The global burden and trends of maternal sepsis and other maternal infections in 204 countries and territories from 1990 to 2019

Liyuan Chen,Zhongxian Wang,Huilong Chen,Jinxiang Zhang,Sheng Cheng,Qi Wang,Yun Gao,Zhilin Zeng

doi:10.1186/s12879-021-06779-0

Abstract

BackgroundMaternal sepsis and other maternal infections (MSMI) have considerable impacts on women’s and neonatal health, but data on the global burden and trends of MSMI are limited. Comprehensive knowledge of the burden and trend patterns of MSMI is important to allocate resources, facilitate the establishment of tailored prevention strategies and implement effective clinical treatment measures.MethodsBased on data from the Global Burden of Disease database, we analysed the global burden of MSMI by the incidence, death, disability-adjusted life year (DALY) and maternal mortality ratio (MMR) in the last 30 years. Then, the trends of MSMI were assessed by the estimated annual percentage change (EAPC) of MMR as well as the age-standardized rate (ASR) of incidence, death and DALY. Moreover, we determined the effect of sociodemographic index (SDI) on MSMI epidemiological parameters.ResultsAlthough incident cases almost stabilized from 1990 to 2015, the ASR of incidence, death, DALY and MMR steadily decreased globally from 1990 to 2019. The burden of MSMI was the highest in the low SDI region with the fastest downward trends. MSMI is still one of the most important causes of maternal death in the developed world. Substantial diversity of disease burden and trends occurred in different regions and individual countries, most of which had reduced burden and downward trends. The MMR and ASR were negatively correlated with corresponding SDI value in 2019 in 204 countries/territories and 21 regions.ConclusionThese findings highlight significant improvement in MSMI care in the past three decades, particularly in the low and low-middle SDI regions. However, the increased burden and upward trends of MSMI in a few countries and regions are raising concern, which poses a serious challenge to maternal health. More tailored prevention measures and additional resources for maternal health are urgently needed to resolve this problem.

Highlights

Maternal sepsis and other maternal infections (MSMI) have considerable impacts on women’s and neonatal health, but data on the global burden and trends of MSMI are limited
The ASIR of MSMI declined by 38.48% gradually from 787 in 1990 to 534 in 2019 with an estimated annual percentage change (EAPC) value of − 1.17 (95% UI − 1.23 to − 1.11) (Fig. 1D and Additional file 4: Table S2)
The middle sociodemographic index (SDI) and low-middle SDI regions had the largest number of incident cases of MSMI until 2017

Summary

Introduction

Maternal sepsis and other maternal infections (MSMI) have considerable impacts on women’s and neonatal health, but data on the global burden and trends of MSMI are limited. Pregnant and recently pregnant women develop infections and are prone to rapid progression to sepsis [1, 2]. Infections or sepsis are preventable causes of maternal morbidity and mortality. The WHO Global Maternal Sepsis Study Research Group reported that approximately 70 pregnant or recently pregnant women per 1000 live births needed hospital management due to maternal infections, and that infection-related maternal deaths contributed to more than half of the intrahospital deaths in 2017 [8]. 2019 GBD data estimate almost 21 million incident cases and 17 thousand deaths from maternal sepsis and other maternal infections (MSMI) worldwide [10]. One study delineated that 23% of all maternal deaths were sepsis-related in the United States, which meant that developed countries were not immune to this serious problem as well [12]

Methods

Results

Discussion

Conclusion