{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T03:41:10Z","timestamp":1788493270352,"version":"build-2803163510"},"reference-count":25,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012232","name":"National Key Clinical Specialty Discipline Construction Program of China","doi-asserted-by":"publisher","award":["Z155080000004"],"award-info":[{"award-number":["Z155080000004"]}],"id":[{"id":"10.13039\/501100012232","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Scientific research project of Shanghai Municipal Health Committee","award":["202040075"],"award-info":[{"award-number":["202040075"]}]},{"name":"Shanghai key discipline clinical research center construction program","award":["2023ZZ02016"],"award-info":[{"award-number":["2023ZZ02016"]}]},{"name":"General Program of National Natural Science Foundation of China","award":["82071370"],"award-info":[{"award-number":["82071370"]}]},{"name":"General Program of National Natural Science Foundation of China","award":["82371378"],"award-info":[{"award-number":["82371378"]}]},{"name":"General Program of National Natural Science Foundation of China","award":["82371380"],"award-info":[{"award-number":["82371380"]}]},{"name":"International (Regional) Cooperation and Communication Program of the National Natural Science Foundation of China","award":["81820108013"],"award-info":[{"award-number":["81820108013"]}]},{"name":"Key Program of National Natural Science Foundation of China","award":["82330062"],"award-info":[{"award-number":["82330062"]}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2024YFA1108200"],"award-info":[{"award-number":["2024YFA1108200"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,5,22]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We aimed to analyse the trends, age distribution and disease burden of maternal sepsis and other maternal infections (MSMI) to improve management strategies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>We extracted data from the global burden of disease (GBD) 2021 database to evaluate MSMI burden with different measures for the whole world, 21 GBD regions and 204 countries from 1990 to 2021.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Studies from the GBD 2021 database generated by population-representative data sources identified through a literature review and research collaborations were included.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Patients with an MSMI diagnosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcomes<\/jats:title>\n                  <jats:p>Total numbers, age-standardised rates (ASRs) of incidence, prevalence, mortality and disability-adjusted life years (DALYs) on MSMI from the GBD 2021 study and their estimated annual percentage changes (EAPCs) were the primary outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 19\u2009047\u2009404 (95% uncertainty interval (UI) 14 608 563 to 24 086 486) annual incident cases, 2\u2009376\u2009876 (95% UI 1\u2009678\u2009868 to 3 421 377) prevalent cases at a single time point, 17\u2009665 (95% UI 14\u2009628 to 21 191) death cases and 1\u2009144\u2009233 (95% UI 956\u2009988 to 1 352 034) DALYs of total MSMI in 2021. From 1990, the case number and ASRs of incidences and prevalence showed decreasing trends, while the case number and ASRs of mortality and DALYs gradually increased with time, reaching the peak in 2001, and then declined. In 2021, the ASRs of incidence, prevalence, mortality and DALYs sharply increased with age, which reached the peak in the 20\u201324 age group. The ASRs were decreased with increasing sociodemographic index (SDI). In 2021, it showed a positive correlation between EAPC and ASR of DALYs (r=0.3398, p&lt;0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The disease burden in low-SDI regions far exceeded that of regions with higher SDI. The persistent disparities in the burden of MSMI between low- and high-SDI regions underscore the urgent need for context-specific interventions, including targeted healthcare infrastructure investments in central and western sub-Saharan Africa, integration of WHO\u2019s Maternal Sepsis Guidelines into national policies, and prioritisation of antenatal care access for women aged 20\u201324 years. These strategies align with sustainable development goals to reduce maternal mortality and achieve universal health coverage by 2030.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-096746","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T04:40:30Z","timestamp":1749184830000},"page":"e096746","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Global, regional and national burden of infections among pregnant women, 1990\u20132021: a prospective cohort study"],"prefix":"10.1136","volume":"15","author":[{"given":"Siqiao","family":"Wang","sequence":"first","affiliation":[{"name":"Division of Spine, Department of Orthopedics, Tongji Hospital Affiliated to Tongji University, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diannan Central Hospital of Yunnan Province, Kunming, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meiyi","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Spine, Department of Orthopedics, Tongji Hospital Affiliated to Tongji University, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Xu","sequence":"additional","affiliation":[{"name":"Division of Spine, Department of Orthopedics, Tongji Hospital Affiliated to Tongji University, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhourui","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Spine, Department of Orthopedics, Tongji Hospital Affiliated to Tongji University, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Hu","sequence":"additional","affiliation":[{"name":"Division of Spine, Department of Orthopedics, Tongji Hospital Affiliated to Tongji University, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Spine, Department of Orthopedics, Tongji Hospital Affiliated to Tongji University, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihui","family":"Xiao","sequence":"additional","affiliation":[{"name":"Division of Spine, Department of Orthopedics, Tongji Hospital Affiliated to Tongji University, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bei","family":"Ma","sequence":"additional","affiliation":[{"name":"Division of Spine, Department of Orthopedics, Tongji Hospital Affiliated to Tongji University, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9494-8211","authenticated-orcid":false,"given":"Liming","family":"Cheng","sequence":"additional","affiliation":[{"name":"Division of Spine, Department of Orthopedics, Tongji Hospital Affiliated to Tongji University, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,6]]},"reference":[{"key":"2025071022154479000_15.6.e096746.1","doi-asserted-by":"crossref","first-page":"100149","DOI":"10.1016\/j.ajogmf.2020.100149","article-title":"Maternal sepsis","volume":"2","author":"Escobar","year":"2020","journal-title":"Am J Obstet Gynecol MFM"},{"key":"2025071022154479000_15.6.e096746.2","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.ccc.2015.08.010","article-title":"Maternal Sepsis and Septic Shock","volume":"32","author":"Chebbo","year":"2016","journal-title":"Crit Care Clin"},{"key":"2025071022154479000_15.6.e096746.3","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"2025071022154479000_15.6.e096746.4","doi-asserted-by":"crossref","first-page":"e661","DOI":"10.1016\/S2214-109X(20)30109-1","article-title":"Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study","volume":"8","author":"Bonet","year":"2020","journal-title":"Lancet Glob Health"},{"key":"2025071022154479000_15.6.e096746.5","doi-asserted-by":"crossref","first-page":"e1252","DOI":"10.1016\/S2214-109X(21)00248-5","article-title":"Availability of facility resources and services and infection-related maternal outcomes in the WHO Global Maternal Sepsis Study: a cross-sectional study","volume":"9","author":"Brizuela","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2025071022154479000_15.6.e096746.6","doi-asserted-by":"crossref","first-page":"e1183","DOI":"10.1016\/S2214-109X(21)00294-1","article-title":"Surviving maternal sepsis in low-income countries","volume":"9","author":"Maswime","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2025071022154479000_15.6.e096746.7","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201504-0781OC"},{"key":"2025071022154479000_15.6.e096746.8","doi-asserted-by":"crossref","unstructured":"Chen L , Wang Q , Gao Y , et al . The global burden and trends of maternal sepsis and other maternal infections in 204 countries and territories from 1990 to 2019. BMC Infect Dis 2021;21. doi:10.1186\/s12879-021-06779-0","DOI":"10.1186\/s12879-021-06779-0"},{"key":"2025071022154479000_15.6.e096746.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30388-9"},{"key":"2025071022154479000_15.6.e096746.10","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)30925-9"},{"key":"2025071022154479000_15.6.e096746.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61899-6"},{"key":"2025071022154479000_15.6.e096746.12","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1007\/s10260-010-0142-z","article-title":"Influence functions of the Spearman and Kendall correlation measures","volume":"19","author":"Croux","year":"2010","journal-title":"Stat Methods Appl"},{"key":"2025071022154479000_15.6.e096746.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00838-7"},{"key":"2025071022154479000_15.6.e096746.14","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1097\/AOG.0000000000004471","article-title":"Top 10 Pearls for the Recognition, Evaluation, and Management of Maternal Sepsis","volume":"138","author":"Shields","year":"2021","journal-title":"Obstet Gynecol"},{"key":"2025071022154479000_15.6.e096746.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32279-7"},{"key":"2025071022154479000_15.6.e096746.16","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.14.04130","article-title":"Trends and disparities of disease burden in infections among pregnant women in 131 low-income and middle-income countries, 1990-2019","volume":"14","author":"Qin","year":"2024","journal-title":"J Glob Health"},{"key":"2025071022154479000_15.6.e096746.17","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1002\/ijgo.12350","article-title":"Resource availability for the management of maternal sepsis in Malawi, other low\u2010income countries, and lower\u2010middle\u2010income countries","volume":"140","author":"Abdu","year":"2018","journal-title":"Intl J Gynecology & Obste"},{"key":"2025071022154479000_15.6.e096746.18","doi-asserted-by":"crossref","unstructured":"Gele A . Challenges Facing the Health System in Somalia and Implications for Achieving the SDGs. Eur J Public Health 2020;30. doi:10.1093\/eurpub\/ckaa165.1147","DOI":"10.1093\/eurpub\/ckaa165.1147"},{"key":"2025071022154479000_15.6.e096746.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003066","article-title":"Exploring sources of insecurity for Ethiopian Oromo and Somali women who have given birth in Kakuma Refugee Camp: A Qualitative Study","volume":"17","author":"Lalla","year":"2020","journal-title":"PLoS Med"},{"key":"2025071022154479000_15.6.e096746.20","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.midw.2019.03.022","article-title":"Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives","volume":"74","author":"Ahrne","year":"2019","journal-title":"Midwifery"},{"key":"2025071022154479000_15.6.e096746.21","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.11.03085","article-title":"The impact of the COVID-19 pandemic on pregnancy, birth and sexual & reproductive health and rights: Perspectives from Germany and Somalia","volume":"11","author":"Habib","year":"2021","journal-title":"J Glob Health"},{"key":"2025071022154479000_15.6.e096746.22","doi-asserted-by":"crossref","DOI":"10.1016\/j.ebiom.2022.104337","article-title":"Immune-metabolic adaptations in pregnancy: A potential stepping-stone to sepsis","volume":"86","author":"Sharma","year":"2022","journal-title":"EBioMedicine"},{"key":"2025071022154479000_15.6.e096746.23","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1111\/j.1728-4457.2007.00180.x","article-title":"Delayed Marriage and Very Low Fertility in Pacific Asia","volume":"33","author":"Jones","year":"2007","journal-title":"Population & Development Rev"},{"key":"2025071022154479000_15.6.e096746.24","doi-asserted-by":"crossref","unstructured":"Kang L , Jing W , Liu J , et al . The prevalence of barriers to rearing children aged 0\u20133\u2009years following China\u2019s new three-child policy: a national cross-sectional study. BMC Public Health 2022;22. doi:10.1186\/s12889-022-12880-z","DOI":"10.1186\/s12889-022-12880-z"},{"key":"2025071022154479000_15.6.e096746.25","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1002\/ijgo.14100","article-title":"Maternal and perinatal complications according to maternal age: A systematic review and meta-analysis","volume":"159","author":"Saccone","year":"2022","journal-title":"Int J Gynaecol Obstet"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-096746","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T05:16:33Z","timestamp":1752210993000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-096746"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":25,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,6]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/bmjopen-2024-096746"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-096746","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}