What is a Cryptic Pregnancy?

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Cryptic pregnancy is the phenomenon whereby women do not become consciously aware of their pregnancy until the last weeks of gestation or in some cases until they give birth. Many case studies report anecdotal cases where even relatives and family doctors do not become aware of the pregnancy. Cryptic pregnancy is, in many cases, characterized by pseudo-menstrual bleeding and lack of typical pregnancy symptoms such as nausea, sickness and vomiting. Current estimates show that 1 in every 475 women experience cryptic pregnancy undiscovered until the 20th week of the pregnancy.

The consequences of cryptic pregnancy, including psychological distress, unassisted delivery and neonaticide, put both the mother and the newborn at risk.

Pregnancy test. Image Credit: Paul Velgos / Shutterstock
Pregnancy test. Image Credit: Paul Velgos / Shutterstock

Risk factors

There has been no established clear-cut topology of the group women whereby the incidence of cryptic pregnancy is the highest. The majority of women studied, contrary to common beliefs, had good social support, leading to the conclusion that external stressors and conflicts can have an adverse effect in otherwise well-adjusted women.

Thus, women who undergo cryptic pregnancy are part of a heterogeneous group with no clear-cut identifying characteristics. Therefore, doctors should be more aware of the possibility of cryptic pregnancy and undergo a thorough examination of women who present with symptoms associated with pregnancy.

Psychiatric disorders

Research has shown contradictory evidence regarding the association of cryptic pregnancy with psychiatric disorders. Psychiatric symptoms related to schizophrenia, depression or personality disorder are only prominent in a minority of cases, thus are not recognized as an essential feature of cryptic pregnancy.

Pseudomenstrual bleeding and absence of nausea

A study by Brezinka and colleagues reports that 26 % of the women in the study had amenorrhea (absence of menstrual bleeding). The majority of women reported bleedings as regular periods. Meanwhile, 26% had experienced nausea. More importantly, none of the women who reported not being aware of the pregnancy until delivery experienced nausea. These results suggest that there is an association between the absence of nausea and other symptoms such as reduced abdominal swelling and low birth weight. This might be the reason why pregnancy remains concealed and in many cases denied until the delivery of the child.

Human chorionic gonadotropin (hCG) is a placental hormone that plays a crucial role during pregnancy. This hormone is involved in many symptomatic aspects of pregnancy, by triggering the release of maternal progesterone and thus inhibiting menstruation. Research has also pointed out the role of hCG in pregnancy-related nausea.

Theories trying to explain cryptic pregnancy

The currently available evidence from the biological point of view of cryptic pregnancy is limited. Some epidemiological studies provide more insight into the topic. However, this evidence is indirect and not sufficient enough to inform explanatory theories. Women use bodily cues to determine whether they are pregnant or not. In the cases of cryptic pregnancy, these cues are reduced or absent. Therefore, in the absence of cues, pregnancy is not assumed.

The parent-offspring conflict has been one of the main frameworks used to understand the biological base of cryptic pregnancy. All factors and symptoms surrounding this phenomenon point to the fact that in this conflict the mother is the figure that benefits the most at the expense of the fetus. Three hypotheses have been formulated to explain the phenomenon in evolutionary terms. Caution should be given to the fact that these hypotheses are not mutually exclusive.

Hypothesis 1: According to this hypothesis, the parent-offspring conflict results in the low investment of the mother. Research speculates that disruptions of the genomic imprinting mechanisms should be involved in reduced maternal involvement. Evidence on the parenting-specific effects of hCG hormone strengthens this hypothesis. This hypothesis is consistent with increased fetal risk. However, the fact that neonates do not show any other obvious problems except for the reduced birth weight is not supportive of the hypothesis.

Hypothesis 2: This hypothesis looks into missed abortion as an explanation of the phenomenon of cryptic pregnancy. If a fetus whose production of hCG is near the mother’s rejection threshold survives the beginning of the pregnancy without abortion, it could survive until childbirth despite the mother’s low investment in the pregnancy.

Hypothesis 3: This hypothesis sees cryptic pregnancy as an adaptive mechanism in stressful life conditions. Research with an Australian sample supports this claim by showing a high incidence of psychosocial stress in mothers.

Final remarks and future directions

Up to date, cryptic pregnancy has been interpreted as a pathological manifestation of unconscious conflict. One of the most cited explanations for cryptic pregnancy is that the woman is not psychologically ready to accept the pregnancy and the implications of it. Pregnancy is not only associated with many biological changes in the woman’s body but also requires preparation for the childbirth and care, all being based on accepting the pregnancy and the fetus and the changes that they are about to bring.

The parent-offspring conflict theory provides a framework for the explanation of cryptic pregnancy although the insufficient evidence leaves rooms for several hypotheses about the physiological mechanisms involved. Future research at many levels including genetics is needed to understand this complex phenomenon.

References

Further Reading

Last Updated: Sep 10, 2019

Mihaela Dimitrova

Written by

Mihaela Dimitrova

Mihaela's curiosity has pushed her to explore the human mind and the intricate inner workings in the brain. She has a B.Sc. in Psychology from the University of Birmingham and an M.Sc. in Human-Computer Interaction from University College London.

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Comments

  1. mizt 60 mizt 60 United States says:

    I applaud someone in the medical field for finally admitting that cryptic pregnancies do exist. However, it's just like the medical field to always blame the patient for why it happens instead of taking time to find the REAL reason. My daughter has been going through it to get the doctors to believe she is pregnant. She has been to 4 doctors, 3 of them OB/GYNs. 3 doctors told her it's all in her head, 2 asked does she WANT TO BE pregnant...but she was already 6 months along. The last one we saw last month could actually SEE the baby MOVING! But because it didn't show on the ultrasound she said she medically or legally call it a pregnancy! So NO, IT'S not JUST WOMEN TRYING TO DENY THEY ARE PREGNANT! IT'S doctors who REFUSE to do ANYTHING BEYOND the standard testing either because they are full of themselves or afraid their malpractice insurance will go up if they go beyond standard treatment. In the meantime my daughter can get prenatal care, lost her job because without a doctor to say she is pregnant she couldn't get FMLA so she had to quit or be terminated and she is in limbo with no due date. Thank God for nurses who told us how to keep both her and the baby healthy. Just think how many pregnant women are forced into this position by the medical practices who think it's all the patients fault!

  2. Tiffany Roquemore Tiffany Roquemore United States says:

    hello, i havent has a period since march. i used the ovia app to track my periods, and i am very regular. i have one son who is 5. negative urine test and blood test at dr . dr told me it is impossible to get a negative blood test if you are pregnant. but i saw about cryptic pregnancies on dr oz and many other places on the web. i mentioned this to my dr and he said anyone who said they got a negative blood test and turned out to be pregnant was a liar. but i dont believe him.
    i really do not know what to do. i am not on birth control. me and my husband do not use protection. i do not have any health issues. at the pap smear the dr said he didnt feel any cysts because i had thought maybe i had one and thats why i missed my period. i dont know what to do.  im really needing to know so i do not smoke or drink alcohol. i am already taking prenatals for about 2 months because i wanted it to help my hair grow faster. what should i do next? i feel like im going crazy. i dont really have much symptoms only heartburn and cravings.

  3. Sara Stevens Sara Stevens United States says:

    this is not only misleading, but demeaning for women actually going through this. If you are not personally experiencing this, you need to be quiet. You have no idea what you are talking about. And to say 'it is in your head' is hurtful, WRONG, INCORRECT & demeaning. How would you feel if I told you your physical ailments are just in your head and you are making it up??!!

  4. Tiffany Dew Tiffany Dew United States says:

    Right now, I’m about 18 weeks pregnant with twins. This is a cryptic pregnancy. All the pee tests, blood tests and ultrasound show up negative. My stomache is getting bigger, I have felt the babies move, and have heard their hearts with a stephyscope, an app for my phone which is like a Doppler and a Doppler that I bought. When I go to a doctor about my symptoms I’m told I’m crazy or that I should know by now that I’m not pregnant based on the tests. It’s hard when you go for help when you start to feel contractions and the minute the tests come back negative your told her is a piece of paper on abdominal pain and they stop talking to you, since they feel like you wasted their time. The only way that I got the ultrasound was to be persistent about it. I’m not making this up, and the more that time continues on the more I can’t get the proper prenatal care and the more time I take off from work for no doctor will give me a note stating that I cannot got back to work due to having early contractions. This is frustrating and when you are not supposed to be stressed and you for no one will take you seriously it’s so stressful. I wish doctors would look beyond tests and listen to every part that they are supposed to do like the abdomen for that would solve have the problems. But until that changes it’s more negative tests and doctors saying that I’m waisting their time, which I’m not.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News-Medical.Net.
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