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Increase in maternal mortality associated with change in the reproductive pattern in Spain: 1996–2005
  1. M Á Luque Fernández1,
  2. A Bueno Cavanillas2,
  3. M Dramaix-Wilmet3,
  4. F S Soria1,
  5. J de Mata Donado Campos1,
  6. D H Guibert1
  1. 1
    National Centre for Epidemiology, Field Epidemiology Training Programme, Carlos III Institute of Health, Madrid, Spain
  2. 2
    Faculty of Medicine, Department of Preventive Medicine and Public Health, University of Granada, Spain
  3. 3
    School of Public Health, Department of Biostatistics, Université Libre de Bruxelles, Brussels, Belgium
  1. Dr M Á Luque Fernández, National Centre for Epidemiology (Centro Nacional de EpidemiologíaCNE), Field Epidemiology Training Programme (FETP), Carlos III Institute of Health, C/Sinesio Delgado 6, Pabellón 12, 28029 Madrid, Spain; fmiguelangel{at}


Background: In Europe, different studies forecast an increase in maternal mortality in the coming 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 to describe the causes of death and associated sociodemographic 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 to 1.4) in 2005 with respect to 1996. The age-related risk of maternal mortality was three times higher (relative risk of 2.90, 95% CI 2.01 to 4.06) among mothers aged 35–44 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 change in pattern identifies the need to intensify maternal mortality surveillance by collecting the necessary set of variables that allows investigation of the causes and determinant factors underlying deaths.

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  • Competing interests: None.

  • Funding: None.