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Elisangela Aparecida Silva Lizzi, Associate Editor of Epidemiology and Health Services: Journal of the Brazilian Unified Health System, Professor at the Federal Technological University of Paraná (UTFPR), Cornélio Procópio campus, Paraná, Brazil.
Betine Pinto Moehlecke Iser, University of Southern Santa Catarina, Postgraduate Program in Health Sciences, Tubarão, Santa Catarina, Brazil.
The article “Prevalence and temporal trend of prematurity in Brazil before and during the COVID-19 pandemic: analysis of the historical series 2011-2021 ,” authored by Alberton and colleagues – researchers from the University of Southern Santa Catarina – and published in the journal Epidemiology and Health Services: Journal of the SUS (RESS, vol. 32, no. 2, 2023), evaluated the occurrence of prematurity in Brazil over ten years, from 2011 to 2021, including the pandemic period in 2020 and 2021. During this time frame, it was found that 11% of births in Brazil were premature, and this proportion did not change throughout the study period (it neither increased nor decreased from 2011 to 2021).
An analysis of the trend using statistical models revealed an increase in premature births during this period, particularly in twin pregnancies and among pregnant women with 4 to 6 prenatal visits. Among the country’s macro-regions, the North region showed the highest prevalence of this condition, reaching 11.6%, and this result could be associated with higher frequencies of teenage pregnancy, low levels of education, and inadequate prenatal care in the region.
The study presents interesting findings about maternal characteristics. For example, it was observed that prematurity rates varied with maternal age; that is, at the extremes of age ranges (10 to 19 years; 40 years and older) there was a higher risk of premature births. Regarding education, a higher proportion of prematurity was shown among pregnant women with less than eight years of schooling. In the context of race/color, it was higher among Indigenous and Black pregnant women. Regarding the number of prenatal visits, pregnant women who had more than seven prenatal visits had the lowest proportion of prematurity in the study. And the low number of prenatal visits, that is, those who had between four and six visits, showed an increasing trend of prematurity throughout the study period.
Image: Unsplash .
It is important to remember that, to consider prenatal care properly conducted, a minimum of 6 prenatal visits during pregnancy is recommended. Twin pregnancies have shown to be a strong indicator of prematurity, with an increasing annual trend during the study period. Over the years, the trend was generally stable, even during the pandemic, showing that there was no immediate effect of the COVID-19 pandemic on prematurity.
Beyond estimating prematurity in Brazil and understanding the influence of the COVID-19 pandemic, this study contributes to determining specific actions in healthcare for the population at highest risk, stimulating preventive actions in the health system that benefit families throughout the country. Furthermore, it highlights the importance of improving prenatal care for vulnerable groups, such as pregnant women over 40 years old, those with lower levels of education, indigenous women, those with twin pregnancies, and pregnant women with fewer than 6 prenatal visits. Prioritizing these actions in primary healthcare should contribute to improving this indicator.
It is important to emphasize, as a perspective of this study, the importance of adequate and humanized prenatal care, since some conditions of the mother or the child’s development could be investigated, treated, and monitored in a timely manner. The birth of a premature baby impacts families and their support networks, as it involves expectations of the arrival of a new life at risk, a long period of hospitalization after birth, and the mother’s mental health. Prenatal care is offered free of charge by the Unified Health System (SUS) in basic health units; every woman has the right to prenatal care. And her child is followed by pediatricians after birth for consultations at the health unit, vaccinations, and monitoring of their development.
ALBERTON, Marcos; ROSA, Vanessa Martins; ISER, Betine Pinto Moehlecke. Prevalence and temporal trends of prematurity in Brazil before and during the COVID-19 pandemic: a historical time series analysis, 2011-2021. Epidemiology and Health Services [online]. 2023, vol. 32, e2022603 [viewed 11 August 2023]. DOI: https://doi.org/10.1590/S2237-96222023000200005 . Available from: https://www.scielo.br/j/ress/a/rR86nL5VqpNxFMKK47BRgsb/?lang=en
Epidemiology and Health Services – RESS: https://www.scielo.br/ress
Epidemiology and Health Services – Website: http://ress.iec.gov.br/
MACHADO, MCH et al . Healthcare in the first year of life of a prospective cohort of late preterm and term infants from Botucatu, São Paulo, 2015-2017. Epidemiology and Health Services [online]. 2021, vol. 30e2020619 [viewed 11 August 2023]. DOI: https://doi.org/10.1590/S1679-49742021000200014 . Available from: https://www.scielo.br/j/ress/a/5B9WSQw9WrXcqbyxDTRbdLF/
TEIXEIRA, JAM et al . Mortality on the first day of life: trends, causes of death and preventability in eight Brazilian Federative Units, between 2010 and 2015. Epidemiology and Health Services [online]. 2019, vol. 28, e2018132 [viewed 11 August 2023]. DOI: https://doi.org/10.5123/S1679-49742019000100006 . Available from: https://www.scielo.br/j/ress/a/b553sbJ6YVR3PnznZkqdrrJ/