ArticleBMJ open2018
Caesarean sections and the prevalence of preterm and early-term births in Brazil: secondary analyses of national birth registration.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
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Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it, 74 citations in OpenAlex.
- The Risk of Preterm Birth in Women With Periodontitis: A Systematic Review and Meta-Analysis.International journal of dental hygiene · 2026Pooled it
- Increasing Prevalence and Temporal Trend of Prematurity, São Paulo, Brazil, 2000-2023.Epidemiologia (Basel, Switzerland) · 2025Article
- National and regional Temporal trends and forecasting of preterm birth in brazil: evidence from National birth data (2014-2023) with projections to 2030.BMC pregnancy and childbirth · 2025Article
- Prevalence and associated factors of caesarean section delivery: analysis from the Nepal Demographic and Health Survey 2022.BMJ open · 2025Article
- Trends in gestational age at birth in the city of São Paulo, Brazil between 2012 and 2019.PloS one · 2025Observational
- COVID-19 Pandemic Impact on the Birth Weight of Children Born in a Brazilian Metropolis.International journal of environmental research and public health · 2024Article
- The effects of a quality improvement project to reduce caesarean sections in selected private hospitals in Brazil.Reproductive health · 2024Article
- An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals.Reproductive health · 2024Article
- Maternal health surveillance panel: a tool for expanding epidemiological surveillance of women's health and its determinants.Revista brasileira de epidemiologia = Brazilian journal of epidemiology · 2024Article
- Risk Factors Associated with Neonatal Mortality and Their Status: A Matched Case-Control Study in Kurdistan.Medical journal of the Islamic Republic of Iran · 2024Article
- Association of Maternal Risk Factors with the Prevalence of Caesarean Section Deliveries: A Cross-Sectional Study.Medical sciences (Basel, Switzerland) · 2023Article
- Cesarean sections and early-term births according to Robson classification: a population-based study with more than 17 million births in Brazil.BMC pregnancy and childbirth · 2023Article
- Association of maternal nationality with preterm birth and low birth weight rates: analysis of nationwide data in Japan from 2016 to 2020.Maternal health, neonatology and perinatology · 2023Article
- Interaction between birth characteristics andFrontiers in oncology · 2023Article
- Gestational age: comparing estimation methods and live births' profile.Revista brasileira de epidemiologia = Brazilian journal of epidemiology · 2023Article
- Intrauterine growth restriction, prematurity, and low birth weight: risk phenotypes of neonatal death, Rio de Janeiro State, Brazil.Cadernos de saude publica · 2023Article
- Placental expression of miR-21-5p, miR-210-3p and miR-141-3p: relation to human fetoplacental growth.European journal of clinical nutrition · 2022Article
- Early-term birth and its association with universal two-child policy: a national cross-sectional study in China.BMJ open · 2021Article
- A Cross-Sectional Study to Assess the Frequency and Risk Factors Associated with Cesarean Section in Southern Punjab, Pakistan.International journal of environmental research and public health · 2021Article
- Cost-effectiveness analysis of a quality improvement program to reduce caesarean sections in Brazilian private hospitals: a case study.Reproductive health · 2021Article
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo investigate whether the high rates of caesarean sections (CSs) in Brazil have impacted on the prevalence of preterm and early-term births.
designIndividual-level, cross-sectional analyses of a national database.
settingAll hospital births occurring in the country in 2015.
participants2 903 716 hospital-delivered singletons in 3157 municipalities, representing >96% of the country's births. PRIMARY AND SECONDARY OUTCOME MEASURES: CS rates and gestational age distribution (<37, 37-38, 39-41 and 42 or more weeks' gestation). Outcomes were analysed according to maternal education, measured in years of schooling and municipal CS rates. Analyses were also adjusted for maternal age, marital status and parity.
resultsPrevalence of CS was 55.5%, preterm prevalence (<37 weeks' gestation) was 10.1% and early-term births (37-38 weeks of gestation) represented 29.8% of all births, ranging from 24.9% among women with <4 years of schooling to 39.8% among those with >12 years of education. The adjusted prevalence ratios of preterm and early-term birth were, respectively, 1.215 (1.174-1.257) and 1.643 (1.616-1.671) higher in municipalities with≥80% CS compared with those <30%.
conclusionsBrazil faces three inter-related epidemics: a CS epidemic; an epidemic of early-term births, associated with the high CS rates; and an epidemic of preterm birth, also associated with CS but mostly linked to poverty-related risk factors. The high rates of preterm and early-term births produce an excess of newborns at higher risk of short-term morbidity and mortality, as well as long-term developmental problems. Compared with high-income countries, there is an annual excess of 354 000 preterm and early-term births in Brazil.
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