PREGNANCY EXPERIENCE AFTER DELIVERY OF A CHILD WITH A MAJOR BIRTH-DEFECT - A POPULATION STUDY

Objective. Data from a large population based, case-control study were analyzed to determine whether women giving birth to children with maj or birth defects have different subsequent pregnancy patterns than tho se giving birth to live-born babies without defects. Other studies exa mining this phenomenon have been smaller, have not been population-bas ed, or have not addressed the different effects that a wide range of m ajor defects might have an mothers' subsequent pregnancy rates. Method s. Mothers of 4918 infants with major birth defects born from 1968 thr ough 1980 in metropolitan Atlanta were compared with mothers of 3029 c ontrol infants, frequency-matched an birth year, birth hospital, and r ace. Results. The pregnancy rate in the first 3 years after the index birth was higher among case mothers (36%) than among control mothers ( 30%, P < .0001). This excess was seen far mothers of stillborn ease in fants (64%) and mothers of case infants who died in infancy (58%), but not for mothers of case infants who survived the first year of life ( 31%). Pregnancy rates varied by birth defect type. Maternal and infant factors varied among case and control subjects and influenced subsequ ent pregnancy rates. Conclusion. The reproductive behavior observed in this study supports the theory that mothers of nonsurviving children with birth defects compensate by acting to ''replace'' the lost child. Reproductive behavior was also strongly associated with having comple ted a previous pregnancy and by the type of birth defect.