Increase in maternal mortality associated with change in the reproductive pattern in Spain: 1996-2005

Abstract

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% 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.

Women's Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957 to 2007

“…This finding indicates the presence of a ‘fertility paradox’: when TFR decreases and produces a delayed motherhood it can also provoke a deleterious effect on maternal health via an increase of the obstetric risk associated with childbearing at advanced ages. This remains consistent with the results of recent studies in developed nations [72]–[75].…”

“…In other words, 90.5% of this change concentrated between 1985 and 2007 indicating an accelerated transition to a delayed motherhood. This reproductive pattern is known to be consistently associated to increased obstetric mortality and morbidity by pre-existing chronic conditions, obesity, gestational hypertension, diabetes, eclampsia, third trimester haemorrhage, caesarean section among others [72], [85]–[88]. Epidemiological studies conducted during the last decade in Chilean pregnant women [89]–[91] have established that the first cause of maternal morbidity and death is related to non-obstetric pre-existing chronic conditions – i.e.…”

The relationship between maternal education and mortality among women giving birth in health care institutions: Analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health

“…The increased risk of maternal mortality among women aged over 35 is not specific to countries in Asia, Africa and Latin America [36], and appears to be related to the increased risk of ill health among older women which produce complications during pregnancy and childbirth [37] and the increased likelihood of caesarean delivery at older ages [38]. There is also evidence that the main causes of death vary between women giving birth above and below the age of 35 [39].…”

Abortion legislation, maternal healthcare, fertility, female literacy, sanitation, violence against women and maternal deaths: a natural experiment in 32 Mexican states

“…Simple direct correlations between TFR and MMR across multiple countries support the common notion that decreasing fertility reduces maternal mortality by reducing a woman's exposure to pregnancy during her reproductive lifetime 10 66 67 70. However, results from recent studies show that the relationship between TFR and maternal mortality is much more complex and may vary from one country to another 30 65 71 72. A plausible mechanism to explain an inverse correlation between TFR and maternal mortality has been referred to as the ‘fertility paradox’ emerging in advanced stages of demographic transition, when TFR falls under 2.5 30.…”

“…A plausible mechanism to explain an inverse correlation between TFR and maternal mortality has been referred to as the ‘fertility paradox’ emerging in advanced stages of demographic transition, when TFR falls under 2.5 30. While early stages of fertility reduction would be associated with a decreased number of children per woman without a substantial delay of motherhood, later stages of fertility reduction appear to be primarily associated with delayed motherhood 30 40 63 65 72 73. The net effect of this change would be an increase in pregnancies among women above 35 years of age, which in turn increases the risk of complications and mortality from non-obstetric pre-existing medical conditions such as hypertension, diabetes, renal disease and obesity, as well as obstetric conditions such as gestational hypertension, pre-eclampsia, gestational diabetes, postpartum haemorrhage, recurrent miscarriage, caesarean section and indirect causes 40 65 71–77.…”