s sake. I was carrying crates of alcohol up flights of stairs until I was eight months pregnant.”

Risk is inherent to cryptic pregnancy, in the gestation period but most acutely in the act of childbirth. Women can go into labour without medical assistance, sometimes in dangerous situations or entirely alone. Tragic cases where the child has been born dead or has died shortly after birth have led to the mother’s prosecution, says Cheyne, especially historically. “In a less understanding society, a woman could be charged with infanticide. People would say: ‘You must have known you were pregnant – otherwise how else would this happen?’”

Even a relatively straightforward birth of a healthy baby can be highly traumatic. “Most parents have nine months to prepare,” says Dollan. “I had two seconds – maybe a minute. Instantly, my life changed for ever.”

Unlike in Dollan and the Bangladeshi mother’s cases, past trauma can be an influential factor in pregnancies going unacknowledged, says Dr Sylvia Murphy Tighe, a midwifery lecturer and the course director at the Department of Nursing and Midwifery at the University of Limerick, Ireland. For her doctorate, Tighe studied concealed pregnancy: where women hide their babies from others and often, on some level, themselves. Given the link, she eschews the term “cryptic pregnancy” in favour of the broader catch-all “denied pregnancy”, which takes in the possibility of both conscious and subconscious rejection (although she considers the former far more common).

The 30 women she interviewed revealed “fluctuating levels of awareness” of their pregnancies, says Tighe. Some told her, years after the fact, that “they absolutely knew” even though they had said at the time that they hadn’t. Others had confided in one person – often a partner, a family member or a health professional – before denying it to everyone else, sometimes in response to that reaction.

The principal motivator, she found, was fear: these women were terrified, often for their own survival. There was also a close association between concealed pregnancy and trauma such as child sexual abuse, sexual assault and domestic violence, applicable to 11 of her 30 interviewees.

The remainder reported feeling more silenced by the social stigma of an unplanned pregnancy, fearing retribution or loss of control of their lives. (Although not all her case studies were Irish, Tighe said the country’s cultural resistance to unplanned pregnancies was a factor.) As such concealed pregnancy could be “externally and internally mediated”, says Tighe, one response was to cope by avoidance. “They might get this awareness of ‘Could I be pregnant?’, but they shut it down because a pregnancy, in their current life circumstances, is a really major crisis.”

Often the impact of this was only fully revealed with time, and in many cases therapy. Her interviewees had been reflecting, says Tighe: “Whether it was six years or 30 years after the event, they were looking back and they were ready to talk … It’s like a process of coming to terms.” At the time, however, they might feel only terror. One case study maintained that she had not known that she was pregnant until her third interview.

“We can avoid thoughts – we can push them from our minds,” says Tighe, especially if there are factors such as contraception or other medical explanations that can bolster that denial. One case study, a nurse from rural Ireland, recalled “blocking the thought”. “She said: ‘If I thought I felt a movement, I told myself maybe I had an ovarian cyst.’ She did not want to go there in terms of acknowledging that she was pregnant.”

These women’s desperate measures, says Tighe, are indicative of the need for an empathetic response to concealed pregnancy from healthcare professionals in particular – one that takes into account the lasting impacts of trauma on individuals’ approaches to motherhood. Sensational media reporting, too, did not help women to feel they could come forward.

For those women who had not experienced significant trauma but concealed their pregnancies, Tighe says, having a child was just not part of their “life plan”.

Dollan says that having a baby with her ex-boyfriend, aged 22, was not part of her plan. But she is also unequivocal: she did not know she was pregnant until she was in labour. “I would have had no qualms about telling my family if I did. Obviously, I would have been nervous to tell them – but there would have been a party, you know?”

She is also glowing about the joy that Amelia has brought into her and her mother’s lives. “It’s funny she’s so lively,” she says, “considering I didn’t feel her moving around.”

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What Is Cryptic Pregnancy and Why Does It Happen?

A small minority of people don't know they're expecting until they go into labor. Here's what causes these rare "I didn't know I was pregnant" situations.

How Does a Cryptic Pregnancy Happen?

Causes of cryptic pregnancy, possible complications of cryptic pregnancies.

If you've ever heard of those "I didn't know I was pregnant" stories, you may have reacted with disbelief. If you have ever experienced pregnancy, it might be especially difficult to understand how someone could possibly not know that they are pregnant. After all, pregnancy can come with many different symptoms and some start even before those two pink lines show up ( super sore boobs , anyone?).

But the fact is, there's a small number of people who progress several months into pregnancy (or even all the way until labor begins) without ever realizing there's a baby on the way—a phenomenon known as cryptic pregnancy or stealth pregnancy.

"This type of pregnancy is a rare condition," says Daniel Boyer, MD , a practicing physician with a focus on medical research at the Farr Institute. But Dr. Boyer says that while rare, it does happen. Research shows that 1 in 475 pregnancies can classify as a cryptic pregnancy, meaning the pregnancy isn't discovered until at least 20 weeks. Even more rare, about 1 in 2,500 people don't know they're expecting until delivery.

Learn more about how cryptic pregnancies can happen, as well as the most common causes of "I didn't know I was pregnant" situations.

Generally speaking, a pregnancy is defined as cryptic when the person goes 20 weeks or more without knowing they're pregnant. Here, we've listed some factors that can make a cryptic pregnancy more likely to occur.

Lack of pregnancy symptoms

Often, cryptic pregnancy occurs because the pregnant person has either very mild or no symptoms of pregnancy . While the majority of pregnant people will experience some kind of pregnancy symptoms, most often morning sickness or nausea by 8 to 10 weeks of pregnancy, not all will.

A person may not be aware they are pregnant when they have a cryptic pregnancy because there are no typical pregnancy signs like fatigue, nausea and vomiting, missed period, or abdominal pain, says Rebekah Diamond, MD , a pediatric hospitalist in New York City and assistant professor of pediatrics at Columbia University.

Missed pregnancy symptoms

Cryptic pregnancy can also happen when someone chalks up their symptoms to something other than pregnancy. For instance, early pregnancy fatigue could be mistaken for not sleeping well or being under too much stress. Vomiting, heartburn, and bloating? Digestive issues! Missed period? Just another irregular cycle .

Some pregnant people can even experience bleeding throughout their pregnancies and mistake that bleeding for getting their period.

"A pregnant person can continue to have bleeding that resembles menstrual periods, can have irregular bleeding, or can not have periods but not think of this as a sign they might be pregnant due to having underlying conditions that make their periods very irregular already," says Dr. Diamond.

Unnoticeable baby bump

What about the unmistakable baby bump that usually appears by the middle of pregnancy? As it turns out, bumps aren't always super noticeable, which can make cryptic pregnancy more likely. It's also true that fundal height (the measurement commonly used in pregnancy to assess bump size) is not always directly correlated to fetal size.

"Depending on how the fetus is positioned in the womb , its growth rate, and body weight distributions, [people] experiencing cryptic pregnancies may not show prominent baby bumps," says Dr. Boyer. "This is especially common in younger [people] who are very athletic and are getting pregnant for the first time, because their abdominal muscles have never stretched before as a result of pregnancy, making them even tighter."

Pregnancy bumps may also be less noticeable in individuals with higher weights.

No positive pregnancy test

False negative pregnancy tests definitely aren't common, but they can happen, especially if the test was taken too early or taken improperly . This could certainly cause someone to have a false sense of assurance that they aren't pregnant when, in fact, they actually are.

"The hormone that is positive in a pregnancy test (hCG) is also the hormone that causes a lot of pregnancy symptoms, including nausea," says Dr. Diamond. "So there may be a relationship with people who have false negative pregnancy tests (especially early on) and people who have few or no pregnancy symptoms, as both could be caused by low hCG levels." Further, she says, "Some pregnant people don't think to take a test at all because they do not have signs or symptoms."

While cryptic pregnancy can happen to anyone, it sometimes has a logical explanation. This can range from hormonal conditions to contraceptive methods to life changes. Dr. Boyer shares some possible causes of cryptic pregnancy.

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) may impact your fertility. PCOS often causes irregular periods, weight gain, excessive oiliness of the skin, and digestive issues. Someone with PCOS may dismiss pregnancy symptoms as symptoms of the syndrome and not realize that they have conceived.

Perimenopause

Pregnancy and perimenopause (a transition into menopause) have some overlapping symptoms, such as weight gain and mood changes. Pregnant people may think they're beginning a new stage of life instead of expecting a child. It's important to realize that it is possible to get pregnant during perimenopause, even if you have an irregular cycle.

Birth control use

Intrauterine devices (IUDs) and birth control pills are very effective at preventing pregnancy, but it's still possible to conceive while using these contraceptive methods. If that happens, a person may have a false sense of security, not realizing they're actually pregnant until they're far into gestation.

High levels of physical activity

People who participate at high levels of physical activity may be less likely to sport an obvious baby bump until later in pregnancy. Female athletes may also have higher muscle mass and lower body fat levels, which could lead to irregular cycles that may cause them to not think twice about a missed period.

History of infertility

If someone has had an infertility diagnosis in the past, they might not think it's possible for them to conceive. Additionally, if they have never experienced pregnancy, they may not be on the lookout for symptoms or realize what pregnancy symptoms may be like.

Early postpartum and lactation

Similarly, people who are breastfeeding or recently gave birth might dismiss pregnancy symptoms if they think ovulation hasn't returned yet. While fertility can be delayed because of breastfeeding , conception is possible as soon as ovulation resumes, which can happen at any time after giving birth.

In rare cases, a cryptic pregnancy occurs because the pregnant person is in denial or is experiencing a mental health issue.

"Some cases of cryptic pregnancy occur in the setting of mental illness (and denying that one is pregnant despite signs of pregnancy is a more prominent feature), but this is not the case by any means for most cryptic pregnancies," says Dr. Diamond.

Because cryptic pregnancies progress without proper medical care or prenatal vitamins , they come with an increased risk of complications for the pregnant person and the fetus. Fetal abnormalities and maternal health conditions (like preeclampsia or gestational diabetes) might go unnoticed.

The pregnant person might also use alcohol or drugs, which aren't considered safe while expecting. Unnoticed pregnancies have been associated with a higher risk of prematurity, low birth weight, hospitalization, unattended delivery, and death.

A new parent's mental health might also be affected by cryptic pregnancy, especially if they aren't prepared for a baby, which can lead to child abuse or neglect, disassociation from the baby, depression, and other signs of psychological distress.

Key Takeaways

While cryptic pregnancies may be hard to comprehend, they do happen. It's important to seek medical care if you experience any unexplained pregnancy-related symptoms—even if you received a negative home pregnancy test. While cryptic pregnancy is rare, it's important to rule it out to ensure you get the medical care you need.

Cryptic pregnancy . Case Reports in Women's Health . 2023.

The onset of nausea and vomiting of pregnancy: a prospective cohort study . BMC Pregnancy Childbirth . 2021.

Patterns and predictors of vaginal bleeding in the first trimester of pregnancy . Ann Epidemiol. 2010.

Measurement of symphysis fundal height for gestational age estimation in low-to-middle-income countries: A systematic review and meta-analysis . PLoS One . 2022.

Absence of menstruation in female athletes: why they do not seek help . BMC Sports Sci Med Rehabil . 2021.

A case report involving the experience of pervasive pregnancy denial: detailed observation of the first 12 postpartum weeks . BMC Psychiatry . 2022.

Prenatal care . Office on Women’s Health. 2021.

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Pregnancy Denial: Toward a New Understanding of the Underlying Mechanisms

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• Published: 19 August 2023
• Volume 25 , pages 493–500, ( 2023 )

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• Natalia Chechko 1 , 2 , 3 ,
• Elena Losse 1 , 3 &
• Susanne Nehls 1 , 2 , 3  

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Purpose of Review

Pregnancy denial is the lack of awareness of being pregnant. The aim of the review is to understand why the affected women do not recognize the signs of pregnancy.

Recent Findings

Twelve case reports of pregnancy denial were published in the last ten years. While in five cases the women had an underlying mental disorder, the rest of the cases involved women who either exhibited no physical symptoms or perceived themselves to be not pregnant despite the symptoms (i.e., repression mechanisms).

Pregnancy denial is considered to be a pathological issue, a likely consequence of trauma, the wish to not have a child, or a psychiatric problem. However, it appears that the majority of cases cannot be linked to any of the above reasons. We argue, therefore, that, in most cases, pregnancy denial is not associated with mental or physiological problems. Under certain circumstances, it can affect any woman.

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Introduction

The acceptance of the state of being pregnant, the attachment to the fetus, preparatory activities, and a realistic perception of the newborn are all part of normal adjustments to pregnancy [ 1 ]. Some women, however, remain unaware of being pregnant after 20 weeks of gestation, and sometimes even until delivery.

Known as pregnancy denial, this is not a rare phenomenon. More common than, for instance, rhesus hemolysis, or uterine rupture [ 2 ], pregnancy denial after the 20th week of gestation has a frequency of 1:300–516 pregnancies in epidemiological and non-epidemiological studies across Europe and the USA [ 2 , 3 , 4 , 5 ••, 2 , 6 , 7 ], making it more common than triplets [ 2 ].

In addition to the time-based criterion for the resolution of pregnancy denial, Miller [ 8 ] and Friedman et al. [ 4 ] have proposed circumstantial criteria based on a qualitative classification. In what they refer to as affective denial, the pregnancy is acknowledged intellectually, but its emotional significance is downplayed in such a way that the pregnant woman continues her life as though she were not pregnant. In pervasive denial, on the other hand, the woman does not acknowledge her pregnancy either emotionally or intellectually. Psychotic denial leads women to misinterpret the relevant physical changes in a delusional manner, perceiving them as blood clot, some form of cancer, or loose organs. Often surfacing and disappearing during pregnancy, this form of denial may be preceded or exacerbated by identifiable stressors. Typically, women with psychotic denial have a comorbid psychiatric illness and tend not to conceal their pregnancies. Also, people around them are unlikely to be complicit in their denial [ 8 , 9 ].

The denial of pregnancy can be considered an emotion-driven strategy in the face of circumstances perceived as unalterable [ 8 ], with avoidance rather than acknowledgment being seen as the more viable option [ 10 ]. For those with cultural or family stigmatization of sexuality, or with a history of sexual trauma, embracing the reality of pregnancy can be difficult [ 8 ]. Although pregnancy denial and subsequent neonaticide resulting from the experience of trauma such as incest, rape, or even early trauma, have long been under the spotlight [ 11 , 12 ], such cases appear to be quite rare. In epidemiological and non-epidemiological studies related to pregnancy denial, trauma histories are either not reported at all or are present only minimally [ 4 , 7 , 13 ••, 14 ]. According to Delong et al. [ 13 ••], women with pregnancy denial are more likely to have had a psychiatric history (23% of women with pregnancy denial reported to have a psychiatric history compared to 8% of their counterparts in the control group). However, the majority of women were mentally healthy. Thus, pregnancy denial is not as closely associated with trauma or other psychiatric conditions as it is assumed to be. The other relevant risk factors are relatively young age, low level of education, precarious work situation, and being single [ 13 ••]. However, none of these factors appears specific enough to explain such a dramatic event as pregnancy denial.

The aim of this review was to fully understand the heterogeneity of the phenomenon. In addition, we sought to explore why the affected women, who may be otherwise healthy, do not recognize the signs of being pregnant. What exactly may underlie this lack of pregnancy awareness? To address this question, we collated information from case reports published over the past 10 years, outlining the circumstances prior to and during the denial, as well as the reported reasons thereof: psychiatric status, pregnancy due to a traumatic experience, possible conflict situations and the benefits of assumed non-pregnancy, denial due to personality, and denial as a common defense mechanism in life.

Peer-reviewed and published articles related to key terms around “pregnancy denial,” “cryptic pregnancy,” “stealth pregnancy,” and “unperceived pregnancy” were retrieved from major databases such as PubMed, Web of Science, and Google Scholar. The reference lists of relevant articles were also scanned for additional material pertaining to similarities in symptom presentation across demographic profiles. All seminal research from 2013 to current publications in 2023 was reviewed. Papers were excluded if they were not available in English or if they did not contribute to identifying consistencies in the clinical presentations of pregnancy denial. The included articles are listed in Table  1 .

Denial Related to a Psychiatric Condition

In the past decade, five case reports were published describing women with pregnancy denial likely due to a preexisting mental disorder (see Table 1 ) [ 9 , 15 , 16 , 17 , 18 ]. Of these, three cases involved psychotic denial, each one of which had a diagnosis of schizophrenia before the onset of pregnancy [ 16 , 17 ], or a novel psychotic episode in the context of a pre-existing mental disorder [ 9 ]. Of interest is the case of one of these women who had a history of pseudocyesis (false pregnancy) [ 17 ], a condition characterized by her belief that she was pregnant despite evidence to the contrary [ 19 ]. Two women denied their pregnancy twice: one with an unspecified mental disorder (aged 26 and 29 years) [ 15 ] and the other with an intellectual disability and additional borderline personality (aged 17 and 22 years) [ 18 ].

Given the underlying psychiatric condition, it is difficult to determine how many of these women were truly unaware of their pregnancy. Reality displacement occurs during psychotic symptoms associated with schizophrenia and depression. A misinterpretation and misjudgment of reality may result in the denial of pregnancy in one moment and a likely acceptance of it in the next. Therefore, it is difficult to determine whether pregnancy denial is an independent entity existing alongside a psychiatric disorder, or if it is another symptom of the same.

While pregnancy denial undoubtedly challenges the psychological functioning of mothers, in general, psychiatric disorders have been found to be linked to only a small number of cases. Thus, it seems not to be a primary feature of pregnancy denial, which can occur without any clinical manifestation of psychiatric disorder [ 2 , 13 ••].

Denial Related to (Early) Trauma

Being pregnant can trigger the return of traumatic memories, causing the mind to repress the somatic cues of pregnancy [ 11 ]. Dissociative symptoms have a close link to trauma, playing a key role during and after labor and delivery [ 20 •]. The trauma can ensue from an early attachment trauma, a history of physical or sexual abuse, as well as trauma associated with the conception of the denied pregnancy, or a combination thereof [ 1 , 11 , 20 •].

Narlesky et al. [ 17 ] described a woman with preexisting schizophrenia and history of pseudocyesis who, as a child, had been sexually abused by her brother (see Table  1 ). In the case described by Jimenez et al. [ 21 ], the woman experienced a tumultuous upbringing marked by an alcoholic father and violence between the parents. Even though the patient denied a trauma history, the authors attributed her denial of pregnancy to her family history and avoidant behavior [ 21 ]. None of the other case reports published in the last 10 years reported traumatic life events.

Denial Related to a Conflict Situation, Denial as an Unconscious Defense Mechanism, and the Benefits of Assumed Non-pregnancy

Based on the notion of parent–child conflict [ 22 ], pregnancy can be viewed as a conflict between the mother and the fetus, involving the fetus’ demands and the mother’s willingness to care, with both trying to protect their individual interests [ 23 •]. Severe external stress and internal conflict may cause a woman to use inappropriate defense mechanisms and not accept the underlying reality of her pregnancy. From the psychodynamic point of view, denial may also be seen as a repression mechanism with unconscious blocking of unpleasant emotions, impulses, memories, and thoughts from the conscious mind [ 24 ]. In an unchangeable situation [ 8 ], a woman’s subconscious decision in favor of her interests, to the detriment of those of the child [ 23 •], may be an emotion-focused survival strategy.

We identified two case reports in which the protection of individual interests was the likely reason behind pregnancy denial (see Table  1 ) [ 25 , 26 ]. The women did not recognize they were pregnant until the onset of labor/delivery. One, who was 19 years of age, admitted that pregnancy would have been catastrophic for her, potentially forcing her to commit suicide, if she had discovered the pregnancy before delivery [ 25 ]. The other, a 21-year-old woman, was in an emotionally stressful situation after the death of her grandfather and was also preparing for a major change in her life situation by leaving her social environment through a student exchange program [ 26 ]. From a psychoanalytical point of view, it may be safe to assume that repression mechanisms likely played a role in both cases.

Denial Related to the Missed Sign of Being Pregnant

Not recognizing one’s own pregnancy can be due to insufficient cues. While it is not scientifically proved, there is anecdotal evidence of midwives hearing women say that they “didn’t realize” they were pregnant. In most of these cases, there seem to be no underlying psychological or psychiatric problems. In three of the reported cases that fit into this category, the women were 38 years and older and already had multiple children (one woman with eight children, one with three, and one with seven children; see Table  1 ) [ 21 , 27 , 28 ]. Only in one case, the woman was 25 years old, but already had a child [ 29 ], and one case involved a 28-year-old primiparous woman (see Table  1 ) [ 30 ]. The last two of these cases, and the one described by Chechko et al. [ 28 ] involved women with stable socioeconomic backgrounds, stable partnerships, and no exceptional life situations. Nanjundaswamy et al. [ 30 ] described a woman exhibiting little empathy and problems with emotion regulation, while the one described by Chechko et al. [ 28 ] showed decreased self-awareness and an inability to recognize her own feelings. In contrast, Jimenez et al. [ 21 ] and Struye et al. [ 27 ] presented women with more challenging backgrounds. The case described by Jimenez et al. [ 21 ] involved a woman who visited her daughter with leukemia in the hospital, had frequent involvements with child welfare services (with seven children), and was in a distant relationship with her husband who accused her of extramarital affairs. In addition, she had suffered from trichotillomania for 20 years, which, however, appeared to have been unproblematic for her. The case reported by Struye et al. [ 27 ] involved a woman currently living with her intimate partner and three children, while three of her other children had been placed for adoption. The woman had grown up in a strictly conservative home where the subjects of sex and sexuality were taboo. She was also described as a person who tended to ignore and forget problems, hoping they would resolve themselves. Thus, in these cases, the women had an elevated threshold with respect to the recognition of emotional and possibly also body-related cues, resulting in a generally reduced self-awareness.

The literature search yielded 12 cases covering women who denied their pregnancies with various background characteristics (see Table  1 ). In five cases, the women had an underlying mental disorder (of which four had psychotic symptoms and one reported trauma in childhood); in two cases, the women had short-term benefits, given their circumstances, from perceiving themselves as not pregnant. In those cases, the women exhibited a general tendency toward using denial as a defense mechanism, which had been facilitated by the lack of physical symptoms. In the remaining five cases, the women appeared to be utterly convinced that they could not be pregnant, and thus did not experience the signs or symptoms of pregnancy. Although the pregnancy denial cases belonging to this category are more common than others, most of them do not get published, presumably because they are not spectacular enough in comparison to those in which psychiatric condition or trauma play a role. Since it is a fairly common phenomenon, we are of the opinion that the highest priority should be given to determining why healthy women frequently living with their partners deny their pregnancies.

Recognizing pregnancy usually involves noticing the symptoms associated with early pregnancy (e.g., absence of periods, tender, swollen breasts, nausea with or without vomiting, increased urination, and fatigue). However, with the exception of amenorrhea, none of these symptoms is a definite sign of pregnancy, which means that women with irregular menstruation, or those who use contraceptives or have bleeding during pregnancy, are more prone to overlooking the ambiguous symptoms and, thus, not recognizing the state of being pregnant. In the prospective case–control study by Delong et al. [ 13 ••], most denied pregnancies occurred while using a contraceptive method, mainly an oral contraceptive. An association between oral contraceptive and pregnancy denial has been described in a number of cases [ 26 , 28 , 29 ]. In denied pregnancies, the physiological symptoms (nausea, amenorrhea, increased breast size, abdomen swelling, weight gain) are often either absent or greatly reduced [ 3 , 13 ••, 14 ], which was the case in most of the reports here [ 21 , 27 , 28 , 29 ]. But do pregnant women have to have symptoms that clearly indicate that they are pregnant? In fact, none of the early pregnancy symptoms (e.g., nausea or vomiting, swollen breasts) is obligatory even though each one is clearly linked to hormonal fluctuations [ 31 ]. In general, the sensitivity to hormonal fluctuations is highly individualized and has been found to depend on a number of personal and biological factors, with some women showing both physical and emotional responses to endocrine changes (e.g., premenstrual syndrome or postpartum baby blues) and others showing no response at all [ 32 ]. Overall, previous studies have suggested that women with insufficient cues are more likely to be unaware that they are pregnant. According to Delong et al. [ 13 ••], pregnancy denial may occur in a particular life circumstance in which pregnancy may not be consciously perceived by some women. Women with pregnancy denial may also have a different perceptual threshold with respect to pregnancy symptoms: They are not focused on getting pregnant because they often believe that pregnancy is not possible [ 13 ••]. Because of their conviction that they cannot, or are not allowed to, become pregnant (as in the cases described by Nto-Ezimah et al. [ 25 ] and Şar et al. [ 26 ]), women often do not pay attention to the signs of pregnancy. These women may also have a tendency toward paying less attention to bodily symptoms in general and have a decreased sense of self-awareness in terms of their own feelings [ 28 ]. It is often impossibly difficult to explain why and how pregnancy remains unrecognized [ 28 ]. The concept of “somatic denial” may shed some light on this phenomenon. The so-called silhouette effect, characterizing the absence of abdominal swelling [ 33 ], suggests a possible somatic denial of pregnancy, the absence of a typical pregnant belly hiding the fact of pregnancy from consciousness [ 18 , 26 ]. Also, menstruation-like bleeding is frequently reported in denied pregnancy [ 15 , 18 , 21 , 25 , 27 , 28 ]. Nausea is found to be suffered most rarely by women who are unaware of pregnancy until delivery [ 2 ].

The underlying mechanisms, however, are not yet understood. The frequently reported correlation of human chorionic gonadotropin (hCG) with nausea and vomiting suggests that women affected by pregnancy denial have lower levels of hCG [ 20 •, 23 •, 19 ]. However, there is a lack of solid scientific data to support this assumption. As it is, even the relationship between hormonal status and vomiting/nausea is debatable [ 31 ].

On the other hand, during pregnancy, the physiological and homeostatic mechanisms of the female body change to meet the needs of the fetus [ 34 ]. For most women, these changes make it impossible for them to not notice their pregnancy. The experience of pregnancy-related symptoms may also have adaptive functions, likely serving to protect the fetus. For example, morning sickness may prevent a pregnant woman from ingesting foods that may be harmful to her or the fetus at a time when its organ systems are developing [ 35 ]. Considering pregnancy as an evolutionary strategy with costs and benefits for parents and offspring, the relevant symptoms are based on maternal costs, benefitting the offspring [ 36 ]. Thus, pregnancy denial may occur when it is more beneficial for a woman to perceive herself as not pregnant and therefore not experience the symptoms, a decision albeit made subconsciously. While denied pregnancies are sometimes associated with harmful side effects for the fetus (e.g., low birth weight, prematurity), the mother benefits greatly by incurring only a fraction of the costs normally associated with pregnancy [ 23 •].

Viewed from an evolutionary perspective, this phenomenon may also be seen as an adaptive mechanism, which forces cooperation between mother and fetus under circumstances that may be stressful or threatening. In this regard, the fetus also profits with the mother reducing her investment to ensure survival and the accomplishment of delivery [ 23 •]. In this context, drawing a parallel between the human and animal worlds may be of interest. While in animals there is no pregnancy denial per se, infanticide can be seen as a precursor to it. In mammals, infanticide by females is common when conditions are harsh, and it is particularly costly to have offspring. Thus, infanticide may enable females to derive significant benefits by helping reduce their costs [ 37 ].

Furthermore, psychological factors in relation to the recognition of pregnancy seem to play an important role. The likelihood of pseudocyesis, or false pregnancy, is a demonstration of this fact. False pregnancy is a condition in which, despite all the physical signs and symptoms of pregnancy, no child is carried [ 38 ]. Women with pseudocyesis have not only been seen to have altered neuroendocrine mechanisms, causing amenorrhea, and abdominal swelling [ 19 ], some have even reported feeling fetal movements [ 19 ]. The reason behind this is that, in some cases, the body simulates pregnancy as a way of coping. For instance, false pregnancy has been seen in women who desperately want to become pregnant, or those who mourn the loss of reproductive ability [ 19 , 39 ]. A comparison between the characteristics of false and denied pregnancies has revealed that, with few exceptions, most women are between 20 and 40 years of age, married or are in stable relationships, have had previous pregnancies, and are in relatively good psychological health [ 20 •, 40 ]. Thus, false pregnancy and pregnancy denial, despite opposite outcomes, have enough in common to represent the two ends of the spectrum of pregnancy-related delusions [ 20 •]. The case described by Narlseky et al. [ 17 ] involves a woman with a psychotic pregnancy denial as well as a history of pseudocyesis, indicating that the two phenomena may be part of the same continuum.

Interestingly, nonpsychotic women who are confident they are not pregnant manage to convince their family members, and even their sexual partners, that they are not pregnant [ 25 , 28 , 30 ]. In some cases, as the ones described by Nanjundasmay et al. [ 30 ], Nto-Ezimah et al. [ 25 ], and Chechko et al. [ 28 ], even treating physicians have been reported to attribute complaints and symptoms to abdominal pain or other somatic problems [ 8 , 41 ]. That even partners can deny having suspected pregnancy suggests that others’ perception of pregnancy is strongly linked to the women’s behavior. Thus, women are perceived as pregnant only when they “signal” this to the environment. This decision can be made by a woman subconsciously, in favor of their benefits [ 36 ], based on the demands of their situation. On the other hand, some women seem not to notice the symptoms due to their diminished capacity of self-awareness. In this context, the concept of “somatic denial” should be explored further. Finally, a somewhat diffuse interface between conscious coping strategies and unconscious defense mechanisms appears to underlie the individual dynamics in pregnancy denial [ 14 ]. Given the large number of factors (including physiological factors) that contribute to the condition, it is impossible to explain the phenomenon in all its complexity. Women with pregnancy denial have been found to belong to a heterogeneous constituency, precluding any clear explanation as to why they deny their pregnancy or what type of women may be prone to pregnancy denial. Thus, the reported cases cannot be condensed into a simple classification and explained by means of a single psychological model.

According to the literature, pregnancy denial is a pathological issue, a likely consequence of some trauma, the wish to not have a child (defense mechanism possibly triggered by trauma), or a psychiatric problem of a different origin. However, given that the majority of cases cannot be clearly linked to any of the above reasons, we argue that the phenomenon cannot be put in any particular category as it is not always associated with mental or physiological problems. Under certain circumstances, it can affect any woman. Therefore, it is important for gynecologists as well as general practitioners to be more aware of this phenomenon so that they can conduct appropriate investigations when pregnancies are suspected by them, despite the patients’ categorical denial of the fact.

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Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

Spielvogel AM, Hohener HC. Denial of pregnancy: a review and case reports. Birth. 1995;22:220–6.

Article   CAS   PubMed   Google Scholar  

Wessel J, Buscher U. Denial of pregnancy: population based study. BMJ : Brit Med J. 2002;324:458.

Article   PubMed   PubMed Central   Google Scholar  

Brezinka C, Brezinka C, Biebl W, Kinzl J. Denial of pregnancy: obstetrical aspects. J Psychosom Obstet Gynecol. 1994;15:1–8.

Article   CAS   Google Scholar  

Friedman SH, Heneghan A, Rosenthal M. Characteristics of women who deny or conceal pregnancy. Psychosomatics. 2007;48:117–22.

Article   PubMed   Google Scholar  

•• Simermann M, Rothenburger S, Auburtin B, Hascoët JM. Outcome of children born after pregnancy denial. Arch Pediatrie. 2018;25:219–22. This article sheds light on children’s development over 2 years, laying grounds for the establishment of appropriate care programs.

Nirmal D, Thijs I, Bethel J, Bhal PS. The incidence and outcome of concealed pregnancies among hospital deliveries: an 11-year population-based study in South Glamorgan. 2009;26:118–121.

Wessel J, Endrikat J, Büscher U. Frequency of denial of pregnancy: results and epidemiological significance of a 1-year prospective study in Berlin. Acta Obstet Gynecol Scand. 2002;81:1021–7.

Miller LJ. Denial of pregnancy. In: Spinelli MG, editor. Infanticide : psychosocial and legal perspectives on mothers who kill. Arlington: American Psychiatric Publishing; 2003. p. 81–104.

Google Scholar  

Chase T, Shah A, Maines J, Fusick A. Psychotic pregnancy denial: a review of the literature and its clinical considerations. J Psychosom Obstet Gynecol. 2021;42:253–7.

Article   Google Scholar  

Murphy Tighe S, Lalor JG. Concealed pregnancy: a concept analysis. J Adv Nurs. 2016;72:50–61.

Bonnet C. Adoption at birth: prevention against abandonment or neonaticide. Child Abuse Negl. 1993;17:501–13.

Spinelli MG. A systematic investigation of 16 cases of neonaticide. Am J Psychiatry. 2001;158:811–3.

•• Delong H, Eutrope J, Thierry A, et al. Pregnancy denial: a complex symptom with life context as a trigger? A prospective case–control study. BJOG. 2022;129:485–92. This recent prospective study includes mother-child dyads with and without pregnancy denial and demonstrates risk factors.

Beier KM, Wille R, Wessel J. Denial of pregnancy as a reproductive dysfunction: a proposal for international classification systems. J Psychosom Res. 2006;61:723–30.

Schultz MJ, Bushati T. Maternal physical morbidity associated with denial of pregnancy. Aust N Z J Obstet Gynaecol. 2015;55:559–64.

Dua D, Grover S. Delusion of denial of pregnancy: a case report. Asian J Psychiatr. 2019;45:72–3.

Narlesky MR, Rasul F, Braaten S, Powell A, Wooten RG. Denial of pregnancy in a patient with a history of pseudocyesis. Cureus. 2021;13:11–5.

Sablone S, Margari A, Introna F, Catanesi R, Mandarelli G. Denial of pregnancy and neonaticide: a historical overview and case report. J Forensic Sci. 2023. https://doi.org/10.1111/1556-4029.15202 .

Tarín JJ, Hermenegildo C, García-Pérez MA, Cano A. Endocrinology and physiology of pseudocyesis. Reprod Biol Endocrinol. 2013;11:39.

• Kenner WD, Nicolson SE. Psychosomatic disorders of gravida status: false and denied pregnancies. Psychosomatics. 2015;56:119–28. This review article sheds light on physiological processes associated with pregnancy denial.

Jimenez XF, Salerno KE, Funk MC. Trichotillomania and trauma: dissociation and alexithymia in a case of pregnancy denial. Journal of Nervous and Mental Disease. 2015;203:971–4.

Trivers RL. Parent-offspring conflict. Integr Comp Biol. 1974;14:249–64.

• Del Giudice M. The evolutionary biology of cryptic pregnancy: a re-appraisal of the “denied pregnancy” phenomenon. Med Hypotheses. 2007;68:250–8. This article features an alternative, evolutionary explanatory approach for pregnancy denial.

Cramer P. Defense mechanisms. The Corsini Encyclopedia of Psychology. 2010. https://doi.org/10.1002/9780470479216.corpsy0254 .

Nto-Ezimah UA, Nto NJ, Esom EA, Okwor CJ, Adiri C. Unexpected delivery: a case report of cryptic pregnancy in nigeria. Pan African Medical Journal. 2020;36:1–5.

Şar V, Aydın N, van der Hart O, Steven Frankel A, Şar M, Omay O. Acute dissociative reaction to spontaneous delivery in a case of total denial of pregnancy: diagnostic and forensic aspects. J Traum Dissoc. 2017;18:710–719.

Struye A, Zdanowicz N, Ibrahim C, Reynaert C. Can denial of pregnancy be a denial of fertility? A case discussion. Psychiatr Danub. 2013;25:113–7.

Chechko N, Losse E, Stickel S. A case report involving the experience of pervasive pregnancy denial : detailed observation of the first 12 postpartum weeks. BMC Psychiat. 2022;1–9.

Di Giacomo E, Calabria M, Colmegna F, Fotiadou M, Pucci B, Vergani P, Clerici M. Pregnancy denial or concealement: a case report highlighting risks and forensic aspects. Aust N Z J Psychiatry. 2016;50:924–5.

Nanjundaswamy MH, Gaddapati S, Thippeswamy H, Thampy M, Vaiphei K, Kashyap H, Kishore T, Ganjekar S, Chandra PS. Denial of pregnancy: psychopathology and clinical management. Psychopathology. 2019;52:271–4.

Lee NM, Saha S. Nausea and vomiting of pregnancy. Gastroenterol Clin North Am. 2011;40:309.

Luciano M, Sampogna G, Del Vecchio V, Giallonardo V, Perris F, Carfagno M, et al. The transition from maternity blues to full-blown perinatal depression: results from a longitudinal study. Front Psychiatry. 2021;12:1871.

Sandoz P. Reactive-homeostasis as a cybernetic model of the silhouette effect of denial of pregnancy. Med Hypotheses. 2011;77:782–5.

Kumar P, Magon N. Hormones in pregnancy. Niger Med J. 2012;53:179.

Flaxman SM, Sherman PW. Morning sickness: a mechanism for protecting mother and embryo. Q Rev Biol. 2000;75:113–48.

de la Rosa LN, Pavličev M, Etxeberria A. Pregnant females as historical individuals: an insight from the philosophy of evo-devo. Front Psychol. 2021;11:3741.

Lukas D, Huchard E. The evolution of infanticide by females in mammals. Philosophical Transactions of the Royal Society B: Biological Sciences. 2019. https://doi.org/10.1098/RSTB.2018.0075 .

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). 2013.  https://doi.org/10.1176/appi.books.9780890425596.744053

Azizi M, Elyasi F. Biopsychosocial view to pseudocyesis: a narrative review. Int J Reprod Biomed. 2017;15:535.

Rosch DS, Sajatovic M, Sivec H. Behavioral characteristics in delusional pregnancy : a matched control group study. 2002;32:295–303.

Wessel J, Endrikat J, Kästner R. Projective identification and denial of pregnancy–considerations of the reasons and background of unrecognized pregnancy also undiagnosed by a physician. Z Geburtshilfe Neonatol. 2003;207:48–53.

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Chechko, N., Losse, E. & Nehls, S. Pregnancy Denial: Toward a New Understanding of the Underlying Mechanisms. Curr Psychiatry Rep 25 , 493–500 (2023). https://doi.org/10.1007/s11920-023-01448-2

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What Is a Cryptic Pregnancy?

Medical review policy, latest update:, what is a cryptic pregnancy, how does a cryptic pregnancy happen, who is more likely to have a cryptic pregnancy, what are the symptoms of a cryptic pregnancy, is a cryptic pregnancy dangerous for the baby or the mother, does a baby born after a cryptic pregnancy need special treatment.

While moms-to-be who don’t realize they’re pregnant can have healthy babies, it’s always better to get excellent prenatal care to minimize the risks and increase the chances of a healthy baby. If you notice any unusual symptoms, weight gain or period changes, give your doctor a call.

What to Expect When You're Expecting , 5th edition, Heidi Murkoff. WhatToExpect.com, 14 Early Pregnancy Signs and Symptoms , July 2021. WhatToExpect.com, Your Pregnant Belly Size and Shape , June 2021. WhatToExpect.com, What Is a Phantom Pregnancy? , March 2022. American College of Obstetricians and Gynecologists, Morning Sickness: Nausea and Vomiting of Pregnancy , December 2021. American College of Obstetricians and Gynecologists, Progestin-Only Hormonal Birth Control: Pill and Injection , October 2020. American Psychological Association, APA Dictionary of Psychology, Defense Mechanism . American Psychological Association, APA Dictionary of Psychology, Denial . Mayo Clinic, Perimenopause , August 2021. National Institutes of Health, National Library of Medicine, Not Your Average Birth: Considering the Possibility of Denied or Concealed Pregnancy , May 2014. National Institutes of Health, National Library of Medicine, Denial of Pregnancy — A Literature Review and Discussion of Ethical and Legal Issues , July 2011. Obstetrics & Gynaecology , Denial of Pregnancy: Characteristics of Women at Risk , December 2010. Planned Parenthood, Birth Control Shot .  

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How to Diagnose a Cryptic Pregnancy

Last Updated: May 15, 2023 Fact Checked

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This article was medically reviewed by Erik Kramer, DO, MPH . Dr. Erik Kramer is a Board-Certified Primary Care Physician at the University of Colorado. With over 15 years of experience, his clinical interests include obesity and weight management, diabetes care, and preventive care, as well as embracing a holistic approach to primary care. He received his Doctorate in Osteopathic Medicine (D.O.) from the Touro University Nevada College of Osteopathic Medicine and completed his residency at Central Maine Medical Center. Dr. Kramer is a Diplomate of the American Board of Obesity Medicine. There are 11 references cited in this article, which can be found at the bottom of the page. This article has been fact-checked, ensuring the accuracy of any cited facts and confirming the authority of its sources. This article has been viewed 64,736 times.

A cryptic pregnancy happens when you don't realize that you are pregnant until several weeks or months in. Recent studies show that as many as 1 in 475 women may experience a cryptic pregnancy at some point in their lives. [1] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source You may be especially at risk for a cryptic pregnancy if you think you can't become pregnant, or if you have PCOS, endometriosis, or are experiencing perimenopause. Having an irregular period and experiencing bleeding or spotting during pregnancy can lead you to believe that you aren't pregnant. If you notice any symptoms of pregnancy, take a test as soon as possible so you can take healthy steps going forward.

• You may also notice other changing symptoms when you are bleeding, such as more or less pain, a shorter or longer period of bleeding, or a change in the color of your blood. All of these could mean you are pregnant.

• Remember that morning sickness doesn't necessarily happen in the morning. It could happen at any time of day.

• Also look for changes in the breasts, like swelling, a change in sensitivity, heaviness, or a darkening of the areola (the area around your nipple).

• Tender breasts, increased urination, bloating, cramping, and constipation can also be signs of pregnancy.

• A pregnancy test may show a false positive if you experience a pregnancy loss soon after taking the test, if you take a fertility drug with HCG, or if you are experiencing menopause, an ectopic pregnancy, or problems with your ovaries.
• A pregnancy test may show a false negative if you take the test too early, read the results before the test is done working, or use diluted urine. For the most accurate results, take the test first thing in the morning a 2-3 days after you think you missed your period.
• A home pregnancy test is not as accurate after the first trimester. [7] X Research source
• If you have any doubt about whether you may be pregnant, see your healthcare provider. They can test for pregnancy hormones in your urine and blood. Your doctor can also determine the quantity of any pregnancy hormones that are present, which will help them evaluate the health and progress of the pregnancy.

• Depending on how early they suspect you are in the pregnancy, your doctor may not recommend an ultrasound right away. While a pregnancy may be visible on an ultrasound as early as 4 ½ weeks, you could get a false negative if the test is done too early.
• Your doctor may also order a blood test to confirm whether or not you are pregnant.
• Conditions such as retroversion of the uterus, a bicornuate uterus, or scar tissue in the uterus can make it difficult to tell for sure if you are pregnant using an ultrasound.

• These tests can help tell if you are experiencing an ectopic pregnancy or other serious complications.

• If you have PCOS and recently lost weight and reduced your insulin levels, pregnancy is more likely.
• Also see a doctor if you have other conditions that affect your periods and reproductive health, like endometriosis, and you experience pregnancy symptoms.

• Look for symptoms that you experienced during your recent pregnancy. If you suspect there is even the smallest chance you could be pregnant, take a test as soon as possible.
• Don’t rely on breastfeeding as a form of birth control after pregnancy. While it can reduce your chances of getting pregnant again, it isn’t completely reliable.

• You and the fetus may be at risk for more complications if you are at the age of perimenopause. Take a pregnancy test as soon as possible so that you can talk to a doctor about steps you can take to reduce those risks.

• Hormonal birth control can harm a fetus, so find out as soon as possible if you are pregnant to reduce risk of complications.

• Even though it can be frightening to face the possibility of a pregnancy, it's better to know sooner rather than later if you are pregnant so that you can prepare yourself physically and mentally and make healthy choices.
• Stress can also cause hormone levels to fluctuate. Confirm the result of your home pregnancy test with an ultrasound.

Expert Q&A

• People with low body fat, like athletes, or people who have extreme weight fluctuations can experience irregular periods and may not know if they are pregnant. Thanks Helpful 0 Not Helpful 0
• Some myths claim that cryptic pregnancies can last up to 2 or even 5 years, but this is not true. Even if you didn't know you were pregnant until very late, the pregnancy will still last around 40 weeks total. Thanks Helpful 0 Not Helpful 0

You Might Also Like

• ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039772/
• ↑ https://health.clevelandclinic.org/can-you-be-pregnant-and-not-know-it/
• ↑ https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/signs
• ↑ https://health.clevelandclinic.org/5-reliable-early-pregnancy-signs/
• ↑ https://kidshealth.org/Nemours/en/parents/pregnancy.html#kha_13
• ↑ https://my.clevelandclinic.org/health/articles/9703-pregnancy-tests
• ↑ https://www.plannedparenthood.org/learn/pregnancy/pregnancy-tests
• ↑ https://medlineplus.gov/lab-tests/doppler-ultrasound/
• ↑ https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/
• ↑ https://www.ncbi.nlm.nih.gov/pubmed/21446106
• ↑ https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-signs-and-symptoms

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