Premature birth rate above global average in Brazil
The commonly cited "nine months" of pregnancy oversimplifies a much more complex process: human gestation lasts about 40 weeks, with a "full-term" pregnancy considered to be between 37 and 42 weeks. However, in 2023, nearly 12 percent of births in Brazil occurred before reaching this milestone, totaling around 300,000 premature babies. These infants face varying health risks, depending on how early they were born. Brazil not only exceeds the global average of around 10 percent but is also one of the top ten countries with the highest number of premature births annually.
According to Denise Suguitani, executive director of the Brazilian Association of Parents, Families, Friends, and Carers of Premature Babies, most of these cases are preventable. She explains, "In Brazil, these rates are closely linked to social factors, including access to healthcare and education. Adolescent pregnancy, for instance, is a risk factor for premature birth because the girl’s body is not yet fully prepared. On the other hand, a planned pregnancy is less likely to result in premature birth, making family planning crucial. And, of course, access to prenatal care is essential. It’s not just the number of appointments that matters, but the quality of care and the information provided."
Obstetrician Joeline Cerqueira, a member of the Prenatal Care Commission of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo), highlights some conditions that can be detected and treated during prenatal care to prevent premature birth and other complications. She explains, "Infections, premature rupture of the amniotic sac, and hypertensive disorders during pregnancy are among the leading causes of premature birth."
The specialist emphasizes that pregnant women should begin prenatal care early, undergo thorough assessments to identify pre-existing risk factors, and complete all recommended tests on time.
Main causes
Hypertension is the leading cause of complications during pregnancy and, in addition to contributing to premature births, is the primary cause of maternal and perinatal death in Brazil. It is estimated that 15 percent of pregnant women experience high blood pressure, and a quarter of premature births are attributed to this condition. For this reason, measuring blood pressure is a fundamental part of prenatal care, as emphasized by the Febrasgo specialist. She explains, "The best prevention is primary prevention—identifying the risk of severe hypertension early and starting prophylactic treatment with ASA (acetylsalicylic acid), a very inexpensive medication, and calcium. Even when high blood pressure is detected, early treatment can prevent up to 80 percent of cases from resulting in adverse outcomes."
Premature rupture of the amniotic sac is more common in teenage or older pregnant women, those with uterine malformations, individuals who are malnourished, and those who consume alcohol, smoke, or use other substances during pregnancy. The risk is also higher in multiple pregnancies and when the placenta is poorly positioned in the uterus. Even in cases where the cause cannot be reversed, the pregnant woman can be closely monitored, possibly hospitalized, and given medication to accelerate the maturation of the baby’s organs and attempt to prolong the pregnancy for as long as possible.
Bacterial infections, particularly urinary tract infections and sexually transmitted infections (STIs), are also significant causes of prematurity. STIs can be detected through laboratory tests and prevented with safe sex practices, while urinary infections are common during pregnancy and may not always present symptoms.
Cesarean sections
Denise Suguitani explains that the high number of cesarean sections in Brazil also contributes to this issue. According to data from the Ministry of Health, nearly 60 percent of births in 2023 were expected to occur through surgery.
“We have a high number of elective cesareans, which are scheduled without a medical necessity. This leads to more premature births because pregnancy is not an exact science. Currently, the Federal Council of Medicine permits scheduling cesareans without medical indication only after 39 weeks. However, when a cesarean is scheduled at 39 weeks, due to misinformation from the woman or an error in calculating the due date, the baby may actually be less than 37 weeks old. In such cases, the baby is premature. While it may not require immediate ICU care, the infant may struggle with breastfeeding and have difficulty breathing,” adds Suguitani.
The executive director of the Brazilian Association of Parents, Families, Friends, and Caregivers of Premature Babies emphasizes that even premature babies who leave the hospital healthy still require ongoing monitoring. “Prematurity is not a sentence; each baby has their own story to write. However, the risks are significant, so we must pay close attention. These children need special care from various professionals, including occupational therapists, physiotherapists, speech therapists, and specialists in multiple medical fields, as well as nutritionists. They must be closely monitored as they have a peculiar development. These experts can identify risks and intervene early,” she added.
