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. 2025 May 26;25(1):612.
doi: 10.1186/s12884-025-07722-w.

Maternal sepsis and other maternal infections: Global Burden from 1990 to 2021

Jianghong Cao  1 , Dongdong Xue  1 , Dan Gao  1 , Gangli Zhang  2
Affiliations

Maternal sepsis and other maternal infections: Global Burden from 1990 to 2021

Jianghong Cao et al. BMC Pregnancy Childbirth. .

Abstract

Background: Maternal sepsis and other maternal infections (MSMIs) pose significant global health challenges, leading to considerable morbidity and mortality. Understanding the global burden of MSMIs is essential for resource allocation and the development of targeted prevention and treatment strategies.

Objectives: To analyse the global burden of MSMIs from 1990 to 2021, and identify disparities across age groups, regions, countries, and socio-demographic indexes (SDIs).

Methods: Data were sourced from the Global Burden of Disease Study (GBD) 2021, stratified by age, SDI level, region, and country. The age-standardized incidence and death rates in 2021, along with their estimated annual percentage changes (EAPCs) from 1990 to 2021, were used to measure the current burden and temporal trends.

Results: In 2021, the numbers of MSMIs incidence and deaths were estimated at 19.05 million (95% [uncertainty interval] UI: 14.61 to 24.09 million) and 17.67 thousand (95% UI: 14.63 to 21.19 thousand), respectively, with age-standardized incidence and death rates of 243.51 (95% UI: 186.01 to 307.48) and 0.22 (95% UI: 0.18 to 0.27) per 100,000 populations. Age-standardized incidence and death rates peaked in the 20-24 age group. From 1990 to 2021, the age-standardized incidence and death rates of MSMIs decreased, with EAPCs of -1.20 (95% [confidence interval] CI: -1.26 to -1.13) and -2.49 (95% CI: -2.95 to -2.03) respectively. The largest increase in the age-standardized incidence rate in 21 GBD regions was found in Australasia (EAPC: 0.70; 95%CI:0.52 to 0.89), and the largest increase in the age-standardized death rate was found in Oceania (EAPC:0.70; 95%CI: 0.51 to 0.88). The largest increase in the age-standardized incidence rate in 204 countries was found in Australia (EAPC:1.80; 95%CI:1.40 to 2.20), and the largest increase in the age-standardized death rate was found in Kazakhstan (EAPC:3.42; 95%CI: 2.56 to 4.29). Both the age-standardized incidence (R = -0.76, P < 0.001) and death rates (R = -0.65, P < 0.001) show a negative correlation with SDI levels.

Conclusions: This study reveals a decreasing trend in the global burden of MSMIs, yet disparities persist, particularly in 20-24 age group, lower SDI regions,and regions and countries with increasing burdens. These findings underscore the need for targeted interventions to address the remaining challenges in MSMIs, especially in more vulnerable populations.

Keywords: Deaths; Global Burden of Disease Study; Incidence; Maternal sepsis and other maternal infections.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Trends in numbers and age-standardized rates of incidence (A) and deaths (B) of maternal sepsis and other maternal infections at the global level, 1990–2021. Error bars indicate the 95% uncertainty interval (UI) for numbers. Shading indicates the 95% UI for rates. ASIR: age-standardized incidence rate, ASDR: age-standardized death rate
Fig. 2
Fig. 2
Age-specific numbers and rates of incidence (A) and deaths (B) of maternal sepsis and other maternal infections by sex, 2021. Error bars indicate the 95% uncertainty interval (UI) for numbers. Shading indicates the 95% UI for rates. ASIR: age-standardized incidence rate, ASDR: age-standardized death rate
Fig. 3
Fig. 3
Age-standardized incidence rate (A) and number of incidence (B) in 2021, as well as estimated annual percentage change of age-standardized incidence rate (C) from 1990 to 2021 for maternal sepsis and other maternal infections across 204 countries and territories. ASIR Age-standardized incidence rate, EAPC estimated annual percentage changes
Fig. 4
Fig. 4
Age-standardized death rate (A) and number of deaths (B) in 2021, as well as estimated annual percentage change of age-standardized death rate (C) from 1990 to 2021 for maternal sepsis and other maternal infections across 204 countries and territories. ASDR Age-standardized death rate, EAPC Estimated annual percentage changes
Fig. 5
Fig. 5
Trend in age-standardized incidence (A) and death (B) rates of maternal sepsis and other maternal infections in the world and 21 GBD regions by socio-demographic index, 1990–2021. For each region, points from left to right depict estimates from each year from 1990 to 2021. GBD, Global Burden of Disease Study. ASIR Age-standardized incidence rate, ASDR Age-standardized death rate
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