Maternal Age Trends and Patterns in Greece (1956-2023): A Nationwide Analysis.

INTRODUCTION

Advanced maternal age is associated with an increased risk of major pregnancy complications. This study aims to investigate long-term trends in maternal age at childbirth in Greece, providing a comprehensive analysis of the evolving distribution of live births by maternal age over time.

MATERIALS AND METHODS

We analyzed national data on 8,208,255 live births in Greece from 1956 to 2023, obtained from the Hellenic Statistical Authority and based on official birth certificate records. Maternal age at delivery was categorized into six groups: < 20, 20-24, 25-29, 30-34, 35-39, and ≥ 40 years. To assess the temporal shift in maternal age distribution, the annual proportion (%) of live births within each age group relative to the total live births per year was calculated, and trends were evaluated using joinpoint regression analysis. Annual percent change (APC) values were calculated along with 95% confidence intervals (95% CI).

RESULTS

The mean maternal age at childbirth in Greece declined to a minimum of 26.1 years in 1983 and 1984, then increased substantially over the past four decades, reaching a historic high of 32.1 years in 2023. This upward trend was characterized by an APC of 0.7 (95% CI: 0.7 to 0.8) between 1984 and 2000, followed by a slightly slower APC of 0.4 (95% CI: 0.4 to 0.4) from 2000 to 2023. The modal maternal age group in Greece shifted from 20-24 years between 1969 and 1988 to 25-29 years during 1989-2004, while since 2005, the most common age group at childbirth has been 30-34 years. Since the 1980s, there has been a notable shift in the distribution of live births in Greece toward older maternal ages. This trend is marked by a significant decline in the proportion of births to women < 30 years of age and a substantial increase among those aged ≥ 30 years. The relative contribution of mothers aged 35-39 years rose from a historic low of 5.20% in 1980 to a record high of 26.87% in 2021, although it has stagnated since 2018. The proportion of neonates born to mothers aged ≥ 40 years increased dramatically with an APC of 2.5 (95% CI: 1.3 to 3.3) between 1984 and 1995, followed by a markedly steeper APC of 7.0 (95% CI: 6.8 to 7.3) from 1995 onward. The percentage for this age group increased from an all-time low of 1.23% in 1984 to a historic peak of 10.69% in 2023, representing one of the highest rates among developed countries.

CONCLUSION

Greece has experienced a significant rise in maternal age since the 1980s, driven by a relative decline in births among women < 30 years and a marked increase in the proportion of births to older mothers, particularly those aged ≥ 40 years. These demographic trends raise important concerns and pose substantial challenges to national perinatal health outcomes.