Women who experience severe health complications during their first pregnancy are less likely to want more children, according to a study published by JAMA. The researchers from the Karolinska Institutet, Sweden, defend that, given Sweden’s steady decline in birth rate, monitoring during antenatal care is key to addressing the problem.
“The clinical monitoring of these women is essential, and they need individualised advice on possible future pregnancies,” says the study’s first author Eleni Tsamantioti, doctoral student at the Department of Medicine in Solna, Karolinska Institutet.
Birth rates and fertility have declined steadily in Sweden over the past years. In this study, the researchers wanted to assess if there is a link between severe maternal morbidity in first-time mothers and the likelihood of their having a second baby. The study followed over a million women in Sweden who had their first baby 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,” said Neda Razaz, associate professor at the same department. “Such events can often have a physical and mental impact on women for a long time to come.”
Overall, 3.5% of the first-time mothers suffered serious complications and were 12% less likely to have a second child. This effect was evident in women who experienced severe cardiac complications, a ruptured uterus, or severe mental health problems. These women were 50% less likely to have another birth compared to women who had not experienced this kind of complications. In addition, women who needed respiratory care or suffered a cerebrovascular accident like stroke or intracranial haemorrhage were 40% less likely to have a second baby. Other conditions that were associated with a lower probability of a second baby included acute kidney failure, severe preeclampsia, and blood clotting.
“The reasons are hard to speculate on and may result from multiple factors, such as decreased desire for more children, trauma, infertility related to psychiatric medications, or lack of health counselling,” concluded Tsamantioti. “Proper support and monitoring by antenatal care staff is therefore essential for women who have suffered serious health problems during pregnancy or delivery.”
Eleni Tsamantioti, Anna Sandström, Charlotte Lindblad Wollmann, Jonathan M Snowden, Neda Razaz (2024) Association of Severe Maternal Morbidity With Subsequent Birth”, JAMA, doi: 10.1001/jama.2024.20957.