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. 2025 Mar 31:59:e2.
doi: 10.11606/s1518-8787.2025059006194. eCollection 2025.

Space-time trends in fetal mortality in Brazil, 1996-2021

[Article in English, Portuguese]
João Batista Francalino da Rocha  1 , Italla Maria Pinheiro Bezerra  2 , Elyecleyde Katiane da Silva Oliveira  3 , Aline Bergamini Effgen Sena  4 , Francisco Naildo Cardoso Leitão  5 , Luiz Carlos de Abreu  6
Affiliations

Space-time trends in fetal mortality in Brazil, 1996-2021

[Article in English, Portuguese]
João Batista Francalino da Rocha et al. Rev Saude Publica. .

Abstract
in English, Portuguese

Objective: To evaluate the space-time trend of fetal mortality in Brazil from 1996 to 2021.

Methods: Ecological time series study with secondary data on fetal deaths at gestational age (GA) ≥ 20 weeks from the Mortality Information System (SIM) in Brazil, between 1996 and 2021, covid-19 pre-pandemic (1996-2019), and years 2020 and 2021 of the pandemic. It analyzed the fetal mortality rate (FMR) to identify the annual risk of fetal death in the specific population. The percentage change (PC), annual percentage change (APC), and average annual percentage change (AAPC) were calculated using Joinpoint regression to determine the trend patterns: increasing, decreasing, or stationary. Excel 2019, Stata, and Joinpoint Regression software were used.

Results: In Brazil, fetal deaths at GA ≥ 20 weeks accounted for 1.14% of births and 58% of perinatal deaths in the period analyzed. Around 93% were antepartum, 6% intrapartum, and 1% were recorded as occurring postpartum. The overall FMR for the period, considering GA ≥ 20, ≥ 22, and ≥ 28 weeks, was 11.4, 10.7, and 8.6/1,000 births, respectively. Despite the increasing trend of stillbirths in perinatal deaths, a slowdown in the reduction and an increase during the covid-19 pandemic, the FMR at the gestational ages evaluated decreased by 20%, 25%, and 41%, respectively, with a AAPC of -1.00, -1.13, and -1.89.

Conclusion: Fetal mortality showed a long-term downward trend at the national and regional levels in Brazil, except in the Central-West region, where the trend was stationary. The covid-19 pandemic slowed down the reduction and increased the measure, however, the downward trend was not interrupted. Regionally, the highest FMRs and the smallest reductions occurred in the North, Northeast, and Central-West, showing regional inequalities.

OBJETIVO: Avaliar a tendência espaço-temporal da mortalidade fetal no Brasil no período de 1996 a 2021.

MÉTODOS: Estudo ecológico de séries temporais com dados secundários de mortes fetais com idade gestacional (IG) ≥ 20 semanas do Sistema de Informações sobre Mortalidade (SIM) no Brasil, entre 1996 e 2021, pré-pandemia de covid-19 (1996–2019) e anos de 2020 e 2021 da pandemia. Analisou a taxa de mortalidade fetal (TMF) para identificar o risco anual de morte fetal na população específica. Foram calculadas a variação percentual (VP), variação percentual anual (VPA) e variação percentual média anual (VPMA) por meio de regressão Joinpoint, para determinar os padrões de tendência: crescente, decrescente ou estacionária. Utilizou-se os softwares Excel 2019, Stata e Joinpoint Regression.

RESULTADOS: No Brasil, mortes fetais na IG ≥ 20 semanas representaram 1,14% dos nascimentos e 58% das mortes perinatais no período analisado. Cerca de 93% foram anteparto, 6% intraparto e 1% foram registradas como ocorrido após o parto. A TMF global do período, considerando a IG ≥ 20, ≥ 22 e ≥ 28 semanas, foi de 11,4, 10,7 e 8,6/1.000 nascimentos, respectivamente. Apesar da tendência crescente dos natimortos nas mortes perinatais, desaceleração na redução e aumento durante a pandemia de covid-19, a TMF, nas idades gestacionais avaliadas, diminuiu 20%, 25% e 41%, respectivamente, com VPMA de -1,00, -1,13 e -1,89.

CONCLUSÃO: A mortalidade fetal apresentou tendência decrescente de longo prazo em âmbito nacional e regional no Brasil, com exceção da região Centro-Oeste, onde a tendência foi estacionária. A pandemia de covid-19 desacelerou a redução e aumentou a medida, no entanto, a tendência decrescente não foi interrompida. No âmbito regional, as TMF mais elevadas e as menores reduções ocorreram no Norte, Nordeste e Centro-Oeste, evidenciando desigualdades regionais.

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Conflict of interest statement

Conflict of Interest: The authors declare no conflict of interest.

Figures

Figure
Figure. Time series of fetal mortality rates in gestational age strata ≥ 20, ≥ 22, and ≥ 28 weeks. Brazil, 1996–2021.
Figura
Figura. Séries temporais de taxas de mortalidade fetal nos estratos de idade gestacional ≥ 20, ≥ 22 e ≥ 28 semanas. Brasil, 1996–2021.
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