DENIAL OF PREGNANCY
Nazan Aydın, MD, Prof.
Turkish Marce Society
1 Dr.Nazan Aydin-Denial of Pregnancy-Swansea 1. Background 2. Objective and Hypothesis 3. Subjects and Methods 9. Results 11. Conclusion
2 Dr.Nazan Aydin-Denial of Pregnancy-Swansea 3 Dr.Nazan Aydin-Denial of Pregnancy-Swansea
Ø Minor or no changes in body weight and waist size Ø No perception of fetus movements Ø No or minor pregnancy symptoms Ø In some instances, periods are normal
4 Dr.Nazan Aydin-Denial of Pregnancy-Swansea
Inadequate prenatal care Ø poor nutrition Ø fetal abuse Ø unattended or precipitous delivery
Neonatal risks Ø prematurity Ø low birth weight Ø small for gestational age
(Neifert and Bourgois, 2000)
Dr.Nazan Aydin-Denial of Pregnancy-Swansea 5 Denial of Pregnancy Ø 1 in 475 pregnancies (211/100 K) (2.11‰)
Ø Full denial 1/2500 (40/100 K) (0.40‰)
(Wessel and Buscher, 2002)
Dr.Nazan Aydin-Denial of Pregnancy-Swansea 6 Contrary to popular belief, women who fail to recognize their pregnancy before delivery are not lying or are not mostly severely psychotic
Determine 1 year prevalance of denial of pregnancy and risk factors in Erzurum province
7 Dr.Nazan Aydin-Denial of Pregnancy-Swansea Duration January 1, 2013 - January 1, 2014
Setting All institutions with deliveries were included
Tools Socio-demographic data form
The Structured Clinical Interview for DSM-IV (SCID-I)
Control Data (Aksoy et * al. The rela onship between fear of childbirth and women’s knowledge about painless childbirth. Obstetrics and Gynecology Interna onal, March, 2014).
8 Dr.Nazan Aydin-Denial of Pregnancy-Swansea
Prevelance of Pregnancy Denial
Ø 30/15792
Ø 1 in 526 pregnancies (1.9 ‰)
Denial of Pregnancy 9 Dr.Nazan Aydin-Denial of Pregnancy-Swansea Ages of Mothers 50 46
45 43 42 42 39 39
40 38 38 38 36 36 35 35
35 33 32 32 32 30 30 30 29 27 27 25 25
25 23 21 21 20 19
20 18
15
10
5
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Dr.Nazan Aydin-Denial of Pregnancy-Swansea 10 Single Married Marital status 2 28
Dr.Nazan Aydin-Denial of Pregnancy-Swansea 11 Education Level
university 3%
illiterate 33% primary 64%
Dr.Nazan Aydin-Denial of Pregnancy-Swansea 12 # of pregnancy
sixth fifth fourth third second first
0 2 4 6 8 10
Dr.Nazan Aydin-Denial of Pregnancy-Swansea 13 Awareness Number of cases Time (weeks) 20 17 21 1 24 6 26 1 28 1 34 1 35 1 37 1 40 1
Dr.Nazan Aydin-Denial of Pregnancy-Swansea 14 History of irregular menses 25
20
15
10
5
0 Yes No
Dr.Nazan Aydin-Denial of Pregnancy-Swansea 15 explanations for amennorrhea 1 3 2 stress infection breastfeeding 2 menapouse pcos
7
Half of women reported that they have had amenorrhea during gestation; others reported some bleeding in that time.
Dr.Nazan Aydin-Denial of Pregnancy-Swansea 16 Birth Weights of Newborns 4.000 3.750 3.500 3.000 2.500 2.000 1.500 1.900 1.000 500 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29
Dr.Nazan Aydin-Denial of Pregnancy-Swansea 17 Yes No Breastfeeding status 18 12
Dr.Nazan Aydin-Denial of Pregnancy-Swansea 18 SCID Diagnosis Number of cases
Anxiety Disorder 5
Somatoform disorder 2
Mild Mental Retardation 1
None 22
Nine of them have had been diagnosed with a psychiatric disorder in the past (most of them were depression)
Dr.Nazan Aydin-Denial of Pregnancy-Swansea 19
Group N Mean Std. Deviation P value Age Control 165 29,2121 4,23802 0.012 Study 30 31,7000 7,80870
BMI Control 165 29,0691 3,18511 0.000 Study 30 26,1667 3,94866
Parity Control 165 2,6424 1,12049 0.020 Study 30 3,3667 1,51960
Gestation Week Control 165 38,9194 1,17717 0.000 Study 30 37,8667 1,61316
Baby Weight Control 165 3519,2424 383,89913 0.000 Study 30 2879,6667 436,25549
Dr.Nazan Aydin-Denial of Pregnancy-Swansea 20 ü Pregnancy denial is not rare as supposed
ü Most of them are not psychotic or concealing
ü Occurrence of denied pregnancy seems yet to be similar across different socio-demographic conditions.
ü This prospective, population-based study has also certain epidemiological relevance. The common view that denied pregnancies are exotic and rare events is no longer valid. ü More studies of similar design are needed.
21 Dr.Nazan Aydin-Denial of Pregnancy-Swansea
Acknowledgement Nazan Aydin (Ataturk University, Medical Faculty, Psychiatry, Erzurum, Turkey)
Hatice Yüce (Ataturk University, Medical Faculty, Psychiatry, Erzurum, Turkey)
Oguz Omay (La Teppe Medical Center, La Teppe, France)
Zahide Koşan (Ataturk University, Medical faculty, Public Health, Erzurum, Turkey)
Aybike Gözde Gültekin (The Ministry of Health of Turkey, Local Public Health Authority of Erzurum, Director of Family Practitioners, Erzurum, Turkey)
Ayşenur Aksoy(Nene Hatun Obstetric and Gynecology Hospital, Erzurum, Turkey)
Jens Wessel (Department of Obstetrics, Charite´, Campus Virchow- Klinikum, Humboldt-University, Berlin, Germany) 22