{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T06:07:20Z","timestamp":1789884440271,"version":"4.0.1"},"reference-count":41,"publisher":"BMJ","issue":"8","funder":[{"DOI":"10.13039\/501100006506","name":"Minist\u00e9rio da Sa\u00fade","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006506","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,7,13]]},"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate whether the high rates of caesarean sections (CSs) in Brazil have impacted on the prevalence of preterm and early-term births.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Individual-level, cross-sectional analyses of a national database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>All hospital births occurring in the country in 2015.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>2 903 716 hospital-delivered singletons in 3157 municipalities, representing &gt;96% of the country\u2019s births.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>CS rates and gestational age distribution (&lt;37, 37\u201338, 39\u201341 and 42 or more weeks\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Prevalence of CS was 55.5%, preterm prevalence (&lt;37 weeks\u2019 gestation) was 10.1% and early-term births (37\u201338 weeks of gestation) represented 29.8% of all births, ranging from 24.9% among women with &lt;4 years of schooling to 39.8% among those with &gt;12 years of education. The adjusted prevalence ratios of preterm and early-term birth were, respectively, 1.215 (1.174\u20131.257) and 1.643 (1.616\u20131.671) higher in municipalities with\u226580%\u2009CS compared with those &lt;30%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Brazil 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\u2009000 preterm and early-term births in Brazil.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-021538","type":"journal-article","created":{"date-parts":[[2018,8,6]],"date-time":"2018-08-06T01:55:34Z","timestamp":1533520534000},"page":"e021538","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":53,"title":["Caesarean sections and the prevalence of preterm and early-term births in Brazil: secondary analyses of national birth registration"],"prefix":"10.1136","volume":"8","author":[{"given":"Fernando C","family":"Barros","sequence":"first","affiliation":[{"name":"Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dacio de Lyra","family":"Rabello Neto","sequence":"additional","affiliation":[{"name":"Ministry of Health, Brasilia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Villar","sequence":"additional","affiliation":[{"name":"Nuffield Department of Obstetrics and Gynaecology and Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK"},{"name":"John Radcliffe Hospital, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen H","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Nuffield Department of Obstetrics and Gynaecology and Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK"},{"name":"John Radcliffe Hospital, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariangela F","family":"Silveira","sequence":"additional","affiliation":[{"name":"Post Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Luis","family":"Diaz-Rossello","sequence":"additional","affiliation":[{"name":"Latin American Center for Perinatology, Women and Reproductive Health (CLAP\/WR-PAHO\/WHO), Montevideo, Uruguay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesar G","family":"Victora","sequence":"additional","affiliation":[{"name":"Post Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,8,5]]},"reference":[{"key":"2025120600154315000_8.8.e021538.1","doi-asserted-by":"crossref","unstructured":"World Health Organization Human Reproduction Programme. 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