Mothers’ subjective retrospective view of previous pregnancies and risk classification in the German maternity record ( Mutterpass ): a nationwide survey from the FeMaR study

OBJECTIVES: High-risk pregnancy classification is associated with intensified antenatal surveillance, increased use of hospital-based services, and substantial healthcare costs. Classification may influence women's subjective perceptions of pregnancy and its care. METHODS: This study assessed women's retrospective perspectives on their subjective risk classification, antenatal care, complications, and perceptions of risk in Germany using a nationwide online cross-sectional survey. Participants were grouped according to their self-reported high- or low-risk pregnancy classification. Data were based on subjective retrospective reports of pregnancies occurring ≤1 to ≥30 years ago. RESULTS: A total of 2012 women participated (mean age 33.4 ± 4.6 years). Approximately half reported having had high-risk pregnancy, most commonly due to a maternal age ≥35 years. Among women who reported having been classified as high-risk, 54.4 % considered the classification appropriate, of whom 81.8 % also assessed their antenatal care as adequate. The perceived appropriateness of the risk classification corresponded with how women evaluated the adequacy of their antenatal care. Self-reported pregnancy- and birth complications were comparable between high-risk and low-risk groups, with fetal distress as the most frequently reported complication in both groups. CONCLUSIONS: Based on retrospective self-reported data, women's perceptions of pregnancy risk classification were associated with their assessment of antenatal care. The findings highlight the importance of transparent, patient-centered communication regarding pregnancy risk classification and provide exploratory insights that may inform the future development of more individualized risk assessment approaches incorporating women's perspectives.