title: [Secular evolution and evolution according to autonomous communities of the frequency of fertility treatments, multiple deliveries and cesarean sections in Spain].
abstract: OBJECTIVE
  Fertility treatments, multiple deliveries and caesarean sections are related to maternal age. Because maternal age has increased in Spain, it can also be expected an increase in these variables. We analyzed their evolution over the time and by maternal age, either globally and by Spanish Autonomous Communities.
  
  
  METHODS
  We studied a sample of 30,956 mothers of non-malformed newborn infants from all over Spain.
  
  
  METHODS
  between 1977 and June 2002.
  
  
  RESULTS
  The percentage of fertility treatments shows a statistically significant increasing trend in all of the maternal ages groups. However, this was higher in mothers older than 34 years, among whom the frequency of multiple deliveries also increased (p = 0.01). The same trends were observed by Spanish Autonomous Communities, yet with differences between them. In the Comunidad Valenciana, we identified the highest frequency of fertility treatments, while the highest mean maternal age was observed in Aragón. Galicia has one of the lowest proportions of multiple deliveries, while the percentage of fertility treatments is similar to other regions. The percentage of caesarean sections (over 25%, globally) shows a statistically significant increasing trend in all the maternal ages groups, the highest one being among mothers older than 39 years.
  
  
  CONCLUSIONS
  The observed increasing maternal age implies a higher use of fertility treatments, multiple deliveries and caesarean sections. All these variables show statistically significant variations between Spanish Autonomous Communities and over the time.
authors.affiliation: Centro de Investigación sobre Anomalías Congénitas, Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo, Madrid, Spain. mlmartinez.frias@isciii.es
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Martínez-Frías
authors.forename: Eva
authors.initials: E
authors.lastname: Bermejo
authors.forename: Elvira
authors.initials: E
authors.lastname: Rodríguez-Pinilla
authors.forename: Griselda
authors.initials: G
authors.lastname: Dequino
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005300:Fertility Agents, Female; D006801:Humans; D007247:Infertility, Female / Q000628:therapy; D008423:Maternal Age; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data*; D013030:Spain / Q000453:epidemiology
chemical_list: D005300:Fertility Agents, Female