Rising Perinatal Mortality in Greece, 2014–2024: Are Changes in Stillbirth Registration Practices the Only Explanation?

Background Perinatal mortality appears to have increased recently in Greece; however, it is unclear whether this increase can be solely attributed to the 2018 change in the defined gestational age threshold for stillbirth registration. Objectives To examine temporal trends in perinatal mortality rates in Greece during the period 2014–2024 and evaluate the potential impact of changes in stillbirth registration practices. Methods Nationwide data from the Hellenic Statistical Authority (2014–2024; Ν = 926,154 total births) were analysed to estimate trends in perinatal mortality. Changes in stillbirth recording after 2018, following the adoption of a 22‐week gestational viability threshold, were taken into account. Poisson Regression, Interrupted Time Series (ITS) and Joinpoint Regression analyses were used. Results Perinatal mortality was 5.6 in 2014 versus 8.2 in 2024 per 1000 total births. Poisson regression showed an overall increase in perinatal mortality rates (4.4% annually, 95% confidence interval [CI] 3.5 to 5.3), driven by rising stillbirth rates (6.8% annually, 95% CI 5.5 to 8.1), while early neonatal mortality rates declined (−2.0% annually; 95% CI −3.0 to −1.1). Stillbirth rates at < 26 weeks' gestation increased sharply (36.1% annually, 95% CI 24.9 to 47.4), whereas a smaller increase was observed at ≥ 26 weeks (1.7% annually, 95% CI 0.4 to 2.9). ITS analysis showed a level increase in 2019 and an increasing post‐2019 trend in stillbirth rates at < 26 weeks, whereas no corresponding level or post‐2019 trend changes were detected at ≥ 26 weeks. Joinpoint regression also identified 2019 as a breakpoint for stillbirths at < 26 weeks. Conclusions The rise in perinatal mortality in Greece over the past decade has been driven by increased stillbirth rates, largely attributable to changes in stillbirth recording practices at gestational ages < 26 weeks. The modest upward trend in stillbirths at ≥ 26 weeks' gestation warrants further investigation and ongoing monitoring.