Key Takeaways:
- Severe maternal morbidity significantly reduces the likelihood of subsequent childbirth.
- The lowest subsequent birth rates were observed with severe uterine rupture, cardiac complications, cerebrovascular accidents, and severe mental health conditions.
- A study published in JAMA highlights the need for reproductive counseling and improved prenatal care for women experiencing severe maternal morbidity.
Study Findings:
Women with severe maternal morbidity after their first childbirth are less likely to pursue subsequent pregnancies, as they often face lasting physical and emotional consequences. These consequences may include reproductive challenges, decreased fertility, or the loss of reproductive ability due to lifesaving procedures like hysterectomy, according to Eleni Tsamantioti, MD, MMedSc, and colleagues from the Karolinska Institutet in Sweden.
The study analyzed data from 1,046,974 women in the Swedish Medical Birth Register and the National Patient Register. All participants had their first childbirth between 1999 and 2021 and were followed from 43 days postpartum to the beginning of a second pregnancy or until death, emigration, or December 2021.
Results:
- Among all women, 3.5% experienced severe maternal morbidity during their first childbirth.
- Women with severe maternal morbidity had a significantly lower incidence of subsequent childbirth compared to those without (136.6 vs. 182.4 per 1,000 person-years; adjusted HR = 0.88; 95% CI, 0.87-0.89).
- The most significant reductions in birth rates were observed with severe uterine rupture (aHR = 0.48), cardiac complications (aHR = 0.49), cerebrovascular accidents (aHR = 0.6), and severe mental health conditions (aHR = 0.48).
- Birth rates were also lower by:
- 40% for those with assisted ventilation or cerebrovascular incidents.
- 35% for those with acute kidney failure or dialysis.
- 14% for those with severe preeclampsia, HELLP syndrome, or eclampsia.
- 13% for those with embolism, disseminated intravascular coagulation, or shock.
Sepsis and anesthesia complications during the first childbirth were not linked to reduced subsequent birth rates.
Expert Commentary:
In an editorial accompanying the study, Anders Husby, MD, PhD, and Heather A. Boyd, PhD, emphasized the importance of further research to understand why women with severe maternal morbidity often forgo subsequent pregnancies. They highlighted the need for evidence-based counseling to guide future reproductive choices and stressed the importance of prioritizing maternal care as a matter of bodily autonomy.
Implications:
The findings underscore the importance of addressing the long-term impacts of severe maternal morbidity. Enhanced counseling and supportive maternal care can help women make informed reproductive decisions while reducing the physical and emotional burden associated with adverse childbirth experiences.
