Monitoring births and their maternal and neonatal characteristics is essential for maternal and child health surveillance, and Brazil’s Live Birth Information System (SINASC) provides standardized national data on prenatal care, delivery characteristics, and newborn outcomes, although substantial regional disparities persist in access, adequacy of care, cesarean rates and neonatal outcomes, reflecting broader socioeconomic inequalities.To describe the sociodemographic, obstetric, and neonatal profile of live births in Brazil in 2024 according to the five macro-regions.A descriptive ecological study was conducted using aggregated SINASC data for 2024, considering the North, Northeast, Southeast, South and Center-West as analytical units; variables were grouped into sociodemographic (maternal age, education, marital status), obstetric (gestational age, pregnancy type, number and adequacy of prenatal visits, delivery type, Robson groups) and neonatal outcomes (Apgar scores, birth weight, congenital anomalies); data were extracted via TabNet/DATASUS, organized in Excel and described using frequencies, proportions and regional comparisons.Brazil recorded 2,384,438 live births in 2024, with the Southeast accounting for 37.9% and the Northeast for 27.9%; adolescent motherhood was highest in the North (22.3%) and Northeast (19.7%), while mothers aged ≥35 years were more common in the Southeast and South; maternal education showed marked inequalities, with higher schooling concentrated in the South/Southeast; prenatal care coverage (≥7 visits) reached 85.5% in the South and 82.3% in the Southeast but only 64.9% in the North, and “more than adequate” care exceeded 75% in the South/Southeast but was 55.7% in the North; cesarean sections comprised 60.6% of all births, reaching 66.6% in the Center-West; preterm birth and low birth weight were slightly higher in the North and Northeast, while Apgar scores at 5 minutes were high nationwide (>96%); congenital anomalies occurred in 1.1% of births with minimal variation.The findings reveal persistent regional inequalities in prenatal care adequacy and birth outcomes, with less developed regions presenting poorer indicators despite high national coverage.Brazil has progressed in prenatal and perinatal monitoring, but significant inequities persist, requiring strengthened primary care, improved prenatal care quality and structural actions to reduce territorial vulnerabilities.