Fetoception: a window into maternal interoception?

Fetoception refers to a pregnant woman’s ability to detect and process signals originating from the fetus, particularly the perception of active fetal movements. Monitoring active fetal movements is widely employed by obstetricians and midwives as a non-invasive means of assessing fetal well-being [1]. Regular, strong, and consistent active fetal movements are generally considered reassuring indicators of fetal viability [2], whereas a marked reduction in perceived movements may precede adverse outcomes, including fetal demise [3].

The initial perception of active fetal movement typically occurs around 22 weeks of gestation, with peak perception reported near 38 weeks [4]. However, substantial variability exists both between individuals and across pregnancies. Maternal factors such as age, parity, placental location, and the frequency of uterine contractions can influence the timing and intensity of active fetal movement perception [4]. In addition, fetal growth parameters, affected by exposures such as tobacco [5] and alcohol use [6], further contribute to this variability. Despite its clinical relevance, the determinants and mechanisms underlying these variations in maternal perception of the fetus remain poorly understood. Clarifying these processes is crucial, as altered maternal perception of the fetus may be associated with increased perinatal risks, including fetal injury and stillbirth [7].

Interoception, defined as the processing of internal bodily signals such as cardiac, respiratory, and visceral inputs, is a core component of bodily self-awareness [8]. It is distinct from exteroception, which involves the perception of external sensory stimuli, and proprioception, which relates to the sense of body position and movement [9]. In the context of pregnancy, interoception is essential for the perception of active fetal movements, which arise from visceral and somatosensory feedback rather than external input [10]. As such, interoceptive processes may underpin maternal awareness of the fetus and contribute to the variability observed in how pregnant individuals experience and interpret fetal activity.

The neural circuits underlying interoception are complex and involve multiple anatomical structures [11]. The autonomic nervous system plays a key role by transmitting afferent visceral signals to the brain and initiating adaptive efferent responses [12]. At the cortical level, regions such as the insular cortex and anterior cingulate cortex are critically involved in processing interoceptive information and regulating autonomic adjustments [13]. Given this close integration, assessing autonomic nervous system function may serve as an indirect marker of interoceptive processes potentially involved in fetoception.

Pregnancy is characterized by profound morphological and functional adaptations in the maternal brain, which may facilitate the integration of novel interoceptive signals arising from the developing fetus. Neuroimaging studies have shown substantial changes in brain regions involved in interoceptive processing during pregnancy, including the insula, anterior cingulate cortex, and prefrontal areas [14]. These structural and functional modifications may enhance the mother’s capacity to detect and interpret the unique visceral inputs associated with gestation.

Conversely, the emergence of new interoceptive signals during pregnancy, such as the continuous mechanical and visceral feedback generated by fetal movements and uterine expansion, may in turn contribute to shaping maternal brain plasticity through bidirectional mechanisms [10]. Thus, the perception of the fetus may actively participate in remodeling the maternal brain, just as the evolving maternal brain may enable more refined detection and integration of fetal signals. Elucidating these dynamic interactions between interoceptive processing and neuroplastic changes during pregnancy could provide novel insights into the neurobiological foundations of maternal adaptation.

Interoception may also constitute a key mechanism underlying the association between altered maternal perception of the fetus and vulnerability to perinatal psychiatric disorders [10], 15]. On one hand, disruptions in interoceptive processing may impair the mother’s ability to accurately detect and integrate fetal signals, contributing to abnormal fetoception. On the other hand, perinatal psychiatric disorders, such as anxiety and depression, are themselves associated with interoceptive dysfunction, including both diminished sensitivity to bodily signals and exaggerated responses to aversive interoceptive inputs [16]. This bidirectional relationship suggests that altered interoception may simultaneously affect both maternal perception of the fetus and emotional regulation during the perinatal period.

Beyond its relevance to perinatal psychiatric vulnerability, maternal interoception may also provide a useful framework for understanding psychosomatic phenomena such as pregnancy denial and pseudocyesis [17]. In pregnancy denial, a woman remains unaware of her pregnancy, sometimes until delivery, while in pseudocyesis, she experiences the physical symptoms of pregnancy despite the absence of a fetus. In both conditions, the subjective experience of pregnancy is profoundly altered, suggesting a disruption in the brain’s ability to interpret or generate bodily signals related to gestation. These clinical presentations may reflect extreme forms of interoceptive dysregulation, in which the encoding, integration, or top-down interpretation of visceral sensations becomes decoupled from physiological reality. As such, interoception may represent a core dimension in the psychophysiological mechanisms underlying atypical maternal awareness of pregnancy.

Understanding these interactions may open new avenues for early detection and intervention in perinatal mental health. Investigating interoceptive mechanisms during pregnancy could provide novel biomarkers for identifying women at risk for psychiatric disorders, while also improving our understanding of how pregnancy-related brain plasticity integrates bodily and emotional experiences. Ultimately, integrating the neuroscience of interoception into perinatal care may contribute to better prevention and management of mental health disorders in this highly vulnerable period.