Emerging trends in late maternal deaths: Insights from the global burden of disease 2021 estimates

OBJECTIVES: The present study aimed to estimate the global burden and trends in late maternal deaths (LMDs). It also aimed to investigate the changing risk factor profiles across Socio-demographic Index (SDI) quintiles. METHODS: We used Global Burden of Disease (GBD) 2021 data to examine global trends in LMDs from 1990 to 2021. Data on deaths and disability-adjusted life-years (DALYs) were extracted using the GBD Compare tool. Analyses included age-specific and regional comparisons, identification of countries with the highest annual percentage change over time, evaluations across SDI categories, and attribution to risk factors. RESULTS: In 2021, there were 5589 LMDs, reflecting an 8.3% reduction since 1990. The DALY rate decreased from 6.95 to 4.21 per 100 000. The highest LMD rates were observed among women aged 25 to 29 years, with absolute numbers highest in the 30- to 34-year age group. Geographically, Rio Grande do Sul in Brazil (39.1 maternal deaths per 100 000 live births; 95% Uncertainty Interval, 29.43-51.8) had the highest burden in 1990, while Colombia (24.29; 95% Uncertainity interval, 16.98-33.21) was the highest in 2021. High-income North American regions showed rising trends (annual percentage change up to 5.91), while low SDI countries showed the most significant burden of age-standardized deaths per 100 000. Globally, high blood pressure and smoking were the leading risk factors for LMDs, whereas high body mass index and fasting glucose were predominant in high-income regions with rising trends. CONCLUSIONS: Despite a global decline in LMDs between 1990 and 2021, high-income regions exhibited rising trends, while low SDI countries bear the highest absolute burden, highlighting the need to monitor postpartum complications beyond 42 days.