Severe maternal morbidity at first birth lowers likelihood of next pregnancy
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Key takeaways:
- Severe maternal morbidity lowers likelihood of subsequent births.
- Subsequent birth rates were lowest with severe uterine rupture, cardiac issues, cerebrovascular accident and severe mental health conditions.
Women with severe maternal morbidity after first childbirth have a lower likelihood of pursuing subsequent births, highlighting the need for reproductive counseling and better prenatal care, according to study results published in JAMA.
“Women may experience persistent health issues after severe maternal morbidity, including reproductive challenges, even after their initial complication resolves,” Eleni Tsamantioti, MD, MMedSc, of the division of clinical epidemiology in the department of medicine at Karolinska Institutet, Sweden, and colleagues wrote. “These long-term consequences may include loss of reproductive ability as a result of lifesaving procedures such as hysterectomy, as well as decreased fertility, leading to physical and emotional consequences.”
Tsamantioti and colleagues conducted a retrospective, population-based cohort study with 1,046,974 women using data from the Swedish Medical Birth Register and the nationwide National Patient Register. All women had a first childbirth occurring between 1999 and 2021. Researchers followed all women from 43 days postpartum to first day of final menstrual period of a second pregnancy resulting in birth or until death, emigration or December 2021.
Overall, 3.5% of women experienced a severe maternal morbidity condition in first childbirth.
Women with vs. without severe maternal morbidity had a lower incidence of subsequent birth (136.6 vs. 182.4 per 1,000 person-years; adjusted HR = 0.88; 95% CI, 0.87-0.89). Researchers observed a lower rate of subsequent births among women with vs. without severe maternal morbidity regardless of severe maternal morbidity subtype. However, the rate reduction was most noticeable for severe uterine rupture (aHR = 0.48; 95% CI, 0.27-0.85), cardiac complications (aHR = 0.49; 95% CI, 0.41-0.58), cerebrovascular accident (aHR = 0.6; 95% CI, 0.5-0.73) and severe mental health conditions (aHR = 0.48; 95% CI, 0.44-0.53) at first childbirth.
Subsequent birth rates were 40% lower after first childbirth with assisted ventilation or cerebrovascular accidence; 35% lower with acute kidney failure or dialysis; 14% lower with severe preeclampsia or hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome or eclampsia; and 13% lower with embolism, disseminated intravascular coagulation or shock.
Both sepsis and anesthesia complications in first childbirth were not associated with a lower subsequent birth rate.
In an accompanying editorial published in JAMA, Anders Husby, MD, PhD, from the department of neonatology at Rigshospitalet and the department of epidemiology research at Statens Serum Institut in Copenhagen, Denmark, and Heather A. Boyd, PhD, from the department of epidemiology research at Statens Serum Institut, wrote that the findings highlight the need for more studies to assess reasons women who had severe maternal morbidity in first childbirth do not pursue subsequent pregnancies, the importance of adequate, evidence-based counseling in clinical practice when discussing future reproductive choices and possible risks and the fundamental principle of maternal care as a right to bodily autonomy.
“There is now strong epidemiological evidence that severe maternal morbidity in a first childbirth negatively influences the likelihood that a woman will have a subsequent childbirth,” the authors wrote. “This study’s findings should fuel calls for research into the processes underlying women’s choices to pursue, or not, a subsequent pregnancy after an adverse first childbirth experience in order to guide reproductive counseling for this group of women.”