The research, led by Flavie Fohanno and Julien Eutrope at the University Hospital of Reims Champagne-Ardenne together with a network of perinatal psychiatry teams across France, was designed as a prospective exposed/not exposed study. Rather than reconstructing cases retrospectively after a dramatic discovery, the investigators enrolled mothers at the moment the denial was identified and compared them with mothers of similar obstetric circumstances who had acknowledged their pregnancies. Seventy-one case mothers with pregnancy denial, labeled D+ in the study, were matched with seventy-one control mothers without denial, labeled D−. Of these, seventy mothers, twenty-four with denial and forty-six controls, completed the postpartum follow-up assessment at eight weeks after delivery, providing the dataset on which the psychological comparisons rest.

The study was funded through the Hospital Research Program of the French Ministry of Health and received ethics approval from the Comité de Protection des Personnes of Nancy in 2012, with all participants providing informed written consent. The scale of the collaboration is notable: obstetric and psychiatric teams in Bordeaux, Besançon, Aubagne, Nancy, Toulouse, Paris, Sèvres, Strasbourg and Reims all contributed recruitment, reflecting how rare and scattered pregnancy denial cases are within any single maternity unit. This distributed design allowed the researchers to assemble one of the largest cohorts of denied-pregnancy mothers ever studied prospectively, a methodological achievement in a field dominated by single-case reports and small retrospective series.

The central hypothesis was that mothers who deny their pregnancies carry insecure attachment styles that increase their vulnerability. Attachment theory holds that early experiences with caregivers shape internal working models of relationships, which in adulthood can be assessed not only through self-report but through the way a person narrates relational scenarios. To capture this, the researchers used the Attachment Script Assessment, a structured instrument that scores how securely a mother’s narrative reflects a script of trusted, cooperative relationships. The results pointed in the hypothesized direction: mothers in the denial group showed a median attachment script score of 2.50, compared with 3.38 among control mothers, indicating less secure attachment representation among women who had denied their pregnancies.

Equally striking was what the study did not find. On standard measures of postnatal emotional state, the two groups were statistically indistinguishable. Scores on the Edinburgh Postnatal Depression Scale, the Beck Depression Inventory II and the State-Trait Anxiety Inventory showed no significant differences between mothers with and without pregnancy denial. This absence of mood differences carries a practical warning: routine screening for depression or anxiety in the perinatal period would not flag these mothers. Pregnancy denial, the findings suggest, is not simply a masked mood disorder but a distinct psychological configuration rooted more in relational history and representation than in current symptom levels.

The personality assessment added a further layer. Using the International Personality Disorders Examination screening, the researchers found that mothers in the denial group tended to show higher rates of borderline and paranoid traits than controls. Borderline traits involve instability in relationships and self-image, while paranoid traits involve pervasive distrust of others. Both, the authors suggest, could plausibly interact with the mechanisms of denial: a mother who fundamentally distrusts others, or whose sense of self is unstable, may be less able to integrate the reality of an impending child into a coherent narrative of her life. The researchers were careful to frame these as tendencies observed in the cohort rather than diagnostic certainties for any individual mother.

Social vulnerability emerged as a consistent thread in the profiles of the denial group. Mothers who had denied their pregnancies more frequently showed indications of social disadvantage, particularly in the quality of their housing accommodations and in their marital status. This finding situates pregnancy denial within a broader ecology of fragility, in which psychological insecurity and material precarity reinforce one another. A woman lacking stable housing and a supportive partner may have fewer opportunities for the conversations and practical cues that normally anchor the recognition of pregnancy, and fewer people positioned to notice when something is amiss. The study thus paints denial not as an isolated mental oddity but as the meeting point of internal attachment insecurity and external social strain.

For clinicians, the implications are twofold. First, the identification of insecure attachment representation as a candidate risk marker suggests that attachment-informed assessment during pregnancy, or even before conception in women with known relational trauma, could help target psychosocial support toward the mothers least equipped to acknowledge and prepare for a child. Second, the null findings on depression and anxiety scores caution against relying on symptom checklists alone. The authors conclude that identifying mothers with insecure histories is crucial for psychosocial support, and their data provide an empirical basis for that recommendation. Because the study was prospective, it avoids some of the recall biases that plague retrospective accounts of denial, though the authors acknowledge that the tendency-level differences observed did not all reach conventional statistical significance, and attrition between inclusion and the eight-week postpartum assessment reduced the final sample.

The phenomenon of pregnancy denial, sometimes discussed in popular media under the label of cryptic pregnancy, has long attracted sensational coverage, with stories of women giving birth in bathrooms or on sidewalks after entirely unnoticed gestations. This study pushes the conversation toward science. It demonstrates that the condition can be studied rigorously with matched controls, standardized instruments and multicenter recruitment, and it begins to map the psychological terrain on which denial arises: insecure attachment scripts, borderline and paranoid personality tendencies, and social disadvantage, all in the absence of overt mood disturbance. Future research will need to clarify the causal pathways, determine whether attachment insecurity is a precursor or a correlate, and test whether attachment-focused interventions can reduce the incidence of denial and improve outcomes for affected mothers and infants.

What the French cohort ultimately delivers is a reframing. Pregnancy denial appears less like a sudden psychiatric rupture and more like the endpoint of a long developmental trajectory, in which a mother’s internal model of relationships, shaped by her own early attachment experiences, interacts with a precarious social world to block the recognition of one of the most profound bodily changes a human can undergo. For the mothers in the study, the eight-week postpartum assessments marked the beginning of clinical follow-up rather than the end of vulnerability. For the research community, the work establishes a template: large prospective cohorts, attachment-based measurement and attention to social context. If the findings are replicated, the humble attachment script score, a number derived from how a mother tells a story, may become one of the most valuable early-warning tools in perinatal mental health.

Subject of Research: Pregnancy denial and its association with insecure attachment representation, personality traits and social vulnerability in mothers

Article Title: Pregnancy denial and maternal style, including attachment representation: a prospective exposed/not exposed study

Article References: Fohanno, F., Thierry, A., Hammami, S., Auer, J., Sutter-Dallay, A.-L., Vulliez, L., Gubler, V., Saad Saint-Gilles, S., Gentilleau, C., Foll, J. L., Viaux, S., Benarous, X., Apter, G., Rolling, J., Rolland-Bride, A.-C., & Eutrope, J. (2026). Pregnancy denial and maternal style, including attachment representation: a prospective exposed/not exposed study. BMC Psychology. https://doi.org/10.1186/s40359-026-05760-3

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05760-3

Keywords: pregnancy denial, cryptic pregnancy, attachment, attachment script assessment, perinatal mental health, borderline traits, paranoid traits, postpartum depression screening, social vulnerability, prospective cohort study, BMC Psychology, maternal mental health