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A groundbreaking study published in the Journal of the American Medical Association (JAMA) has revealed that women who experience severe maternal morbidity (SMM) during their first pregnancy are significantly less likely to undergo subsequent pregnancies, highlighting a critical need for improved reproductive counseling and monitoring.
Severe maternal morbidity, a life-threatening event occurring during pregnancy, delivery, and up to 42 days postpartum, affects approximately 270.2 per 10,000 deliveries in Sweden, according to data from 1999 to 2019. This alarming rate underscores the importance of addressing SMM and its long-term consequences for women’s reproductive health.
Women who experience SMM are more likely to encounter persistent health issues, including reproductive challenges that can impact their future reproductive ability. Research has shown that SMM at first birth may increase the risk of general and reproductive health problems following pregnancy, emphasizing the need for comprehensive care and support.
Despite the significance of SMM, data on the link between SMM during the first birth and the odds of subsequent births is scarce. To address this knowledge gap, investigators conducted a population-based retrospective cohort study, analyzing data from the Swedish Medical Birth Register (MBR) and the National Patient Register (NPR) from 1999 to 2021.
The study’s primary exposure was any SMM occurring between 22 weeks’ gestation and 42 days post-delivery, defined using 14 distinct types based on a validated definition of SMM used for maternal health surveillance in Sweden. The primary outcome was subsequent birth, determined using records in the MBR between 1999 and 2021.
The final analysis included 1,046,974 women, of whom 3.5% presented with SMM during their initial delivery. Notably, these women were often older, shorter, and more likely to have higher body mass index, pregestational hypertension and diabetes, and assisted reproductive technology use compared to those without SMM.
The rate of subsequent births was significantly decreased in women with SMM compared to those without SMM, at 136.6 per 1000 person-years versus 182.4 per 1000 person-years, respectively. After adjusting for maternal characteristics, the adjusted hazard ratio (aHR) for subsequent birth was 0.88, indicating a reduced likelihood of subsequent pregnancy.
This association was observed regardless of SMM type, although a more significant decrease in the odds of a subsequent birth was reported for cardiac complication, severe uterine rupture, and severe mental health condition, with aHRs of 0.49, 0.48, and 0.48, respectively.
These findings underscore the importance of providing adequate reproductive counseling and improved monitoring among women with SMM. As Eleni Tsamantioti, doctoral student at Karolinska Institutet and first study author, emphasized, “The clinical monitoring of these women is essential, and they need individualized advice on possible future pregnancies.”
The study’s results are particularly relevant in the context of Sweden’s declining birth rates over time, highlighting the need to address reproductive health and provide comprehensive support for women experiencing SMM.
References
- Tsamantioti E, Sandström A, Lindblad Wollmann C, Snowden JM, Razaz N. Association of severe maternal morbidity with subsequent birth. JAMA. 2024. doi:10.1001/jama.2024.20957
- Women who suffer pregnancy complications have fewer children. Karolinska Institutet. November 25, 2024. Accessed November 25, 2024.
