But, even though we’ve determined that we can’t blame mental illness for denied pregnancies, we’ve also yet to discover a truly satisfying explanation for this phenomenon. Some have posited that denied pregnancies are driven by suppressed beta-human chorionic gonadotropin (hCG) production, which, in turn, is an adaptive response to resource scarcity,4 but these results haven’t been widely replicated and the causative chain seems somewhat tenuous. 

At the same time, though, it seems clear that denied pregnancies aren’t completely random; for instance, they occur more frequently among younger and older patients, which makes sense since these groups are also more likely to experience irregular menstrual periods.

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And also know that denied pregnancies don’t happen without consequences. By definition, these pregnancies do not receive any of the antenatal care provided in the vast majority of pregnancies. This leads not only to increased rates of intrapartum complications, but probably also allows relatively manageable conditions (like pre-eclampsia) to progress to more urgent ones (like eclampsia).

The absence of medical supervision probably also partially explains why denied pregnancies more frequently result in stillbirths, low birth weights, and birth defects — although one would intuitively expect the type of pregnancy that produces such minimal physical changes as to go unnoticed would frequently result in small or unhealthy children, regardless of whether mom was being followed by an obstetrician not.

When we hear hoof beats, we’re taught to think of horses — not zebras or subjective denial of a full-term pregnancy. And on a global level, that impulse has steered a lot of doctors away from chasing unlikely diagnoses. 

But rare diagnoses deserve our attention, too, and we’d do well not to rule them out as fantastical or impossible, especially in the case of conditions — such as denied pregnancy — that can occur in almost anyone. Let’s not allow our focus on horses make us miss the foal that’s on the way.  


  1. Wessel J, Buscher U. Denial of pregnancy: population based study. BMJ. 2002;324(7335):458.
  2. Friedman SH, Heneghan A, Rosenthal M. Characteristics of women who deny or conceal pregnancy. Psychosomatics. 2007;48(2):117-122. doi:10.1111/j.1552-6909.2009.01004.x
  3. Wessel J, Gauruder-Burmester A, Gerlinger C. Denial of pregnancy‐characteristics of women at risk. Acta Obstetricia et Gynecologica Scandinavica. 2007;86(5):542-546. doi:10.1080/00016340601159199