Global, regional, and national burden of maternal disorders, 1990-2021: a systematic analysis from the global burden of disease study 2021.

BACKGROUND

Maternal morbidity and mortality, encompassing pregnancy-related complications and obstetric disorders, pose a persistent global health challenge with significant multigenerational consequences. As the second leading cause of disability-adjusted life years (DALYs) among women of reproductive age globally, these conditions exert profound impacts on perinatal outcomes and intergenerational health equity. The Global Burden of Disease Study (GBD), recognized as the most comprehensive epidemiological surveillance system, provides critical evidence for optimizing maternal health policies through systematic quantification of disease burden patterns. This multinational study employs GBD 2021 data to conduct a spatiotemporal analysis of maternal disorder burden across 21 GBD regions and 204 countries and territories from 1990 to 2021, utilizing standardized metrics including DALYs, prevalence rates, and mortality incidence.

METHODS

This population-based multinational investigation employed systematically collected epidemiological evidence from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2021, with data acquisition was conducted through the standardized Global Health Data Exchange platform ( https://vizhub.healthdata.org/gbd-results/.GBD Results Tool; data retrieval date: November 11, 2024). We systematically analyzed temporal trends in maternal disorder burden from 1990 to 2021 using a standardized analytical framework stratified across three dimensions: age cohorts (10-54 years), 21 GBD-defined geographical regions, and socio-demographic index (SDI) quintiles-a composite metric integrating income, education, and fertility rates. The burden quantification employed five core metrics: (1) Disability-adjusted life years (DALYs): Integrating years of life lost (YLLs) and years lived with disability (YLDs). (2) Mortality counts: Absolute maternal deaths by etiology. (3) Estimated annual percentage change (EAPC). (4) Age-standardized mortality rate (ASMR). (5) Age-standardized DALYs rate (ASDR): Adjusted using the GBD reference population structure. All estimates reported with 95% uncertainty interval (UI) derived from 1,000 Bayesian posterior draws.

RESULTS

Quantitative analysis of the Global Burden of Disease (GBD) 2021 dataset reveals significant advancements in maternal health metrics. Between 1990 and 2021, maternal mortality decreased by 60% (age-standardized mortality rate [ASMR]: 12.45 to 4.87 per 100,000), with disability-adjusted life years (DALYs) declining by 43.5% (age-standardized DALY rate [ASDR]: 780.8 to 315.3 per 100,000). The estimated annual percentage change (EAPC) for mortality (-3.1%, 95% CI: -3.2 to -2.99) and DALYs (-3.0%, 95% CI: -3.1 to -2.89) underscores sustained global progress. Maternal abortion and miscarriage (-4.67% EAPC), Maternal hemorrhage (-4.06% EAPC), and Maternal obstructed labor and uterine rupture (-3.68% EAPC) drove maternal mortality reductions. Maternal mortality peaked at ages 20-24 globally, with variations in high-income regions (peaks at 25-34 years). Hemorrhage dominated in sub-Saharan Africa, whereas high-income regions prioritized hypertensive disorder management. The highest maternal mortality remained in low-SDI regions, with a substantial 63% decrease (51.85 to 19.44 per 100,000), while high-SDI regions showed minimal changes. Disease burden from hemorrhage, hypertensive disorders, and abortion declined significantly, while ectopic pregnancy saw stagnation. Regional trends revealed substantial improvements in Southern Asia, while Sub-Saharan Africa remained challenged.

CONCLUSIONS

The significant decline in global maternal mortality and DALYs over the past three decades highlights the progress made in improving maternal health. However, the persistent disparities across regions and SDI levels underscore the need for targeted interventions. The findings emphasize the importance of continued surveillance and monitoring of maternal health indicators to guide policy and resource allocation. Strengthening the healthcare systems, particularly in low-SDI regions, is crucial to further reduce the burden of maternal disorders.