Revisiting maternal age and child health: A nationwide birth cohort study in Taiwan

Yi-Yu Su; Chi-Jen Chen; Mei-Huei Chen; Ching-Chun Lin; Wu-Shiun Hsieh; Hsi Chang; Chin-Kan Chan; Wan-Ling Ho; Mu-Ming Chien; Pau-Chung Chen

doi:10.1016/j.jfma.2025.04.018

Revisiting maternal age and child health: A nationwide birth cohort study in Taiwan

J Formos Med Assoc. 2025 Apr 18:S0929-6646(25)00187-1. doi: 10.1016/j.jfma.2025.04.018. Online ahead of print.

Authors

Yi-Yu Su¹, Chi-Jen Chen², Mei-Huei Chen³, Ching-Chun Lin⁴, Wu-Shiun Hsieh⁵, Hsi Chang⁶, Chin-Kan Chan⁷, Wan-Ling Ho⁸, Mu-Ming Chien⁹, Pau-Chung Chen¹⁰

Affiliations

¹ Institute of Environmental and Occupational Health Sciences, National Taiwan University, College of Public Health, Taipei, Taiwan; Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan.
² Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan.
³ Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
⁴ Institute of Environmental and Occupational Health Sciences, National Taiwan University, College of Public Health, Taipei, Taiwan.
⁵ Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.
⁶ Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁷ Department of Pediatrics, Taoyuan General Hospital, Ministry of Health and Welfare, Taiwan; Department of Biotechnology, Ming Chuan University, Taiwan.
⁸ Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Pediatric Brain Tumor Program, Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan.
⁹ Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Taipei Medical University Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan.
¹⁰ Institute of Environmental and Occupational Health Sciences, National Taiwan University, College of Public Health, Taipei, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan. Electronic address: pchen@ntu.edu.tw.

PMID: 40253261
DOI: 10.1016/j.jfma.2025.04.018

Abstract

Background: Delayed childbearing is a growing trend globally, with Taiwan experiencing one of the steepest increases in maternal age. Advanced maternal age affects offspring health, including birth outcomes and long-term morbidity. However, its impact in Taiwan remains underexplored. This study investigates these effects using a nationwide birth cohort.

Methods: This retrospective cohort study utilized data from Taiwan's National Health Insurance Research Database (NHIRD), covering infants born from January 1, 2004, to December 31, 2014. The cohort included 2,068,672 infants, categorized into six maternal age groups: <20, 20-24, 25-29, 30-34, 35-40, and ≥40 years. Principal outcomes were stillbirth, mortality, preterm birth, congenital anomalies, neurodevelopmental outcomes, and atopic diseases. Multivariate logistic regression models adjusted for covariates to assess associations between maternal age and health outcomes.

Results: Among the 2,068,672 infants, stillbirth and mortality rates were highest in infants born to mothers <20 years, decreased with increasing maternal age, then rose again for mothers ≥30 years, showing a reverse J-shaped pattern. Similar trends were noted for preterm birth, congenital anomalies, and neurodevelopmental outcomes. Atopic diseases followed a nonlinear trend, peaking at maternal age 25-34 years.

Conclusion: Maternal age significantly impacts child health, with risks associated with both younger and older maternal ages. These findings are crucial for regions experiencing delayed childbearing. Further research is needed to explore underlying mechanisms and establish causality.

Keywords: Atopic diseases; Birth outcomes; Child mortality; Neurodevelopmental disorders; Taiwan.