Time Trend Analysis of Early Term Births in Greece (1980-2023): Persistent High Rates Raise Public Health Concerns

Neonates born at 37-38 weeks of gestation have been shown to face a relatively higher risk of mortality and various morbidities compared to those born at full term (39-41 weeks). The aim of this study was to conduct a comprehensive analysis of early term birth rate (ETBR) trends in Greece from 1980 to 2023.

Data on live births in Greece from 1980 to 2023 were obtained from the Hellenic Statistical Authority (ELSTAT), based on birth certificate records. A total of 4,595,020 live births were categorized by gestational age. The annual ETBR was calculated as the number of live births occurring at 37-38 completed gestational weeks (from 37+0 to 38+6 weeks) per 100 total live births. Additionally, ETBR was calculated separately for 37 and 38 gestational weeks, as well as the overall birth rate < 39 weeks of gestation. Time trends were evaluated using joinpoint regression analysis.

The ETBR decreased with an annual percent change (APC) of -1.4 (95% confidence interval (CI): -1.8 to -0.9, p = 0.004) between 1980 and 1994, followed by a sharper decline with an APC of -12.8 (95% CI: -14.4 to -8.5, p = 0.005) during 1994-1997. Subsequently, the ETBR increased with an APC of 3.2 (95% CI: 2.0 to 5.6, p = 0.016) from 1997 to 2004. This trend reversed again from 2004 to 2010, with an APC of -2.6 (95% CI: -5.9 to -1.1, p = 0.016), while in the most recent period (2010-2023), the ETBR stabilized (p = 0.630), fluctuating between 41.9% in 2010 and 44.3% in 2012 and 2013. During the study period (1980-2023), the ETBR at 37 weeks increased by an average of 7.1% per year, whereas the ETBR at 38 weeks decreased by an average of -2.1% annually. The overall birth rate < 39 weeks of gestation has remained consistently above 50% over the past two decades (2004-2023). In 2023, the ETBR was 43.7%, while a total of 56.0% of neonates were born < 39 gestational weeks.

This study provides a comprehensive analysis of ETBR in Greece, revealing persistently high levels that exceed those of all developed countries. The elevated rate is likely driven by factors such as maternal demographics and obstetrical practices. The alarmingly high levels of ETBR, combined with the country's extremely high preterm birth rates, result in a substantial burden of neonatal morbidity and an increased risk of potential chronic diseases. These findings underscore an enormous public health challenge.