Fewer Boys Were Born After Brazil's Gamma COVID-19 Wave and Pele's Death: A National Time-Series Analysis

The sex ratio at birth (SRB), or secondary sex ratio, is stable, with more boys born alive, but shifts after major events. Acute stress may reduce SRB through disproportionate male fetal loss, while sexual intercourse patterns around conception are associated with offspring sex. We examined whether Brazil's April 2021 Gamma-wave mortality peak was followed by an SRB decline within the previously reported stress-sensitive 3-5 month window. We analysed >81 million live births (1997-2024) from Brazil's Live Birth Information System (SINASC) using pre-pandemic autoregressive forecasts with 95% prediction intervals (PIs). In July 2021, SRB was 50.951% versus 51.185% expected, below the 95% PI (50.968-51.402%), indicating fewer boys. All five macroregions were below expectation, largest in the North, including Amazonas, where Gamma was first identified. Monte Carlo simulation showed that, under usual SRB patterns, a decline with this timing and consistency across Brazil would occur about once in 200 simulations (probability 0.00467), making July 2021 unusual. In February 2023, SRB was 51.441% versus 51.220% expected, above the 95% PI (51.003-51.438%), indicating more boys, nine months after Brazil ended its COVID-19 emergency, suggesting increased sexual intercourse after pandemic relaxation. In April 2023, SRB was 50.956% versus 51.221% expected, below the 95% PI (51.004-51.439%), indicating fewer boys, four months after Pele's death. A comparable UK decline followed Princess Diana's death 4-5 months later. Gamma was prespecified; later observations are hypothesis-generating. These findings highlight SRB's population-level utility and warrant investigation of stress-related and behavioural pathways; ecological design precludes causality.