title: Maternal physical morbidity associated with denial of pregnancy.
abstract: BACKGROUND
  Denial of pregnancy, an inappropriate reaction where the woman does not consciously recognise her pregnancy, has been widely associated with poor outcomes for the woman's mental health, the events of labour and the newborn's health. However, reports of maternal physical complications are rare.
  
  
  OBJECTIVE
  To evaluate the physical morbidity associated with denial of pregnancy.
  
  
  METHODS
  Birth records from 2007 to 2013 were searched for women who did not receive any antenatal care. The medical records of women with denial of pregnancy were then examined in detail. The primary outcome measure was physical morbidity in women with denial of pregnancy until labour, using the hospital's general obstetric population as a comparator.
  
  
  RESULTS
  Six cases of denial of pregnancy (involving five women) were identified, a rate of 1:1420 births. All characteristics and complications were in keeping with previous studies, except regarding maternal physical morbidity. Three of the five women experienced physical complications, namely pre-eclampsia and its sequelae. Concerningly, two of these women required admission to the intensive care unit, one after an eclamptic seizure. These complications were significantly higher than in the hospital's wider obstetric population (all P < 0.05).
  
  
  CONCLUSIONS
  Previous reports of low maternal physical morbidity associated with denial of pregnancy are likely a reflection of low rates of diagnosis and underreporting. Given this study's increased rate of maternal physical morbidity and the implications this has for the women's future pregnancies, this underlines the importance of actively considering physical complications in women presenting with denial of pregnancy.
authors.affiliation: Department of Obstetrics and Gynaecology, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.
authors.forename: Meleesa J
authors.initials: MJ
authors.lastname: Schultz
authors.affiliation: Department of Obstetrics and Gynaecology, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Bushati
mesh_terms: D000328:Adult; D002585:Cesarean Section; D003717:Denial, Psychological; D004461:Eclampsia / Q000209:etiology; D005260:Female; D017359:HELLP Syndrome / Q000209:etiology; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D050498:Live Birth; D007752:Obstetric Labor, Premature / Q000209:etiology; D011225:Pre-Eclampsia / Q000209:etiology*; D011247:Pregnancy / Q000523:psychology*; D012189:Retrospective Studies; D050497:Stillbirth; D055815:Young Adult
keywords: denial of pregnancy; pre-eclampsia; pregnancy; pregnancy complications; prenatal care