What It’s Like to Have a Cryptic Pregnancy

Alex Paige Moore didn’t know she was five months pregnant. Moore, who lives in Adelaide, Australia, was 22 at the time and thought she couldn’t get pregnant: She had polycystic ovary syndrome (PCOS), which her gynecologist said could make it harder to conceive. “I was like, well if I do want to get pregnant, I’d probably have to go through IVF,” she says.

As a result, Moore wasn’t consistent with contraception. She’d take the pill for a month or two to improve her skin, then stop “whenever I was being lazy and couldn’t be bothered doing it anymore, or if I felt like the pill affected me badly, where I’d get down and feel not good about myself,” she explains. “I really had no routine.” Her then-boyfriend didn’t wear condoms.

Although it was early November and Moore hadn’t had her period since July, it “wasn’t really unusual.” Because of PCOS, her period was irregular and appeared just a couple of times per year. She may have had a hunch, though, because she asked her boyfriend to grab a test at the grocery store. “He was like, no, I’m embarrassed,” Moore says. “Then he never did anything.”

Moore had visited a generalist in August for bloodwork because she felt dizzy, which she attributed to bulimia. The eating disorder started around the time she’d conceived and caused her to lose weight. “I think maybe subconsciously my body was changing, and I was kind of aware of it,” she says. Moore says her doctor didn’t mention anything unusual, including pregnancy, when the bloodwork results came back.

But by November, Moore began to have heartburn and threw up after a workout, “which isn’t like me,” she says. Her mom persuaded her to visit the doctor again. This time, they took a look at her bloodwork and informed her that she was pregnant. She wouldn’t know how far along until her ultrasound the following week, but she was already about five months along. “I was sort of in shock. I was in disbelief,” Moore says. “I was really scared thinking about what I was going to do. I’ve always wanted kids, but not that young.” The doctor suggested taking another pregnancy test at home the following day. “I think he just wanted to let it sink in,” she says.

Expecting Without Symptoms

Moore had what’s known as a “cryptic pregnancy,” or pregnancy denial. It’s variously defined as not knowing you’re pregnant when most people do — which is “by about 10 to 12 weeks,” says Erin Higgins, M.D., an ob-gyn at Cleveland Clinic in Independence, OH — or by the time most people feel fetal movement (around week 20).

Cryptic pregnancy happens in about one per 475 births, with one in 2,500 people unaware until they’re in labor. “I have been an OBGYN for 12 years, and I can only count on one hand the number of patients who I would categorize in this group,” says Emily Donelan, MD, obstetrician-gynecologist at Dartmouth Hitchcock Medical Center. “There is not a formal medical definition, nor is there much literature on this topic, so we don’t know much about it, except anecdotally.”

As was the case for Moore, some of the research we do have has found that people with cryptic pregnancies generally don’t have — or don’t register — the typical signs of pregnancy, such as nausea, weight gain, missed periods, or fetal movement. It can happen at any age, although it’s statistically more likely among teens and people over 40, who are least likely to suspect they’re pregnant. While roughly a third of people who experience cryptic pregnancies aren’t in a relationship, more than half are officially partnered or married. Most don’t regularly visit an ob-gyn; of those who take contraception, most use the pill.

How Can You Not Know You’re Pregnant?

People usually figure out they’re pregnant because they miss their period. But if, like Moore, you have an endocrine disorder like PCOS and your cycles are irregular, skipping a few periods isn’t out of the ordinary. If you’re over the age of 40, you might attribute irregular periods for perimenopause. Similarly, breastfeeding can stop you from ovulating, but it’s not foolproof, notes Charlene Emmanuel, M.D., an ob-gyn at NewYork-Presbyterian/Columbia University Irving Medical Center.

If you think you aren’t ovulating you might not be as careful about contraception. And people “who are inconsistent with birth control use are also at higher risk of cryptic pregnancy,” says Higgins. Even when used correctly, birth control can fail, and it is possible to get a false negative on a pregnancy test, notes Emmanuel, especially if you test too soon after a missed period or use an expired test.

Here’s a more baffling stat: Nearly half of people with cryptic pregnancies continue to experience regular period-like bleeding or spotting. “It is possible but not common or normal to bleed throughout pregnancy,” says Donelan. Relatively rare conditions such as cervical friability or a subchorionic hematoma can cause ongoing spotting, but “typically this bleeding does not persist throughout pregnancy,” notes Higgins.

What about other pregnancy symptoms, like nausea or weight gain? Sometimes people just don’t recognize them, “especially if it is their first pregnancy,” says Higgins. They can sometimes also be masked due medical conditions, like UTIs or viral infections, notes Emmanuel.

When people do notice pregnancy symptoms, they may rationalize them away. Irregular periods can be explained as travel, stress, breastfeeding, or contraception. Weight gain can be blamed on appetite. Fetal movements can be mistaken for gas or constipation, and even labor might be mistaken for the flu, food poisoning, or painful periods. “Fetal movements often aren’t felt until (at least) 18 weeks, so it can be normal not to notice this until midway through a pregnancy,” says Higgins. People with conditions such as IBS may already often experience pregnancy-like symptoms including nausea, bloating, and constipation, adds Donelan.

Moore didn’t feel fetal movements and didn’t have morning sickness. Retrospectively, she noticed that she threw up violently a couple of times the morning after she had a couple of drinks. “I was like, this isn’t like me. I didn’t have much to drink. Usually I can tolerate that,” she says. Coworkers at the dentist office, where she worked as a dental nurse, also complimented her more often. “Like, ‘your skin looks really nice today.’ I kind of just thought it was maybe me losing weight, but now I come to think of it, maybe I had a little glow,” Moore says.

Because of her eating disorder, Moore didn’t notice that her body had changed, and she lost about 17 pounds between July and November. “I was underweight,” she says. Similarly, people with large bodies may be less likely to notice weight changes or body changes. “Women carry their pregnancies very differently depending on their height, weight, parity (past pregnancies), fetal weight, and torso length,” says Donelan.

There’s a second type of cryptic pregnancy, “which is less common and associated with a pre-existing mental health disorder,” says Emmanuel. Some research suggests that between 42 to 80 percent of people who experience cryptic pregnancies have a prior psychiatric diagnosis — especially depression, schizophrenia, and substance abuse — as well as a history of physical or sexual abuse. For some people, a mix of physical and psychological factors may play a role.

When people do discover they’re pregnant — often coincidentally by a healthcare practitioner — physical symptoms can appear quickly. About a week after learning she was pregnant, Moore noticed a small but pronounced bump under her workout leggings. There are reports of women whose pregnancies “pop” minutes later, as their abdominal muscles relax.

Shock and Denial

Discovering you’re pregnant in the second or third trimester understandably comes as a big shock, causing numbness or denial, then incomprehension and fear. People who don’t know they’re pregnant until they give birth are at risk for disassociation or post-traumatic stress disorder (PTSD).

Moore was living with her parents and on the outs with her boyfriend when she first found out she was pregnant. Because she didn’t know how far along she was, she wasn’t sure at first if she wanted to keep the baby.

“We felt like our heads were saying we shouldn’t have a baby, but our hearts were like, I don’t know why, but we really need this baby.” When an ultrasound the following week confirmed she was around five months pregnant, “it was perfect. Like, we can’t do anything now. We’re having it. And it was like a really big relief,” she says.

Because people don’t know they’re pregnant, they may continue to consume alcohol, tobacco, or medicine while they are pregnant that they would have otherwise stopped. They often feel fearful, guilty, or betrayed by their own bodies. “I was drinking and I wasn’t doing the right things. I was really, really worried,” Moore says.

The Resilience of Babies — and Parents

Besides drinking and using other substances, a major risk of cryptic pregnancy is not getting prenatal care or taking prenatal vitamins, which reduce the odds of neural tube defects, says Donelan. “Pregnancy is a time that many women improve their overall health for the wellbeing of their future child,” she says, “and this is a missed opportunity for some women.”

Some research suggests that cryptic pregnancy increases the risk of intrauterine growth restriction (a condition where babies are unusually small for their age), admission to the neonatal intensive care unit (NICU), uterine rupture, and eclampsia, due to “a lack of prenatal care throughout the pregnancy,” notes Emmanuel. This includes monitoring and testing for pregnancy complications such as gestational diabetes, congenital conditions, and preeclampsia. “An undetected pregnancy may also mean an unassisted delivery, which can be dangerous for both mom and baby,” she adds. While rates of infant death in cryptic pregnancies are low, some research suggests they’re higher than in the general population.

Doctors were concerned that Moore’s baby wasn’t growing due to bulimia and weight loss. The placenta she delivered was small, shriveled, and dark. Her practitioner asked if she smoked (she doesn’t), then suggested her placenta might look sickly because she was overdue. Because she was undereating for the first half of her pregnancy, her baby might have been measuring smaller than expected, throwing off her due date. Donelan says this can occur because doctors can’t properly date the pregnancy with a last menstrual period or an early ultrasound. “Thank God we got her out that night,” Moore says. “Because otherwise I might have actually had a stillborn.” Fortunately, her daughter, Alora, was born healthy and full-term in May 2020. “It was a big relief,” says Moore.

Ultimately, there’s not enough research to get a full picture of the true outcomes of cryptic pregnancies. “In my experience, many of these women have uncomplicated, full-term deliveries,” Donelan says.

We all have enough to worry about, says Donelan — ultimately cryptic pregnancy doesn’t have to be on your list. Know your body, track your menstrual cycle, and be aware of early signs of pregnancy, including missed periods or irregular bleeding, breast tenderness, nausea, constipation, bloating, and weight gain. “Birth control is not 100 percent effective, even if you are consistently taking a reliable form of contraception,” she adds. “If you ever have any doubt at all, it never hurts to take a pregnancy test. OTC pregnancy tests are cheap and highly reliable.”

Moore, who is now 26 and has an Only Fans page where she earns her income, broke up with her boyfriend about a year after the birth of Alora, who is now 4 years old and the light of her life. “She’s so funny. She’s so naughty and cheeky,” says Moore. “Everyone that meets her just falls in love with her.”

If you or someone you know is struggling with an eating disorder, the National Eating Disorder Association (NEDA) has resources available including a 24/7 helpline at (800) 931-2237.For a 24-hour crisis line, text “NEDA” to 741741 or use its click-to-chat help messaging system.

Colleen de Bellefonds is a Paris-based journalist with two kids and a serious baguette habit. She covers science, health, parenting and French culture for US News & World Report, Well+Good, Women’s Health, Self, Healthline, and more.