# Effect of COVID-19 on Brazilian cesarean and prematurity rates: a cross-sectional study

## TL;DR

This study found that Brazil saw increases in both cesarean sections and preterm births during the early stages of the COVID-19 pandemic.

## Contribution

The study provides new evidence of a moderate association between rising cesarean rates and prematurity during the pandemic in Brazil.

## Key findings

- Cesarean section rates increased from 56.34% to 57.05% during the pandemic.
- Preterm delivery rates rose from 8.99% to 9.13% during the same period.
- A moderate positive relationship (R2 = 0.3121) was observed between cesarean rates and prematurity.

## Abstract

To investigate the relationship between prematurity and cesarean section rate in Brazil during the beginning of COVID-19 pandemic.

Utilizing the Robson Classification, this study analyzed data from the Brazilian Ministry of Health's Live Births Panel, comparing CSR) and group 10 (preterm deliveries) between 2019 (pre-pandemic) and 2021 (pandemic) in each of Brazilian states and the overall country. The prematurity and CSR were compared using prevalence ratio and confidence interval, and p-value was obtained. The variation of prematurity and CSR were compared through the coefficient of determination (R2).

A total of 5,522,910 deliveries were evaluated during the period. The CSR increased from 56.34% to 57.05% (p<0.01), and the frequency of preterm deliveries rose from 8.99% to 9.13% (p<0.01). The CSR increased in 23 States and decreased in 4 States, while the prematurity rate increased in 16 States and decreased in 10 States. A positive relationship between the increase of CSR and prematurity was observed during COVID-19, with an R2 value of 0.3121, suggesting a moderate association between these two variables.

Between 2019 (pre-COVID-19 pandemic) and 2021 (the first full year of the COVID-19 pandemic), there was an increase in prematurity and CSR in Brazil. These increases were observed in most Brazilian states and may be correlated. However, it is impossible to establish a cause-effect relationship given the design of this study.