A recent study published in JAMA by researchers at Karolinska Institutet indicates that women who experience serious complications during their first pregnancy or childbirth are less likely to have additional children. In light of Sweden’s ongoing decline in birth rates, the researchers suggest that improved monitoring during antenatal care could help tackle this issue.
“It is crucial to monitor these women, and they require personalized advice regarding their potential future pregnancies,” stated Eleni Tsamantioti, the study’s lead author and doctoral student at the Department of Medicine in Solna, Karolinska Institutet.
In recent years, Sweden has seen a consistent decrease in birth rates and fertility levels. The researchers conducted a population-based study to examine the link between severe maternal health issues in first-time mothers and their chances of having a second child. The study analyzed data from over a million women in Sweden who had their first baby from 1999 to 2021.
“Our findings revealed that women who encountered significant complications during their first pregnancy, childbirth, or the postnatal period had a notably lower chance of having additional children,” explained Neda Razaz, the study’s senior author and an associate professor at the same department. “Such experiences can have long-lasting physical and emotional effects on women.”
Overall, 3.5 percent of the first-time mothers in the study faced serious complications, which made them 12 percent less likely to have a second child. The most affected were those who had cardiac issues, a ruptured uterus, or severe mental health challenges, with these women being 50 percent less likely to conceive again compared to those without such complications.
Women requiring respiratory support or who experienced a cerebrovascular event, such as a stroke or intracranial hemorrhage, were 40 percent less likely to have another baby. Additionally, conditions like acute kidney failure, severe preeclampsia, and blood clotting disorders were associated with a lower likelihood of subsequent pregnancies. The researchers also compared the women to any sisters they had to account for hereditary factors.
“Speculating on the reasons can be difficult, as it may stem from multiple influences, like a decreased desire for more children, trauma, infertility linked to psychiatric medications, or insufficient health counseling,” Tsamantioti noted. “Thus, proper support and monitoring from antenatal care professionals are critical for women who have faced significant health issues during pregnancy or delivery.”
The study received funding from the Swedish Heart-Lung Foundation, Region Stockholm, the ALF scheme, and the Swedish Research Council. There were no disclosed conflicts of interest.
