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

Objective: To investigate the relationship between prematurity and cesarean section rate in Brazil during the beginning of COVID-19 pandemic. Methods: 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). Results: 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. Conclusion: 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.