Global burden of maternal sepsis and other maternal infections from 1990 to 2021, with projections to 2050: risk factors and trends.

OBJECTIVES: Maternal sepsis and other maternal infections (MSMI) account for approximately 10.7 % of maternal deaths globally with a significant burden persisting in low-income and middle-income countries. METHODS: Using GBD 2021 data, this ecological analysis extracted incidence, mortality, disability-adjusted life years(DALYs), and their age-standardized rates(ASR) of MSMI globally, across 21 GBD regions, 204 countries and territories from 1990 to 2021. Locally weighted regression and Spearman correlation were used to evaluate associations between MSMI burden and Socio-demographic Index(SDI). Attributable risk burdens were estimated using the GBD comparative risk assessment framework, and the autoregressive integrated moving average(ARIMA) model projected temporal trends. RESULTS: In 2021, substantial regional disparities persisted. Low-SDI regions had persistently high burden with slow declines, while high-SDI regions showed low burden converging toward negligible levels. Burden was inversely associated with SDI, peaking in the 20-29 age group. ARIMA projections indicated continued decline in incidence and DALYs, but mortality trends remain uncertain. Maternal malnutrition and iron deficiency were major contributors in low-SDI regions, while behavioral factors played a limited role in high-SDI regions. CONCLUSIONS: Although global MSMI burden is declining, low-income and low-middle income regions still carry a disproportionately high disease burden. Overall, strengthening early identification, standardized treatment, infection prevention and control, and nutritional interventions remain critical.