According to a study published in JAMA, researchers from Karolinska Institutet have found that women who endure severe complications during their initial pregnancy or childbirth often feel disinclined to expand their families. This trend aligns with the concerning and recent decline in birth rates observed in Sweden, prompting the researchers to advocate for enhanced monitoring during antenatal care to mitigate this emerging issue.
“The clinical monitoring of these women is essential, and they need individualised advice on possible future pregnancies,” emphasizes Eleni Tsamantioti, the study’s first author and a doctoral student at the Department of Medicine in Solna, Karolinska Institutet.
In recent years, both birth rates and overall fertility have been on a downward trajectory in Sweden. In conducting this extensive population-based study, the researchers meticulously examined the correlation between severe maternal morbidity experienced by first-time mothers and their likelihood of pursuing a second pregnancy. This comprehensive study encompassed over one million women in Sweden who welcomed their first child between 1999 and 2021.
“We found that the likelihood of having more children was much lower in women who had experienced severe complications during their first pregnancy, delivery, or postnatal period,” states Neda Razaz, the study’s last author and an associate professor at the same department. “Such events can often have a physical and mental impact on women for a long time to come.” These findings underline the profound and lasting effects that pregnancy complications can impose on women.
In total, 3.5 per cent of first-time mothers within the study faced significant complications and were found to be 12 per cent less likely to have a second child. The most affected were those who experienced serious cardiac issues, a ruptured uterus, or severe mental health challenges, demonstrating a staggering 50 per cent reduced likelihood of having another child compared to their counterparts who did not encounter such complications.
Women requiring respiratory care or experiencing cerebrovascular events, such as a stroke or intracranial hemorrhage, were 40 per cent less likely to embrace the prospect of a second baby. In addition, acute kidney failure, severe preeclampsia, and blood clotting disorders were also linked to a diminished probability of a subsequent pregnancy. The researchers took care to compare the data from these women with their sisters to account for potential familial influences.
The study received funding through grants from the Swedish Heart-Lung Foundation, Region Stockholm, the ALF scheme, and the Swedish Research Council. Notably, there are no reported conflicts of interest associated with this research.
**Interview with Eleni Tsamantioti on Birth Rates and Maternal Health in Sweden**
**Editor:** Thank you for joining us today, Eleni Tsamantioti. Your recent study published in *JAMA* sheds important light on the relationship between severe maternal complications and birth rates in Sweden. Can you summarize the key findings of your research?
**Tsamantioti:** Thank you for having me. Our study focused on how severe complications during a woman’s first pregnancy can impact her decision to have more children. We found that women who experience significant health issues—like severe bleeding, infections, or other serious morbidities—are often hesitant to pursue a second pregnancy. This reluctance is contributing to a broader trend of declining birth rates in Sweden, which has seen a decrease in both birth rates and overall fertility in recent years.
**Editor:** That’s alarming. Why do you think this reluctance to have more children exists among these women?
**Tsamantioti:** The physical and emotional toll of severe complications can be quite overwhelming. Many women who go through traumatic childbirth experiences are understandably scared about the risks involved in future pregnancies. They may question their health and ability to manage another pregnancy, which leads to feelings of apprehension and reluctance.
**Editor:** In light of these findings, what do you believe should be done to address this issue in Sweden?
**Tsamantioti:** It’s essential that we enhance clinical monitoring and support for women who have experienced severe complications. Providing individualized advice and tailored care during antenatal visits can help women feel more informed and supported about their reproductive choices. By ensuring these women have access to the right resources and information, we hope to mitigate the concerns that lead to a decline in future pregnancies.
**Editor:** How does this study fit within the larger context of Sweden’s declining birth rate, which has been noted in recent statistics?
**Tsamantioti:** Our research indicates a clear linkage between the health experiences of new mothers and broader demographic shifts. Recent statistics show an overall decline in births, partially attributed to instances like those we studied. As we continue to see fewer women entering motherhood, addressing maternal health complications becomes increasingly vital. Our findings serve as a critical call to action for improved antenatal care strategies that focus not just on immediate health, but on long-term family planning and decision-making.
**Editor:** Thank you, Eleni, for sharing these insights. It’s clear that understanding and supporting women through their pregnancy experiences is essential for addressing Sweden’s declining birth rates.
**Tsamantioti:** Thank you for discussing this important topic. It’s crucial that we continue to put emphasis on maternal health to encourage informed family planning decisions in the future.
