Delusional Pregnancy Presenting to the Massachusetts General Hospital National Pregnancy Registry for Atypical Antipsychotics

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Excerpt

To the Editors
Somatic delusions, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, are false beliefs about one's bodily function or sensation that persist despite evidence to the contrary. Patients with delusional disorder usually lack insight into their psychiatric experiences and, in the case of a delusional pregnancy, the patient's delusion focuses on the belief that she is pregnant despite medical evidence that she is not. In contrast, pseudocyesis is diagnosed when a nonpsychotic patient exhibits signs and symptoms of pregnancy, but a fetus cannot be detected.1
This report describes a woman, diagnosed with schizophrenia, who enrolled in the Massachusetts General Hospital (MGH) National Pregnancy Registry for Atypical Antipsychotics (https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/) and her experience with a delusional pregnancy.
A 39-year-old single, African American woman contacted a study staff member at the MGH National Pregnancy Registry for Atypical Antipsychotics to enroll in the registry. During a baseline interview performed through telephone by a trained research assistant, the participant reported that she was 27 weeks pregnant and exposed to paliperidone palmitate (INVEGA TRINZA), which is an extended release injectable antipsychotic medication. She discovered the registry through her own online research, which brought her to womensmentalhealth.org, a perinatal and reproductive psychiatry website managed by the Ammon-Pinizzotto Center for Women's Mental Health at MGH. Her self-reported age, pregnancy status, and medication exposure qualified her to participate in the registry's exposure group. After being read the MGH Institutional Review Board–approved consent form, the participant provided verbal consent to participate in the study and to be contacted in the future about additional research studies she may be eligible for.
Study procedures outlined in a previous publication were followed explicitly.2 To briefly summarize the registry methodology, participation involves the following 3 telephone interviews with a trained research assistant: first at enrollment during pregnancy, second at 27 weeks gestation, and third at postpartum interview occurring 12 weeks after the estimated date of delivery. Although recruitment efforts focus on accessioning participants during the first trimester of pregnancy, women can still enroll at 27 weeks gestation or later in pregnancy. In this scenario, the second interview is waived. All participants are also asked to give the study staff permission to obtain their medical records for the pregnancy of interest. The acquisition of medical records is not universal in pregnancy registries and is considered one of the major strengths of the National Pregnancy Registry for Atypical Antipsychotics.
The structure of the initial interview has the following 5 components: inquiring about demographics, obstetric history, detailed medication exposure for the 3 months leading up to pregnancy to present, a general health history, and a brief psychiatric history. For context, the participant's responses to each interview component are summarized in this report.
When asked about demographics in the initial interview, the participant reported that she was disabled, living with her parents, had Medicaid insurance, and completed some college. She did not know the date of her last menstrual period or her estimated date of delivery but was confident that she was 27 weeks pregnant. In her obstetric history, she reported a 12-lb weight gain since conception, having an ultrasound 2 weeks before (at 25 weeks gestation), that the current pregnancy was a planned pregnancy, and that she had been pregnant more than 6 times but could not recall the exact number of pregnancies. She recalled that one of her pregnancies ended in miscarriage and one resulted in a neonatal death. She stated she had never experienced postpartum depression or psychosis.
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