Global Burden of Maternal Disorders and Mortality Among Female Individuals Aged 15-49 Years, 1990-2021.

Abstract

OBJECTIVE To quantify mortality trends among female individuals of childbearing age (15-49 years) across global regions from 1990 to 2021, systematically evaluating persistent geographic inequities in preventable deaths. METHODS We analyzed data from the GBD (Global Burden of Diseases, Injuries, and Risk Factors Study) 2021, focusing on five leading causes of maternal mortality: hemorrhage, hypertensive disorders, sepsis and infections, obstructed labor and uterine rupture, and abortion and miscarriage. We calculated estimated annual percent change (APC) in age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) for these conditions, stratified by age group and sociodemographic index, to examine temporal trends. Joinpoint regression identified trends and inflection points in age and sociodemographic index stratification. Spearman correlation analysis assessed the relationship between ASIRs and sociodemographic index levels. RESULTS Globally, an estimated 102,854,299 new incident cases of the five major maternal disorders and 129,331 deaths were reported in 2021. Between 1990 and 2021, the ASIR declined annually by -1.4% (95% CI, -1.5% to -1.3%) (estimated APC), and the ASMR decreased even more substantially at -3.6% (95% CI, -3.7% to 3.4%) per year. Annual declining trends in ASIR and ASMR were observed across all leading causes of maternal mortality. However, regions such as Central Sub-Saharan Africa still reported persistently high rates. Epidemiologic curves revealed peak mortality in the age stratum of 20-24 years, with progressive attenuation to nadir levels in individuals aged 45-49 years. Although abortion or miscarriage became increasingly prevalent as a cause of death worldwide over three decades, maternal hemorrhage remained the leading cause of death, accounting for 35.8% of deaths globally. Higher sociodemographic index correlated with declining ASIR and ASMR trends overall. Notably, sepsis-related mortality increased in younger cohorts, and high-middle-sociodemographic index regions achieved the steepest ASMR and ASIR reductions from 1990 to 2006. Joinpoint regression identified inflection points in incidence and mortality trends in age- and sociodemographic index-stratified populations over time. CONCLUSION There was a substantial global reduction in maternal mortality between 1990 and 2021; however, Central Sub-Saharan Africa persists as the most critical regional hotspot. Maternal hemorrhage was the leading cause of death. The Sociodemographic index serves as a robust predictor of mortality, necessitating precision-targeted interventions that prioritize geographic regions with both elevated risk and obstetric complications.