Pregnancy denial: a complex symptom with life context as a trigger? A prospective case-control study*

Objective To identify risk factors for a woman to experience pregnancy denial. Design, setting and population A French multicentric prospective case-control study with 71 mother-infant dyads having experienced a pregnancy denial versus a control group of 71 dyads. Methods Data were collected in the week after delivery using an observational leaflet and two psychiatric scales (MINI and QSSP). Main outcome measures Statistically significant differences between the two groups regarding social, demographic, medical and psychiatric data. Results Not being in a stable relationship (odds ratio [OR] 17.18, 95% CI 3.37-87.60]; P < 0.0001), not having a high school diploma (OR 1.11, 95% CI 1.04-1.38]; P < 0.0001) and having a psychiatric history (OR 6.33, 95% CI 1.62-24.76; P = 0.0002) were risk factors to experience pregnancy denial, whereas being older was a protective factor (OR 0.86, 95% CI 0.79-0.93; P = 0.0054) (logistic regression, Wald 95% CI). Other risk factors included late declarations of pregnancy history and past pregnancy denials (case n = 7, 9.7% versus 0% in controls; P = 0.01), past pregnancy denials in the family (case n = 13, 18% versus control n = 4, 5.6%; P = 0.03), and use of a contraceptive method (75% for cases versus 7% in control; P < 0.0001), primarily an oral contraceptive (75%). Conclusion Family or personal history of pregnancy denial should be part of the systematic anamnesis during the first visit of a patient of child-bearing age. Further, our study points out that life context (young age, single status, socio-economic precarity, pill-based contraception) could be a trigger for pregnancy denial in certain women. Tweetable abstract Life context can be a trigger for pregnancy denial.