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Objectives To determine the excess risk of non-chromosomal congenital anomaly (NCA) among teenage mothers and older mothers. Design and setting Population-based prevalence study using data from EUROCAT congenital anomaly registers in 23 regions of Europe in 15 countries, covering a total of 1.75 million births from 2000 to 2004. Participants A total of 38 958 cases of NCA that were live births, fetal deaths with gestational age ≥20 weeks or terminations of pregnancy following prenatal diagnosis of a congenital anomaly. Main outcome measures Prevalence of NCA according to maternal age, and relative risk (RR) of NCA and 84 standard NCA subgroups compared with mothers aged 25–29. Results The crude prevalence of all NCA was 26.5 per 1000 births in teenage mothers (<20 years), 23.8 for mothers 20–24 years, 22.5 for mothers 25–29 years, 21.5 for mothers 30–34 years, 21.4 for mothers 35–39 years and 22.6 for mothers 40–44 years. The RR adjusted for country for teenage mothers was 1.11 (95% CI 1.06–1.17); 0.99 (95% CI 0.96–1.02) for mothers 35–39; and 1.01 (95% CI 0.95–1.07) for mothers 40–44. The pattern of maternal age-related risk varied significantly between countries: France, Ireland and Portugal had higher RR for teenage mothers, Germany and Poland had higher RR for older mothers. The maternal age-specific RR varied for different NCAs. Teenage mothers were at a significantly greater risk ( P < 0.01) of gastroschisis, maternal infection syndromes, tricuspid atresia, anencephalus, nervous system and digestive system anomalies while older mothers were at a significantly greater risk ( P < 0.01) of fetal alcohol syndrome, encephalocele, oesophageal atresia and thanatophoric dwarfism. Conclusions Clinical and public health interventions are needed to reduce environmental risk factors for NCA, giving special attention to young mothers among whom some risk factors are more prevalent. Reassurance can be given to older mothers that their age in itself does not confer extra risk for NCA. [ABSTRACT FROM AUTHOR]