Heterogeneity in the impact of the COVID-19 pandemic on neonatal vitality indicators across urban and rural municipalities in Espírito Santo, Brazil

https://doi.org/10.63923/smhs.2026.146

Abstract

The COVID-19 pandemic posed major challenges to maternal and neonatal care, with potential repercussions for neonatal vitality indicators. This study aimed to analyze the associations between prenatal care adequacy, maternal age, and neonatal outcomes, birth weight and 5-minute Apgar score, in the state of Espírito Santo, Brazil, considering different epidemiological periods of the COVID-19 pandemic and the degree of urbanization of the municipalities. All live births recorded in the state between 2017 and 2024 in the Brazilian Live Birth Information System (SINASC) were included, totaling 427,605 cases. The variables analyzed were birth weight, 5-minute Apgar score, number of prenatal visits, and gestational duration, which were compared across the following periods: pre-pandemic (2017–2019), pandemic (2020–2021), and post-pandemic (2022–2024). Municipalities of birth were classified as urban, rural, or adjacent intermediate according to the Brazilian Institute of Geography and Statistics (IBGE). The results showed that the effects of the pandemic differed according to the degree of urbanization. In rural municipalities, reductions in gestational age, gestational duration, and birth weight were observed during the pandemic period, whereas in urban municipalities, 5-minute Apgar scores improved in the post-pandemic period. The number of prenatal visits showed a progressive increasing trend throughout the study period, regardless of the degree of urbanization. In the multivariate analysis, gestational duration was the main determinant of birth weight and 5-minute Apgar score, followed by the number of prenatal visits, whereas maternal age had a significant but smaller effect. These findings suggest that the quality of prenatal care and the organization of healthcare networks may be more relevant to neonatal outcomes than the number of prenatal visits alone, reinforcing the need to strengthen maternal and neonatal care and reduce territorial inequalities in preparedness for future public health emergencies.

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