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Increase in maternal mortality associated with change in the reproductive pattern in SPAIN: 1996-2005.
  1. Miguel Angel Luque Fernandez1,
  2. Aurora Bueno Cavanillas2,
  3. Michèle Dramaix-Wilmet3,
  4. Fernando Simón Soria1,
  5. Juan de Mata Donado Campos1,
  6. Dionisio Herrera Guibert1
  1. 1 National Centre for Epidemiology, Spain;
  2. 2 Department of Preventive Medicine and Public Health. Faculty of Medicine. Universty of Granada, Spain;
  3. 3 Department fo Biostatistics. School of Public Health. Université Libre de Bruxelles, Belgium
  1. E-mail: fmiguelangel{at}


Background: In Europe different studies forecast an increase in maternal mortality for the next years, associated with advanced maternal age and delay in maternity. This study aims to analyse the age-related trend in the maternal mortality ratio among mothers in Spain for the decade, 1996-2005; and describe the causes of death and associated socio-demographic factors for the years with highest mortality.

Methods: An ecological study on trends, for the age-related trend in the maternal mortality ratio; an indirect standardisation and poisson regression model was used. For the description of the causes of death, a cross-sectional study was used.

Results: Prevalence of live births among mothers aged 35 years and over was 15% higher in Spain than in Europe. The maternal mortality rate increased by 20% (Standardised Mortality Ratio of 1.2, 95%CI= 0.9-1.4) in 2005 with respect to 1996. The age-related risk of maternal mortality was 3 times higher (relative risk of 2.90, 95% CI [2.01-4.06]) among mothers aged 35 to 44 years versus those aged under 35 years. The highest mortality was detected during 2003-2004. The risk of maternal mortality was higher in foreign mothers.

Conclusion: This study confirms that there was a change in the maternal mortality trend characterised by an increase in deaths, associated with advanced maternal age, as well as an increase in the prevalence of live births among mothers aged 35 years and over. This pattern change poses the need of intensifying maternal mortality surveillance by collecting the necessary set of variables that allow investigation of the causes and determinant factors underlying deaths.

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