Introduction: Gestational syphilis remains a significant public health issue due to its severe maternal and neonatal complications. Understanding its epidemiological profile in Brazil is essential for guiding public health interventions and reducing its impact on vulnerable populations. Methods: A cross-sectional, descriptive, retrospective, and quantitative study was conducted on cases of gestational syphilis across Brazil's five regions between January 2020 and December 2023. Data were collected through the Department of Informatics of the Brazilian Unified Health System (DATASUS), as well as from the 2022 census conducted by the Brazilian Institute of Geography and Statistics (IBGE). The analysis included variables such as age groups, patient race, sex, and regional distribution. Results: Between 2020 and 2023, 246,265 cases of gestational syphilis were reported in Brazil. The Northern region of the country presented the highest incidence rate, with approximately 157 cases per 100,000 inhabitants. The most affected age group was women aged 20 to 39 years, accounting for approximately 76% of the cases, followed by adolescents aged 15 to 19 years (21%). Furthermore, brown women (pardas) comprised about 53% of the reported cases, while white women represented 28%. Conclusions: The elevated number of gestational syphilis cases in Brazil from 2020 to 2023 underscores persistent regional disparities in healthcare access. The disproportionately high rates in the North may be linked to limited healthcare infrastructure and socioeconomic vulnerabilities. These findings highlight the urgent need for targeted public health interventions to address the unique challenges faced by this region.