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Key Points: Question: What is the association of severe maternal morbidity (SMM) during a first birth with the probability of having a subsequent birth? Findings: In this nationwide population cohort study in Sweden, women with any SMM had a significantly lower incidence rate of subsequent birth compared with those without SMM in their first delivery (136.6 vs 182.4 per 1000 person-years). The associations were not influenced by familial confounding as indicated by sibling analyses. Meaning: Women who experience SMM in their first birth are less likely to have a subsequent birth. Adequate reproductive counseling and enhancing antenatal care are crucial for these women. Importance: Women who experience severe maternal morbidity (SMM) might have lasting health issues, and the association of SMM with the probability of future reproductive intentions is unknown. Objective: To examine the association between SMM in a first birth and the probability of a subsequent birth. Design, Setting, and Participants: Retrospective, population-based cohort study conducted among 1 046 974 women in Sweden who had their first birth between 1999 and 2021. Exposure: Overall SMM and SMM subtypes were identified among all deliveries at 22 weeks of gestation or later (including complications within 42 days of delivery) from the Swedish Medical Birth Register and National Patient Register. Main Outcomes and Measures: All women with a recorded first delivery were followed up from 43 days postpartum until the first day of the last menstrual period of the second pregnancy that resulted in a birth (stillbirth or live birth) or until death, emigration, or end of follow-up on December 31, 2021. Multivariable Cox proportional hazards regression was used to estimate associations between SMM and time to subsequent birth with adjusted hazard ratios (aHRs). Sibling analysis was performed to evaluate potential genetic and familial confounding. Results: A total of 36 790 women (3.5%) experienced an SMM condition in their first birth. Women with any SMM had a lower incidence rate of subsequent birth compared with those without SMM in their first delivery (136.6 vs 182.4 per 1000 person-years), with an aHR of 0.88 (95% CI, 0.87-0.89). The probability of subsequent birth was substantially lower among women with severe uterine rupture (aHR, 0.48; 95% CI, 0.27-0.85), cardiac complications (aHR, 0.49; 95% CI, 0.41-0.58), cerebrovascular accident (aHR, 0.60; 95% CI, 0.50-0.73), and severe mental health conditions (aHR, 0.48; 95% CI, 0.44-0.53) in their first birth. The associations were not influenced by familial confounding as indicated by sibling analyses. Conclusions and Relevance: Our findings suggest that women who experience SMM in their first birth are less likely to have a subsequent birth. Adequate reproductive counseling and enhancing antenatal care are crucial for women with a history of SMM. This cohort study analyzed the association between severe maternal morbidity occurring in a first childbirth and the probability of a subsequent birth among women in Sweden. [ABSTRACT FROM AUTHOR]

Background and Aims A variety of maternal heart conditions are associated with abnormal placentation and reduced foetal growth. However, their impact on offspring's long-term cardiovascular health is poorly studied. This study aims to investigate the association between intrauterine exposure to pre-existing maternal cardiovascular disease (CVD) and offspring CVD occurring from infancy to early adulthood, using paternal CVD as a negative control. Methods This nationwide cohort study used register data of live singletons without major malformations or congenital heart disease born between 1992 and 2019 in Sweden. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, adjusted for essential maternal characteristics. Paternal CVD served as a negative control for assessment of unmeasured genetic and environmental confounding. Results Of the 2 597 786 offspring analysed (49.1% female), 26 471 (1.0%) were born to mothers with pre-existing CVD. During a median follow-up of 14 years (range 1–29 years), 17 382 offspring were diagnosed with CVD. Offspring of mothers with CVD had 2.09 times higher adjusted HR of CVD (95% CI 1.83, 2.39) compared with offspring of mothers without CVD. Compared with maternal CVD, paternal CVD showed an association of smaller magnitude (HR 1.49, 95% CI 1.32, 1.68). Increased hazards of offspring CVD were also found when stratifying maternal CVD into maternal arrhythmia (HR 2.94, 95% CI 2.41, 3.58), vascular (HR 1.59, 95% CI 1.21, 2.10), and structural heart diseases (HR 1.48, 95% CI 1.08, 2.02). Conclusions Maternal CVD was associated with an increased risk of CVD in offspring during childhood and young adulthood. Paternal comparison suggests that genetic or shared familial factors may not fully explain this association. [ABSTRACT FROM AUTHOR]

Hypertensive disorders of pregnancy (HDP), especially preeclampsia, and diabetes during pregnancy pose significant risks for both maternal and infant health, extending to long‐term outcomes such as early‐onset cardiovascular disease and metabolic disorders. Current strategies for managing HDP focus on screening, prevention, surveillance, and timely intervention. No disease‐modifying therapies exist so far for established preeclampsia; delivery remains the definitive resolution. Preventive measures—including early pregnancy screening, exercise, and low‐dose aspirin—show promise. Antihypertensive treatments reduce severe hypertension risks, whereas magnesium sulfate remains the standard for preventing eclampsia. Planned delivery from gestational week 37 can balance maternal benefits and neonatal risks in women with established preeclampsia. Delivery between 34 and 37 weeks gestation in women with preeclampsia has to balance risks for mother and infant. Lifestyle interventions—particularly diet and physical activity—are pivotal in managing gestational diabetes mellitus and type 2 diabetes. The oral antidiabetic metformin has shown benefits in glycaemic control and reducing maternal weight gain, although its long‐term effects on offspring remain uncertain. The safety of other peroral antidiabetics in pregnancy is less studied. Advancements in glucose monitoring and insulin administration present encouraging prospects for enhancing outcomes in women with diabetes types 1 and 2. Both HDP and diabetes during pregnancy necessitate vigilant management through a combination of lifestyle modifications, pharmacological interventions, and timely obstetric care. Although certain treatments such as low‐dose aspirin and metformin show efficacy in risk reduction, further research is ongoing to ensure safety for both mothers and their offspring to reduce short‐ and long‐term adverse effects. [ABSTRACT FROM AUTHOR]

Objective: To quantify temporal trends and regional variation in severe maternal morbidity (SMM) in Sweden. Design: Cohort study. Population: Live birth and stillbirth deliveries in Sweden, 1999–2019. Methods: Types and subtypes of SMM were identified, based on a standard list (modified for Swedish clinical setting after considering the frequency and validity of each indicator) using diagnoses and procedure codes, among all deliveries at ≥22 weeks of gestation (including complications within 42 days of delivery). Contrasts between regions were quantified using rate ratios (RRs) and 95% confidence intervals (95% CIs). Temporal changes in SMM types and subtypes were described. Main outcome measures: Types and subtypes of SMM. Results: There were 59 789 SMM cases among 2 212 576 deliveries, corresponding to 270.2 (95% CI 268.1–272.4) per 10 000 deliveries. Composite SMM rates increased from 236.6 per 10 000 deliveries in 1999 to 307.3 per 10 000 deliveries in 2006, before declining to 253.8 per 10 000 deliveries in 2019. Changes in composite SMM corresponded with temporal changes in severe haemorrhage rates, which increased from 94.9 per 10 000 deliveries in 1999 to 169.3 per 10 000 deliveries in 2006, before declining to 111.2 per 10 000 deliveries in 2019. Severe pre‐eclampsia, eclampsia and HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome (103.8 per 10 000 deliveries), severe haemorrhage (133.7 per 10 000 deliveries), sepsis, embolism, disseminated intravascular coagulation, shock and severe mental health disorders were the most common SMM types. Rates of embolism, disseminated intravascular coagulation and shock, acute renal failure, cardiac complications, sepsis and assisted ventilation increased, whereas rates of surgical complications, severe uterine rupture and anaesthesia complications declined. Conclusions: The observed spatiotemporal variations in composite SMM and SMM types provide substantive insights and highlight regional priorities for improving maternal health. [ABSTRACT FROM AUTHOR]

Objective: The impact of first stage labour duration on maternal outcomes is sparsely investigated. We aimed to study the association between a longer active first stage and maternal complications in the early postpartum period. Design: A population‐based cohort study. Setting: Regions of Stockholm and Gotland, Sweden, 2008–2020. Population: A cohort of 159 459 term, singleton, vertex pregnancies, stratified by parity groups. Methods: The exposure was active first stage duration, categorised in percentiles. Poisson regression analysis was performed to estimate the adjusted relative risk (aRR) and the 95% confidence interval (95% CI). To investigate the effect of second stage duration on the outcome, mediation analysis was performed. Main outcome measures: Severe perineal lacerations (third or fourth degree), postpartum infection, urinary retention and haematoma in the birth canal or ruptured sutures. Results: The risks of severe perineal laceration, postpartum infection and urinary retention increased with a longer active first stage, both overall and stratified by parity group. The aRR increased with a longer active first stage, using duration of <50th percentile as the reference. In the ≥90th percentile category, the aRR for postpartum infection was 1.64 (95% CI 1.46–1.84) in primiparous women, 2.43 (95% CI 1.98–2.98) in parous women with no previous caesarean delivery (CD) and 2.33 (95% CI 1.65–3.28) in parous women with a previous CD. The proportion mediated by second stage duration was 33.4% to 36.9% for the different outcomes in primiparous women. The risk of haematoma or ruptured sutures did not increased with a longer active first stage. Conclusions: Increasing active first stage duration is associated with maternal complications in the early postpartum period. [ABSTRACT FROM AUTHOR]

Objective: To investigate the risk of recurrent maternal red‐cell transfusion in delivery. Design: Nationwide long‐standing retrospective cohort study. Setting: Swedish medical birth register. Population: All registered births from 2000 to 2017 in Sweden. Methods: We included all women with between one and three consecutive registered births from 22 weeks of gestation onwards and all maternal red‐cell transfusions in the peripartum period within the defined period of study. Information on gestational and non‐gestational comorbidity was collected and we identified any female siblings. In our analyses we compared the risk of red‐cell transfusion in delivery in relation to transfusion history and gestational and non‐gestational comorbidity. Main outcome measures: Maternal peripartum red‐cell transfusion, defined as a recorded transfusion in the period from 1 day before and 7 days after delivery. Results: We included 825 451 women with a total 1 419 909 deliveries, including 786 097 (55.4%) first, 511 398 (36.0%) second and 122 414 (8.6%) third deliveries. Of women with previous obestric transfusion, 8.7% were transfused in a second delivery, compared with 1.7% of women without transfusion or diagnosis of haemorrhage. A previous diagnosis of haemorrhage did not affect the odds ratio of transfusion recurrence. Among women who were transfused in their first two deliveries, 15.5% were transfused in third delivery, corresponding to an 11‐fold increase, compared with non‐transfused women (adjusted odds ratio aOR 11.5, 95% CI 7.9–16.6). Women with a sister transfused in delivery were at increased risk of transfusion in a second delivery (aOR 1.8, 95% CI 1.6–2.1). Conclusions: Women with previous red‐cell transfusion are at an increased risk of red‐cell transfusion in a subsequent delivery, compared with women without a history of red‐cell transfusion. [ABSTRACT FROM AUTHOR]

Background We aimed to investigate the associations of pre-existing maternal cardiovascular disease (CVD) with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID) in offspring. Methods This population-based cohort study included singletons live-born without major malformations in Sweden (n  = 2 699 675) and British Columbia (BC), Canada (n  = 887 582) during 1990–2019, with follow-up from age 1 year until the outcome, death, emigration or December 2020, whichever came first. The primary exposure was defined as a composite CVD diagnosed prior to conception: cerebrovascular disease, arrhythmia, heart failure, valvular and congenital heart diseases. The incidences of ADHD, ASD and ID, comparing offspring of mothers with versus without CVD, were calculated as adjusted hazard ratios (aHRs). These results were compared with models using paternal CVD as negative control exposure. Results Compared with offspring of mothers without CVD, offspring of mothers with CVD had 1.15-fold higher aHRs of ADHD [95% confidence interval (CI): 1.10–1.20] and ASD (95% CI 1.07–1.22). No association was found between maternal CVD and ID. Stratification by maternal CVD subtypes showed increased hazards of ADHD for maternal heart failure (HR 1.31, 95% CI 1.02–1.61), cerebrovascular disease (HR 1.20, 95% CI 1.08–1.32), congenital heart disease (HR 1.18, 95% CI 1.08–1.27), arrhythmia (HR 1.13, 95% CI 1.08–1.19) and valvular heart disease (HR 1.12, 95% CI 1.00–1.24). Increased hazards of ASD were observed for maternal cerebrovascular disease (HR 1.25, 95% CI 1.04–1.46), congenital heart disease (HR 1.17, 95% CI 1.01–1.33) and arrythmia (HR 1.12, 95% CI 1.01–1.21). Paternal CVD did not show associations with ADHD, ASD or ID, except for cerebrovascular disease which showed associations with ADHD and ASD. Conclusions In this large cohort study, pre-existing maternal CVD was associated with increased risk of ADHD and ASD in offspring. [ABSTRACT FROM AUTHOR]