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Prevalence and risk factors related to preterm birth in Brazil

Maria do Carmo Leal1, Ana Paula Esteves-Pereira2, Marcos Nakamura-Pereira3

  • 1National School of Public Health - Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, sala 809, Manguinhos, Rio de Janeiro, CEP 21041-210, Brazil. ducaleal@gmail.com.

Reproductive Health
|October 22, 2016
PubMed

Insights

Preterm birth in Brazil is a significant public health issue. This study found spontaneous preterm birth linked to social disadvantages, while provider-initiated preterm birth is associated with medical interventions and higher-risk pregnancies.

Area of Science:

  • Obstetrics and Gynecology
  • Public Health
  • Perinatal Epidemiology

Background:

  • The global increase in preterm birth rates presents a significant public health challenge due to associated morbidity, mortality, and long-term health effects.
  • Brazil is experiencing a rise in preterm births, necessitating a detailed understanding of contributing factors to inform public health strategies.
  • This study addresses the critical need to describe and quantify factors influencing both spontaneous and provider-initiated preterm birth in the Brazilian context.

Purpose of the Study:

  • To analyze and quantify the determinants of spontaneous preterm birth in Brazil.
  • To analyze and quantify the determinants of provider-initiated preterm birth in Brazil.
  • To identify key socio-demographic, clinical, and healthcare system factors associated with different pathways to preterm birth.

Main Methods:

  • Utilized data from the national population-based 'Birth in Brazil' study (2011-2012), encompassing 23,940 women.
  • Employed a three-level hierarchical methodology for variable analysis.
  • Conducted non-conditional multiple logistic regression to assess factors for spontaneous and provider-initiated preterm birth.

Main Results:

  • The overall preterm birth rate was 11.5%, with 60.7% spontaneous and 39.3% provider-initiated (over 90% pre-labor cesareans).
  • Spontaneous preterm birth was associated with adolescent pregnancy, low schooling, inadequate prenatal care, previous preterm birth, multiple pregnancy, placental abruption, and infections.
  • Provider-initiated preterm birth correlated with private healthcare, advanced maternal age, prior cesarean deliveries, multiple pregnancy, and maternal/fetal pathologies.

Conclusions:

  • Reducing provider-initiated preterm birth may be feasible, given its links to prior cesarean deliveries and maternal/fetal pathologies.
  • The strong association between spontaneous preterm birth and socio-economically disadvantaged groups highlights the need for continued efforts to reduce health inequalities.
  • Addressing social and health disparities is crucial for national strategies aimed at lowering preterm birth rates in Brazil.
Abstract

Keywords:
BrazilProvider-initiated preterm birthRisk factorsSpontaneous preterm birthpPROM

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