Caesarean sections and the prevalence of preterm and early-term births in Brazil: secondary analyses of national birth registration
ObjectivesTo investigate whether the high rates of caesarean sections (CSs) in Brazil have impacted on the prevalence of preterm and early-term births.DesignIndividual-level, cross-sectional analyses of a national database.SettingAll hospital births occurring in the country in 2015.Participants2 903...
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| creator | Barros, Fernando C Rabello Neto, Dacio de Lyra Villar, Jose Kennedy, Stephen H Silveira, Mariangela F Diaz-Rossello, Jose Luis Victora, Cesar G |
| description | ObjectivesTo investigate whether the high rates of caesarean sections (CSs) in Brazil have impacted on the prevalence of preterm and early-term births.DesignIndividual-level, cross-sectional analyses of a national database.SettingAll hospital births occurring in the country in 2015.Participants2 903 716 hospital-delivered singletons in 3157 municipalities, representing >96% of the country’s births.Primary and secondary outcome measuresCS rates and gestational age distribution ( |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6078248</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2099481522</sourcerecordid><originalsourceid>FETCH-LOGICAL-b472t-e6fb8165253c10e60aa3427ffef03956cae5a13159fe1b057f3ba5578a851dc3</originalsourceid><addsrcrecordid>eNqNkU9v1DAQxS0EolXpJ0BCkbhwSfGfTOJwQIIVtEiVuPRuTbLjblaOvdjZSsuVL46zWarCCV_ssX_veUaPsdeCXwmh6vfduA078qXkQpdcClD6GTuXvKrKmgM8f3I-Y5cpbXleFbQA8iU7U5xrqUCds18rpISR0BeJ-mkIPhXo18W0oWIX6QEd-Z6KYOdqojgeXwmjO5THshvitEnF4IvPEX8O7sPsE_wa4yGj6A6J0iz3OJujWwRFpPshTfF4-Yq9sOgSXZ72C3b39cvd6qa8_X79bfXptuyqRk4l1bbTogYJqhecao6oKtlYS5arFuoeCVAoAa0l0XForOoQoNGoQax7dcE-Lra7fTfSuief_3dmF4cxN2sCDubvFz9szH14MDVvtKx0Nnh3Mojhx57SZMYh9eQcegr7ZCTXVStkrSGjb_9Bt2Ef8_gz1baVFiBlptRC9TGkFMk-NiO4mWM2p5jNHLNZYs6qN0_neNT8CTUDVwuQ1f_l-Bsxf7ap</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2099481522</pqid></control><display><type>article</type><title>Caesarean sections and the prevalence of preterm and early-term births in Brazil: secondary analyses of national birth registration</title><source>BMJ Open Access Journals</source><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>PubMed Central Open Access</source><creator>Barros, Fernando C ; Rabello Neto, Dacio de Lyra ; Villar, Jose ; Kennedy, Stephen H ; Silveira, Mariangela F ; Diaz-Rossello, Jose Luis ; Victora, Cesar G</creator><creatorcontrib>Barros, Fernando C ; Rabello Neto, Dacio de Lyra ; Villar, Jose ; Kennedy, Stephen H ; Silveira, Mariangela F ; Diaz-Rossello, Jose Luis ; Victora, Cesar G</creatorcontrib><description>ObjectivesTo investigate whether the high rates of caesarean sections (CSs) in Brazil have impacted on the prevalence of preterm and early-term births.DesignIndividual-level, cross-sectional analyses of a national database.SettingAll hospital births occurring in the country in 2015.Participants2 903 716 hospital-delivered singletons in 3157 municipalities, representing >96% of the country’s births.Primary and secondary outcome measuresCS rates and gestational age distribution (<37, 37–38, 39–41 and 42 or more weeks’ gestation). Outcomes were analysed according to maternal education, measured in years of schooling and municipal CS rates. Analyses were also adjusted for maternal age, marital status and parity.ResultsPrevalence of CS was 55.5%, preterm prevalence (<37 weeks’ gestation) was 10.1% and early-term births (37–38 weeks of gestation) represented 29.8% of all births, ranging from 24.9% among women with <4 years of schooling to 39.8% among those with >12 years of education. The adjusted prevalence ratios of preterm and early-term birth were, respectively, 1.215 (1.174–1.257) and 1.643 (1.616–1.671) higher in municipalities with≥80% CS compared with those <30%.ConclusionsBrazil faces three inter-related epidemics: a CS epidemic; an epidemic of early-term births, associated with the high CS rates; and an epidemic of preterm birth, also associated with CS but mostly linked to poverty-related risk factors. The high rates of preterm and early-term births produce an excess of newborns at higher risk of short-term morbidity and mortality, as well as long-term developmental problems. Compared with high-income countries, there is an annual excess of 354 000 preterm and early-term births in Brazil.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2018-021538</identifier><identifier>PMID: 30082353</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Age ; Cesarean section ; Epidemiology ; Health facilities ; Health risk assessment ; Marital status ; Mortality ; Multiple births ; Premature birth ; Public health ; Trends</subject><ispartof>BMJ open, 2018-08, Vol.8 (8), p.e021538-e021538</ispartof><rights>Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2018 Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b472t-e6fb8165253c10e60aa3427ffef03956cae5a13159fe1b057f3ba5578a851dc3</citedby><cites>FETCH-LOGICAL-b472t-e6fb8165253c10e60aa3427ffef03956cae5a13159fe1b057f3ba5578a851dc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://bmjopen.bmj.com/content/8/8/e021538.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://bmjopen.bmj.com/content/8/8/e021538.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27526,27527,27901,27902,53766,53768,77343,77374</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30082353$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Barros, Fernando C</creatorcontrib><creatorcontrib>Rabello Neto, Dacio de Lyra</creatorcontrib><creatorcontrib>Villar, Jose</creatorcontrib><creatorcontrib>Kennedy, Stephen H</creatorcontrib><creatorcontrib>Silveira, Mariangela F</creatorcontrib><creatorcontrib>Diaz-Rossello, Jose Luis</creatorcontrib><creatorcontrib>Victora, Cesar G</creatorcontrib><title>Caesarean sections and the prevalence of preterm and early-term births in Brazil: secondary analyses of national birth registration</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><description>ObjectivesTo investigate whether the high rates of caesarean sections (CSs) in Brazil have impacted on the prevalence of preterm and early-term births.DesignIndividual-level, cross-sectional analyses of a national database.SettingAll hospital births occurring in the country in 2015.Participants2 903 716 hospital-delivered singletons in 3157 municipalities, representing >96% of the country’s births.Primary and secondary outcome measuresCS rates and gestational age distribution (<37, 37–38, 39–41 and 42 or more weeks’ gestation). Outcomes were analysed according to maternal education, measured in years of schooling and municipal CS rates. Analyses were also adjusted for maternal age, marital status and parity.ResultsPrevalence of CS was 55.5%, preterm prevalence (<37 weeks’ gestation) was 10.1% and early-term births (37–38 weeks of gestation) represented 29.8% of all births, ranging from 24.9% among women with <4 years of schooling to 39.8% among those with >12 years of education. The adjusted prevalence ratios of preterm and early-term birth were, respectively, 1.215 (1.174–1.257) and 1.643 (1.616–1.671) higher in municipalities with≥80% CS compared with those <30%.ConclusionsBrazil faces three inter-related epidemics: a CS epidemic; an epidemic of early-term births, associated with the high CS rates; and an epidemic of preterm birth, also associated with CS but mostly linked to poverty-related risk factors. The high rates of preterm and early-term births produce an excess of newborns at higher risk of short-term morbidity and mortality, as well as long-term developmental problems. Compared with high-income countries, there is an annual excess of 354 000 preterm and early-term births in Brazil.</description><subject>Age</subject><subject>Cesarean section</subject><subject>Epidemiology</subject><subject>Health facilities</subject><subject>Health risk assessment</subject><subject>Marital status</subject><subject>Mortality</subject><subject>Multiple births</subject><subject>Premature birth</subject><subject>Public health</subject><subject>Trends</subject><issn>2044-6055</issn><issn>2044-6055</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkU9v1DAQxS0EolXpJ0BCkbhwSfGfTOJwQIIVtEiVuPRuTbLjblaOvdjZSsuVL46zWarCCV_ssX_veUaPsdeCXwmh6vfduA078qXkQpdcClD6GTuXvKrKmgM8f3I-Y5cpbXleFbQA8iU7U5xrqUCds18rpISR0BeJ-mkIPhXo18W0oWIX6QEd-Z6KYOdqojgeXwmjO5THshvitEnF4IvPEX8O7sPsE_wa4yGj6A6J0iz3OJujWwRFpPshTfF4-Yq9sOgSXZ72C3b39cvd6qa8_X79bfXptuyqRk4l1bbTogYJqhecao6oKtlYS5arFuoeCVAoAa0l0XForOoQoNGoQax7dcE-Lra7fTfSuief_3dmF4cxN2sCDubvFz9szH14MDVvtKx0Nnh3Mojhx57SZMYh9eQcegr7ZCTXVStkrSGjb_9Bt2Ef8_gz1baVFiBlptRC9TGkFMk-NiO4mWM2p5jNHLNZYs6qN0_neNT8CTUDVwuQ1f_l-Bsxf7ap</recordid><startdate>20180801</startdate><enddate>20180801</enddate><creator>Barros, Fernando C</creator><creator>Rabello Neto, Dacio de Lyra</creator><creator>Villar, Jose</creator><creator>Kennedy, Stephen H</creator><creator>Silveira, Mariangela F</creator><creator>Diaz-Rossello, Jose Luis</creator><creator>Victora, Cesar G</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180801</creationdate><title>Caesarean sections and the prevalence of preterm and early-term births in Brazil: secondary analyses of national birth registration</title><author>Barros, Fernando C ; Rabello Neto, Dacio de Lyra ; Villar, Jose ; Kennedy, Stephen H ; Silveira, Mariangela F ; Diaz-Rossello, Jose Luis ; Victora, Cesar G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b472t-e6fb8165253c10e60aa3427ffef03956cae5a13159fe1b057f3ba5578a851dc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Age</topic><topic>Cesarean section</topic><topic>Epidemiology</topic><topic>Health facilities</topic><topic>Health risk assessment</topic><topic>Marital status</topic><topic>Mortality</topic><topic>Multiple births</topic><topic>Premature birth</topic><topic>Public health</topic><topic>Trends</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Barros, Fernando C</creatorcontrib><creatorcontrib>Rabello Neto, Dacio de Lyra</creatorcontrib><creatorcontrib>Villar, Jose</creatorcontrib><creatorcontrib>Kennedy, Stephen H</creatorcontrib><creatorcontrib>Silveira, Mariangela F</creatorcontrib><creatorcontrib>Diaz-Rossello, Jose Luis</creatorcontrib><creatorcontrib>Victora, Cesar G</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Barros, Fernando C</au><au>Rabello Neto, Dacio de Lyra</au><au>Villar, Jose</au><au>Kennedy, Stephen H</au><au>Silveira, Mariangela F</au><au>Diaz-Rossello, Jose Luis</au><au>Victora, Cesar G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Caesarean sections and the prevalence of preterm and early-term births in Brazil: secondary analyses of national birth registration</atitle><jtitle>BMJ open</jtitle><addtitle>BMJ Open</addtitle><date>2018-08-01</date><risdate>2018</risdate><volume>8</volume><issue>8</issue><spage>e021538</spage><epage>e021538</epage><pages>e021538-e021538</pages><issn>2044-6055</issn><eissn>2044-6055</eissn><abstract>ObjectivesTo investigate whether the high rates of caesarean sections (CSs) in Brazil have impacted on the prevalence of preterm and early-term births.DesignIndividual-level, cross-sectional analyses of a national database.SettingAll hospital births occurring in the country in 2015.Participants2 903 716 hospital-delivered singletons in 3157 municipalities, representing >96% of the country’s births.Primary and secondary outcome measuresCS rates and gestational age distribution (<37, 37–38, 39–41 and 42 or more weeks’ gestation). Outcomes were analysed according to maternal education, measured in years of schooling and municipal CS rates. Analyses were also adjusted for maternal age, marital status and parity.ResultsPrevalence of CS was 55.5%, preterm prevalence (<37 weeks’ gestation) was 10.1% and early-term births (37–38 weeks of gestation) represented 29.8% of all births, ranging from 24.9% among women with <4 years of schooling to 39.8% among those with >12 years of education. The adjusted prevalence ratios of preterm and early-term birth were, respectively, 1.215 (1.174–1.257) and 1.643 (1.616–1.671) higher in municipalities with≥80% CS compared with those <30%.ConclusionsBrazil faces three inter-related epidemics: a CS epidemic; an epidemic of early-term births, associated with the high CS rates; and an epidemic of preterm birth, also associated with CS but mostly linked to poverty-related risk factors. The high rates of preterm and early-term births produce an excess of newborns at higher risk of short-term morbidity and mortality, as well as long-term developmental problems. Compared with high-income countries, there is an annual excess of 354 000 preterm and early-term births in Brazil.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>30082353</pmid><doi>10.1136/bmjopen-2018-021538</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Age Cesarean section Epidemiology Health facilities Health risk assessment Marital status Mortality Multiple births Premature birth Public health Trends |
| title | Caesarean sections and the prevalence of preterm and early-term births in Brazil: secondary analyses of national birth registration |
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