Global burden of maternal disorders, 1990–2021: insights from the Global Burden of Disease Study 2021 and challenges for achieving 2030 Sustainable Development Goals

Background: The Sustainable Development Goals (SDGs) aim to reduce the global maternal mortality ratio (MMR) to below 70 deaths per 100 000 live births by 2030. However, progress has been uneven, with regional disparities and new challenges. We aimed to report global trends in maternal disorder burdens from 1990 to 2021. Methods: Using the Global Burden of Disease (GBD) 2021 database, we systematically analysed trends in incidence, mortality, and disability-adjusted life-years (DALYs) associated with maternal disorders from 1990 to 2021 and employed age-period-cohort (APC) models to assess changes in these indicators. For selected age-specific analyses, we additionally expressed incidence and DALY rates per 100 000 live births using age-specific fertility rates. We used the Bayesian APC model to forecast trends in maternal disorder incidence and mortality from 2022 to 2036. Results: From 1990 to 2021, there was a decrease in global incidence (38.5%), mortality (43.2%), and DALYs (61.4%) of maternal disorders. However, significant regional disparities persist. The burden was considerably lower in higher-sociodemographic-index regions than in sub-Saharan Africa. Maternal haemorrhage and hypertensive disorders continue to represent the primary causes of mortality, with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)-related deaths increasing, particularly among women aged 30-34 years and older. The APC model revealed that the age effect on maternal disorders initially decreased and then increased. The projected MMR of 136.5 (95% confidence interval = 100.2-172.7) per 100 000 live births by 2030 falls short of the SDG target of 70 maternal deaths per 100 000 live births, indicating a markedly insufficient annual reduction rate. Conclusions: Despite a decrease in the global burden of maternal disorders, regional disparities persist. Major challenges include haemorrhage, hypertensive disorders, and increasing HIV/AIDS-related deaths. Achieving SDG targets by 2030 requires universal access to quality maternal care.