Spatiotemporal trends and regional inequities in preeclampsia and eclampsia in Brazil, 2008–2023

OBJECTIVES: To analyze the spatiotemporal distribution of preeclampsia and eclampsia in Brazil over 16 years. STUDY DESIGN: Retrospective study (2008-2023) using nationwide SUS data. Women aged 10-49 years with ICD-10 codes O14 and O15 were included. MAIN OUTCOME MEASURES: Hospitalization and maternal mortality rates per 100,000 estimated pregnancies; in-hospital mortality; and Disability-Adjusted Life Years (DALYs). Spatial patterns were assessed using Global Moran's I and Local Indicators of Spatial Association (LISA), and trends using Joinpoint and Mann-Kendall tests. RESULTS: Of 877,555 hospitalizations identified, the national rate rose from 38.2 to 86.3 per 1,000 pregnancies (AAPC = 5.7%; p < 0.001). The Northeast had the highest average rate (74.1) and sustained growth. Spatial analysis revealed significant clustering for hospitalization (Moran's I = 0.565) and mortality (Moran's I = 0.121), with hotspots in the Northeast and Southeast (Minas Gerais). Eclampsia caused 18.4% of maternal deaths. While national DALY trends were stable, driven by the mortality component (YLL > 99%), the Central-West showed a significant decline (tau = - 0.55; p = 0.0034). DALY rates were highest in the North (mean = 8.26) and lowest in the South (mean = 3.28). CONCLUSIONS: Preeclampsia/eclampsia hospitalizations are rising in Brazil, yet persistent mortality exposes a quality chasm exacerbated by workforce shortages and SUS underfunding. Addressing these inequities requires strengthening surveillance and referral systems to ensure dignified, high-quality care and reduce the disease burden.