Severe Birth Complications Reduce Future Pregnancy Rates

TOPLINE:

Women experiencing severe maternal morbidity (SMM) during their first birth have a 12% lower likelihood of having subsequent births, with cardiac complications and severe mental health conditions reducing the probability by more than 50%. Sibling analysis confirms these associations are not influenced by genetic or familial factors.

METHODOLOGY:

• A nationwide retrospective population-based cohort study analyzed data from 1,046,974 women in Sweden who had their first birth between 1999 and 2021, with follow-up until December 31, 2021.
• Researchers identified SMM events using diagnostic and procedure codes from hospital records between 22 weeks of gestation and 42 days postdelivery, categorizing 14 distinct SMM types including severe preeclampsia, cardiac complications, and mental health conditions.
• Analysis utilized multivariable Cox proportional hazards regression to estimate associations between SMM and time to subsequent birth, with adjusted hazard ratios accounting for maternal characteristics, education level, and preexisting conditions.
• Sibling analysis compared outcomes between 9,575 women with SMM and 11,306 of their full sisters without SMM to evaluate potential genetic and familial confounding factors.

TAKEAWAY:

• Among the study population, 36,790 women (3.5%) experienced SMM in their first birth, showing a lower incidence rate of subsequent birth than those without SMM (136.6 vs 182.4 per 1000 person-years; adjusted hazard ratio [AHR], 0.88; 95% CI, 0.87-0.89).
• Women with cardiac complications showed substantially reduced probability of subsequent birth (AHR, 0.49; 95% CI, 0.41-0.58), as did those with severe mental health conditions (AHR, 0.48; 95% CI, 0.44-0.53).
• Severe uterine rupture significantly affected subsequent births (AHR, 0.48; 95% CI, 0.27-0.85), while sepsis and anesthesia complications showed no significant association with subsequent births.
• Sibling analysis revealed similar associations (AHR, 0.88; 95% CI, 0.84-0.93), suggesting genetic and familial factors did not explain the observed relationships.

IN PRACTICE:

“Our findings suggest that women who experience SMM in their first birth are less likely to have a subsequent birth. Adequate reproductive counseling and enhancing antenatal care are crucial for women with a history of SMM,” wrote the authors of the study. An accompanying editorial noted “The decreased likelihood of second births could be due to decisions made after careful, well-informed consideration of the risks involved but might also be influenced by significant morbidity preventing or complicating subsequent conception or maintenance of pregnancy, lack of access to or understanding of accurate information on recurrence risks, prejudices consciously or unconsciously communicated by health care personnel, or unresolved trauma from the first pregnancy and childbirth.”

SOURCE:

The study was led by Eleni Tsamantioti, MD, MMedSc, Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet in Stockholm, Sweden. It was published online on November 25 in JAMA. The authors of the editorial are from the Department of Neonatology, Rigshospitalet, and the Department of Epidemiology Research, Statens SerumInstitut, Copenhagen, Denmark.

LIMITATIONS:

According to the authors, the study focused exclusively on first and second recorded deliveries, potentially limiting generalizability to higher-order pregnancies. The research did not explore the underlying mechanisms leading to a reduced probability of subsequent births. Additionally, since the study was conducted in Sweden, findings might not be applicable to healthcare systems in other countries.

DISCLOSURES:

The study received support through grants from the Swedish Heart and Lung Foundation, the Stockholm County Council, ALF Medicine, and the Swedish Research Council. Jonathan M. Snowden, PhD, disclosed receiving grants from the National Institute of Nursing Research, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Oregon Health Authority, as well as personal fees from the Patient-Centered Outcomes Research Institute. Neda Razaz, PhD, reported receiving personal fees from Aixial Group. Heather A. Boyd, PhD, reported receipt of grants from Novo Nordisk Foundation.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.