Denial is a defense that can help reduce anxiety when coping with a stressful event, but can be detrimental to an individual if it prevents adaptation. Three types of denial of pregnancy have been described: affective, pervasive and psychotic denial. The pregnancies of women with schizophrenia can be complicated by psychotic denial of pregnancy. Misinterpretations of the symptoms of pregnancy, grief from prior loss of custody of a child, and active psychiatric symptoms may increase the risk for denial of pregnancy. The consequences of failing to accept a pregnancy can be severe, including lack of prenatal care, limited time to prepare for parenting (with subsequent risk of custody loss), and neonaticide. These risks can be alleviated by early identification of women with psychotic denial of pregnancy and implementation of medication, psychotherapy and social support. At the individual level, education about family planning may be helpful in preventing further episodes. At the public policy level, Safe Haven laws may prove to be beneficial in preventing neonaticide.