Severe maternal morbidity in first birth impacts subsequent pregnancies, reveals study

A recent Swedish study that involved over 1 million women revealed that severe maternal morbidity (SMM) during a first birth significantly lowers the probability of having a subsequent child. The findings of this study were published in the Journal of American Medical Association.

This population-based cohort study analyzed data from 1,046,974 women in Sweden who gave birth between 1999 and 2021. This study drew information from the Swedish Medical Birth Register and the National Patient Register and identified instances of SMM which was defined as severe complications occurring during delivery or within 42 days postpartum.

Of the participants, 36,790 women (3.5%) underwent SMM during their first birth. Women with SMM had a lower rate of subsequent births, with an incidence rate of 136.6 per 1000 person-years when compared to 182.4 per 1000 person-years for the women without SMM. After adjusting for factors like age and socioeconomic status, this study calculated an adjusted hazard ratio (aHR) of 0.88 by indicating that women with SMM were 12% less likely to have another child.

This study also identified specific SMM subtypes that significantly reduced the probability of subsequent births. Women who underwent severe uterine rupture (aHR, 0.48), cardiac complications (aHR, 0.49), cerebrovascular accidents (aHR, 0.60), or severe mental health conditions (aHR, 0.48) in their first birth were particularly less likely to have another child. These findings suggest that both physical and psychological maternal health challenges can profoundly affect reproductive decisions. The research included sibling comparisons to rule out familial or genetic confounding factors and to strengthen the reliability of the results. The findings suggest that the association between SMM and subsequent childbirth is unlikely to be influenced by shared genetic or environmental factors.

The study underlined the long-term impact of SMM on the reproductive health of women. The outcomes emphasize the need for tailored reproductive counseling and improved antenatal care for women with a history of SMM. Proactive management and support during subsequent pregnancies could reduce risks and provide reassurance for affected women. This large-scale study provides critical insights and highlights the importance of addressing the far-reaching effects of severe maternal complications. With adequate care and support, women who have underwent SMM can better navigate future reproductive decisions.

Source:

Tsamantioti, E., Sandström, A., Lindblad Wollmann, C., Snowden, J. M., & Razaz, N. (2024). Association of Severe Maternal Morbidity With Subsequent Birth. In JAMA. American Medical Association (AMA). https://doi.org/10.1001/jama.2024.20957