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.

Life context can be a trigger for pregnancy denial.

Hippocampal dysgenesis and variable neuropsychiatric phenotypes in patients with Bardet-Biedl syndrome underline complex CNS impact of primary cilia

The Bardet-Biedl syndrome (BBS) is a rare ciliopathy clinically defined by the association of retinitis pigmentosa, polydactyly, obesity, kidney disease and cognitive impairment. The cognitive functioning, behavioral phenotype, prevalence of psychiatric diseases and memory performances of a cohort of 34 patients with BBS were evaluated and a systemic brain magnetic resonance imaging (MRI) was performed. The patients' cognitive functioning was of marked variable efficiency ranging from normal to disabling performances. Neuropsychological disorders such as slow thought process, attention difficulties and obsessive-compulsive traits were observed. Our main finding was hippocampal dysgenesis, diagnosed by MRI, found in 42.31% of the patients in this cohort. Moreover, we show that BBS proteins are expressed in the human hippocampus and in the human brain in the normal subject. Recent literature in the murine model shows that hippocampal neurogenesis, in particular in the adult mouse, requires an intact primary cilia. These results encourage us to further investigate the possible role of BBS proteins in the hippocampus and related central nervous system structures.