Increasing age of mothers in Spain leads to rise in mortality rates

Medicine has taken giant strides during the 20th Century. However, European studies show a clear and constant increase in maternal mortality rates over recent years. Now, a new study reveals the evolution in the mortality rate of Spanish mothers from 1996 to 2005. The data, which appear in the latest issue of the Journal of Epidemiology and Community Health, show the mortality rate is low compared with other countries in Europe, but confirm that death rates are rising in Spain.

"This change, linked to the rise in maternal age, clearly shows the need for epidemiological monitoring of maternal mortality, because this is an avoidable phenomenon, and above all because it shows the importance of studying the causes in order to prevent deaths", Miguel Ángel Luque, lead author of the study and a researcher at the Carlos III Health Institute (ISCIII) in Madrid, tells SINC.

The maternal mortality risk rose exponentially in line with mothers' ages in Spain during the decade studied. Since the start of the study, 148 women have died in Spain. While successful births among women older than 35 were 15% more common in Spain than in the rest of Europe, maternal mortality was 20% higher by 2005 than in 1996.

The risk was three times greater for women aged between 35 and 44 than those who were younger. Most deaths were due to preeclampsia (a condition characterised by high blood pressure and protein in the urine, which starts to develop after the twentieth week of the pregnancy) and obstetric embolisms (pulmonary, or the amniotic liquid, etc.).

Malaga was the province with the highest number of deaths (20%). The highest mortality rate was in 2003 and 2004, and among foreign women. According to the authors, this is the first study to underline the high percentage of deaths in the country among women who are not of Spanish nationality (who accounted for 32% of the deaths in 2003 and 2004).

"We need more studies to help us to define the distribution, frequency and determining factors involved in maternal mortality. While the role of changing reproductive patterns is obvious in Europe, it is still not clear what other factors, aside from maternal age, are related to the increase in deaths", adds Luque.

Poor work-life balance, much medical intervention

According to Eurostat, the EU's Statistical Office, the age of women at their first pregnancy is rising in most European countries. This can be explained by social, economic and cultural changes that took place in western countries at the end of the 20th Century.

The authors suggest that the lack of initiatives to help balance family and work life in Spain, along with the increased medicalisation of births over the past 10 years as a result of the progressive incorporation of assisted reproduction techniques, are some of the factors involved in the rising age of mothers.

"We need greater understanding of the agents causing this increase in the death rate in order to be able to tackle them", stresses the ISCIII researcher. All maternal deaths in countries such as the United Kingdom, France, Holland the United States are today investigated by means of qualitative surveys in order to gain information about their determining factors.

Spain and Italy, with some of the lowest fertility rates in the whole of Europe, are the two countries with the highest rates of births among women aged above 35. Compared with the rest of the countries in Europe, these two have the highest number of assisted reproduction clinics. The experts are already forecasting that "this change suggests a continued future increase in maternal mortality rates".

More information: M. A. Luque Fernández, A. Bueno Cavanillas, M. Dramaix-Wilmet, F. S. Soria, J. de Mata Donado Campos, D. H. Guibert. "Increase in maternal mortality associated with change in the reproductive pattern in Spain: 1996". Journal of Epidemiology and Community Health 63:433, junio de 2009.

Source: FECYT - Spanish Foundation for Science and Technology