Maternal disorders among women aged 15 to 49 years: global trends and inequalities from the GBD study 2021

Maternal disorders remain a significant global health challenge with inequalities across sociodemographic strata. This study examines the global burden of six maternal disorders—Maternal Hemorrhage, Maternal Sepsis and Other Maternal Infections, Maternal Hypertensive Disorders, Maternal Obstructed Labor and Uterine Rupture, Maternal Abortion and Miscarriage, and Ectopic Pregnancy—from 1990 to 2021, focusing on disease burden trends and disparities across sociodemographic indices. We analyzed Global Burden of Disease Study 2021 data for women aged 15 to 49 years, examining disability-adjusted life years (DALYs) and incidence rates. The Sociodemographic Index (SDI) was used to contextualize inequalities across 204 countries and territories. Slope and concentration indices quantified absolute and relative disparities. Decomposition analyses explored demographic and epidemiological drivers of DALYs changes, while joinpoint regression identified temporal trend shifts. Age-period-cohort analysis examined incidence patterns, and Bayesian age-period-cohort modeling projected future trends to 2044, with internal and external validation. Global maternal disorder burden declined substantially from 1990 to 2021, with DALYs rates decreasing from 1,609.33 to 622.97 per 100,000 women. However, while absolute disparities narrowed between high and low-SDI regions, relative inequalities persisted or increased for most disorders. Low-SDI regions experienced slower burden reductions, primarily driven by population growth offsetting epidemiological improvements. Decomposition analyses revealed that population growth remains a central barrier to progress, while epidemiological advances substantially reduced DALYs across all disorders. Projections through 2044 suggest continued incidence declines globally, with validated models indicating persistent inequities requiring sustained intervention. Despite overall global improvements in maternal health outcomes, persistent inequalities highlight the need for targeted interventions in low-SDI regions. Enhanced maternal healthcare access, improved nutrition programs, and strengthened health systems may help address these disparities and promote more equitable maternal health outcomes.