Global, regional and national burden of infections among pregnant women, 1990-2021: a prospective cohort study

Abstract

Objectives: We aimed to analyse the trends, age distribution and disease burden of maternal sepsis and other maternal infections (MSMI) to improve management strategies.

Design: We extracted data from the global burden of disease (GBD) 2021 database to evaluate MSMI burden with different measures for the whole world, 21 GBD regions and 204 countries from 1990 to 2021.

Setting: Studies from the GBD 2021 database generated by population-representative data sources identified through a literature review and research collaborations were included.

Participants: Patients with an MSMI diagnosis.

Outcomes: Total numbers, age-standardised rates (ASRs) of incidence, prevalence, mortality and disability-adjusted life years (DALYs) on MSMI from the GBD 2021 study and their estimated annual percentage changes (EAPCs) were the primary outcomes.

Results: There were 19 047 404 (95% uncertainty interval (UI) 14 608 563 to 24 086 486) annual incident cases, 2 376 876 (95% UI 1 678 868 to 3 421 377) prevalent cases at a single time point, 17 665 (95% UI 14 628 to 21 191) death cases and 1 144 233 (95% UI 956 988 to 1 352 034) DALYs of total MSMI in 2021. From 1990, the case number and ASRs of incidences and prevalence showed decreasing trends, while the case number and ASRs of mortality and DALYs gradually increased with time, reaching the peak in 2001, and then declined. In 2021, the ASRs of incidence, prevalence, mortality and DALYs sharply increased with age, which reached the peak in the 20-24 age group. The ASRs were decreased with increasing sociodemographic index (SDI). In 2021, it showed a positive correlation between EAPC and ASR of DALYs (r=0.3398, p<0.001).

Conclusions: The disease burden in low-SDI regions far exceeded that of regions with higher SDI. The persistent disparities in the burden of MSMI between low- and high-SDI regions underscore the urgent need for context-specific interventions, including targeted healthcare infrastructure investments in central and western sub-Saharan Africa, integration of WHO's Maternal Sepsis Guidelines into national policies, and prioritisation of antenatal care access for women aged 20-24 years. These strategies align with sustainable development goals to reduce maternal mortality and achieve universal health coverage by 2030.

Keywords: Maternal medicine; Mortality; Prevalence.

Figure 1. Global numbers and ASRs of incidence, prevalence, mortality and DALYs for MSMI from 1990 to 2021. (A) Trend of case number and ASR of incidence of MSMI in the global from 1990 to 2021. (B) Trend of case number and ASR of prevalence of MSMI in the global from 1990 to 2021. (C) Trend of case number and ASR of mortality of MSMI in the global from 1990 to 2021. (D) Trend of case number and ASR of DALYs of MSMI in the global from 1990 to 2021. ASRs, age-standardised rates; DALYs, disability-adjusted life years; MSMI, maternal sepsis and other maternal infections.

Figure 2. Global age-standardised incidence, prevalence, mortality and DALYs rates per 10 000 for MSMI in 2021. (A) Age-standardised incidence rate of MSMI in 2021 in 204 countries and territories. (B) Age-standardised prevalence rate of MSMI in 2021 in 204 countries and territories. (C) Age-standardised mortality rate of MSMI in 2021 in 204 countries and territories. (D) Age-standardised DALYs rate of MSMI in 2021 in 204 countries and territories. DALYs, disability-adjusted life years; MSMI, maternal sepsis and other maternal infections.

Figure 3. Numbers and ASRs of MSMI for different age groups, sex and SDI regions in 2021. (A) Age-standardised incidence, prevalence, mortality and DALYs of MSMI for different age groups in 2021. (B) The absolute case numbers of incidence, prevalence, mortality and DALYs of MSMI for different age groups in 2021. ASRs, age-standardised rates; DALYs, disability-adjusted life years; MSMI, maternal sepsis and other maternal infections; SDI, sociodemographic index.

Figure 4. Numbers and ASRs of MSMI for different SDI regions in 2021. (A) Age-standardised incidence, prevalence, mortality and DALYs rates of MSMI for different SDI regions in 2021. (B) The absolute case numbers of incidence, prevalence, mortality and DALYs of MSMI for different SDI regions in 2021. ASRs, age-standardised rates; DALYs, disability-adjusted life years; MSMI, maternal sepsis and other maternal infections; SDI, sociodemographic index.

Figure 5. Numbers and ASRs of MSMI for different GBD regions in 2021. (A) Age-standardised incidence, prevalence, mortality and DALYs rates of MSMI for 50 GBD regions in 2021. (B) The absolute case numbers of incidence, prevalence, mortality and DALYs of MSMI for 50 GBD regions in 2021. ASRs, age-standardised rates; DALYs, disability-adjusted life years; GBD, global burden of disease; MSMI, maternal sepsis and other maternal infections.