A recent study published in JAMA has raised significant concerns about the declining birth rates in Sweden, suggesting a link between severe complications during a woman’s first pregnancy and a decreased likelihood of having additional children. Conducted by researchers at Karolinska Institute, the study underscores the critical need for proper monitoring and individualized care to address the long-term effects of maternal complications.
The research tracked over a million women in Sweden who gave birth to their first child between 1999 and 2021. The study focused on severe maternal morbidity—serious complications that arise during pregnancy, delivery, or the postnatal period—and its association with the likelihood of these women having a second child. The findings revealed that 3.5% of first-time mothers experienced serious complications, and as a result, they were 12% less likely to have a second baby.
The study highlighted various complications that had a particularly strong impact on a woman's decision or ability to have more children.
Cardiac Complications and Mental Health Issues: Women who experienced cardiac issues, a ruptured uterus, or severe mental health problems were 50% less likely to have another baby.
Respiratory Care and Stroke: Women who required respiratory care or suffered a cerebrovascular accident, such as a stroke or intracranial hemorrhage, were 40% less likely to have a second child.
Kidney Failure and Preeclampsia: Other serious conditions like acute kidney failure, severe preeclampsia, and blood clotting were also associated with a lower probability of having a second pregnancy.
The study's first author, Eleni Tsamantioti, a doctoral student at Karolinska Institute, explained that severe complications can leave lasting physical and mental effects on women. Tsamantioti pointed out that such events often lead to trauma and psychological distress, which could deter women from considering future pregnancies.
Neda Razaz, the last author of the study, an associate professor at the Department of Medicine in Solna, elaborated that women who faced these serious complications were much less likely to have additional children due to the enduring impact these events had on both their physical health and mental well-being.
The study emphasizes the importance of proper support and individualized care for women who experience serious health complications during pregnancy. Tsamantioti stressed that clinical monitoring is essential to help these women navigate the challenges they face in future pregnancies. She added that personalized advice on potential risks, along with psychological support, could make a significant difference in helping them make informed decisions about whether to have more children.
While the researchers did not speculate on the exact reasons for the decline in subsequent pregnancies, they suggested that multiple factors could be at play. According to Tsamantioti, the decline in birth rates may result from a combination of factors, including a decreased desire for more children, trauma from previous complications, infertility linked to psychiatric medications, or simply a lack of health counseling for these women.
1. Tsamantioti, E., et al. (2024). Association of Severe Maternal Morbidity with Subsequent Birth. JAMA. https://doi.org/10.1001/jama.2024.20957.
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