# Temporal trends and factors associated with live preterm births in Espírito Santo, 2012-2021

## TL;DR

This study examines preterm birth trends and associated factors in Brazil's Espírito Santo state from 2012 to 2022, finding regional variations and key risk factors.

## Contribution

The novel contribution is identifying regional disparities and socioeconomic factors linked to preterm births in Espírito Santo.

## Key findings

- Prematurity rates were higher among male infants with low weight and low Apgar scores.
- Maternal factors like lack of education and no prenatal care were strongly associated with preterm births.
- Some regions showed increasing preterm birth rates, while others decreased, highlighting regional health inequalities.

## Abstract

To analyze the temporal trend of live premature births in the State of Espírito Santo (Brazil) between 2012 and 2022 and to identify associated factors.

Ecological study using secondary data from the Live Birth Information System (SINASC), covering premature births in Espírito Santo between 2012 and 2022. Prais-Winsten regression was used to assess the temporal trend of the prematurity rate, and the Prevalence Ratio (PR) was used to identify factors associated with premature birth.

A higher prevalence of premature birth was observed among boys (PR=1.06) with weight <2,500 g, Apgar score at one and five minutes <7 (PR=3.10 and PR=4.05), and with the presence of congenital anomalies (PR=2.74). Among maternal factors, higher prevalences were found among mothers with no schooling (PR=1.51), without a partner (PR=1.11), aged <19 years or >35 years (PR 1.14; PR 1.32), who did not have prenatal care (PR=2.32), twin pregnancy (PR=6.21) and cesarean delivery (PR=1.05). In all analyses, statistical significance was p<0.001. Regarding the temporal trend analysis, Barra de São Francisco, Santa Teresa, and Vitória showed an increasing prematurity rate (2012-2022). Alegre, Cachoeiro de Itapemirim, and Itapemirim showed decreasing rates. Espírito Santo showed a stationary rate.

Espírito Santo has a stationary prematurity rate, with some microregions showing increasing or decreasing rates, indicating territorial heterogeneity and regional inequalities in access to health. Maternal and gestational socioeconomic risk factors stand out as indicators of a higher prevalence of prematurity.

Analisar a tendência temporal dos nascimentos prematuros vivos no estado do Espírito Santo (Brasil) entre 2012 e 2022 e identificar os fatores associados.

Estudo ecológico com dados secundários do Sistema de Informações sobre Nascidos Vivos (SINASC), abrangendo partos prematuros no Espírito Santo entre 2012 e 2022. Utilizaram-se a regressão de Prais-Winsten na avaliação da tendência temporal da taxa de prematuridade e a razão de prevalência (RP) para identificar fatores associados ao nascimento prematuro.

Observou-se maior prevalência de nascimento prematuro entre os meninos (RP=1,06) com peso <2.500 g, Apgar no primeiro e quinto minuto <7 (RP=3,10 e RP=4,05) e a presença de anomalias congênitas (RP=2,74). Entre os fatores maternos, maiores prevalências estavam entre mães sem nenhuma escolaridade (RP=1,51), sem parceiro (RP=1,11), de idade <19 anos ou >35 anos (RP=1,14; RP=1,32), que não realizaram consulta pré-natal (RP=2,32), gestação gemelar (RP=6,21) e parto cesáreo (RP=1,05). Em todas as análises a significância estatística foi de p<0,001. Quanto à análise de tendência temporal, Barra de São Francisco Santa Teresa e Vitória apresentaram taxa de prematuridade crescente (2012-2022). Alegre, Cachoeiro de Itapemirim e Itapemirim apresentaram taxas decrescentes. O Espírito Santo apresentou taxa estacionária.

O Espírito Santo possui taxa de prematuridade estacionária, com algumas microrregiões com taxas crescentes ou decrescentes, indicando heterogeneidade territorial e desigualdades regionais no acesso à saúde. Destacam-se os fatores socioeconômicos maternos e gestacionais de risco como indicadores de maior prevalência de prematuridade.