Preterm births prevalence during the COVID-19 pandemic in Brazil: results from the national database

Abstract

The SARS-CoV-2 (COVID-19) pandemic impacted the health systems between and within countries, and in the course of the pandemic sexual and reproductive health services were the most disrupted. Findings from high-income settings have reported significant changes in preterm birth prevalence during the pandemic period. To understand the possible effects of the COVID-19 pandemic on preterm birth numbers at the Brazilian national level. We compare the number of preterm deliveries during the COVID-19 pandemic period (2020 and 2021) with previous years. We conducted a population-based cross-sectional study taking the period from January 2017 to December 2021 to account. We use individual-level live births data from the Brazilian Live Birth Information System (SINASC), and we estimate the odds ratio (OR) of preterm deliveries using propensity score weighting analysis in Brazil and its regions. During the study period (from 2017 to 2021), about 2.7 million live births were recorded per year, and the missing value for gestational age at delivery was less than 1.5%. The preterm birth prevalence slightly increased during the COVID-19 pandemic compared to the pre-pandemic period (11.32% in 2021 vs 11.09% in 2019, p-value < 0.0001). After adjusting for sociodemographic variables, the OR of preterm births in Brazil has significantly increased, 4% in 2020 (OR: 1.04 [1.03–1.05] 95% CI, p-value < 0.001), and 2% in 2021(OR: 1.02 [1.01–1.03] 95% CI, p-value < 0.001), compared to 2019. At the regional level, the preterm birth pattern in the South, Southeast and Northeast regions show a similar pattern. The highest odds ratio was observed in the South region (2020 vs 2019, OR: 1.07 [1.05–1.10] 95% CI; 2021 vs 2019, OR: 1.03 [1.01–1.06] 95% CI). However, we also observed a significant reduction in the ORs of preterm births in the northern region during the COVID-19 pandemic (2020 vs 2019, OR: 0.96 [0.94–0.98] 95% CI) and (2021 vs 2019, OR: 0.97 [0.95–0.99] 95% CI). Our analysis shows that the pandemic has increased regional variation in the number of preterm births in Brazil in 2020 and 2021 compared to the pre-pandemic years.

Cognition, mental health and quality of life amongst siblings of preterm born children: A systematic review

“…Also amongst the included studies we must acknowledge important contextual background differences that can influence the associations we reviewed. In fact, these countries may have distinct reported preterm birth rates, [51][52][53] primary health care and social and school systems that could modify the studied relationships. Due to a high level of heterogeneity between studies and the small sample size used, these factors were not tested for interaction, and we cannot conclude on their effects or their absence of effects.…”

Impact of the COVID-19 Pandemic on Births, Vaginal Deliveries, Cesarian Sections, and Maternal Mortality in a Brazilian Metropolitan Area: A Time-Series Cohort Study

“…Maternal health is of great interest in all conditions impacted by COVID-19 as it is a proxy indicator of the quality of a country's healthcare services. [4][5][6][7] As the COVID-19 pandemic continued to spread, there was a notable rise in cases of moderate to severe illness among pregnant women, leading to concerns about their susceptibility to infection and potential fatalities. [4][5][6][8][9][10][11] Thus, beyond the fear of the possibility of vertical transmission, special attention was initially given to understanding the direct effects of COVID-19 on maternal health.…”

“…Notably, the severity of infection during pregnancy was a primary area of concern, especially in women from high-risk groups, such as those with obesity, hypertension, diabetes, and immunosuppression conditions. 1,[6][7][8][9][10][11] In this aspect, a systematic review with meta-analysis including 42,754 infected pregnant patients showed a rapid increase in cesarian sections (c-sections); the mortality trend was not elucidated with a maternal mortality rate of 1.2% and a rise of preterm births. 11 It is important to note that the impact of the pandemic on maternal health transcended the direct effects of individual infections.…”

“…The indirect effects, such as the reduced access to and provision of maternal healthcare services and lower levels of their utilization due to fear of being infected, may lead to a significant impact on the quality of maternal care. [5][6][7][8][9][10][11][12] Thus, apart from the direct effects of COVID-19 on maternal health, the interruption of maternal healthcare services provision during the pandemic, breaking the continuum of healthcare throughout antenatal, intrapartum, and postnatal stages, could adversely affect both mother and newborn health, including a rise in preterm births and maternal mortality. [5][6][7][8][9][10][11][12] The adaptations made in antenatal and postnatal services, the modifications to provide maternity care can also influence intrapartum services.…”

“…[5][6][7][8][9][10][11][12] Thus, apart from the direct effects of COVID-19 on maternal health, the interruption of maternal healthcare services provision during the pandemic, breaking the continuum of healthcare throughout antenatal, intrapartum, and postnatal stages, could adversely affect both mother and newborn health, including a rise in preterm births and maternal mortality. [5][6][7][8][9][10][11][12] The adaptations made in antenatal and postnatal services, the modifications to provide maternity care can also influence intrapartum services. These modifications can involve changes to provide care for pregnant women during labor, including alterations in anesthesia practices and the approach to childbirth itself.…”