{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T04:03:10Z","timestamp":1788321790360,"version":"build-2803163510"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Iron deficiency is a key risk factor for maternal sepsis and other maternal infections (MSMIs). This study aims to investigate the trends of MSMIs attributable to iron deficiency based on data from the Global Burden of Disease (GBD) 2021 database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data on MSMIs attributable to iron deficiency were utilized. Epidemiological tendencies were assessed using the estimated annual percentage change (EAPC) for age-standardized rate in mortality (ASMR) and disability-adjusted life years (DALYs). The correlation between socio-demographic index (SDI) and age-standardized rates (ASRs) of deaths and DALYs in different GBD regions was evaluated using the Pearson correlation coefficient. Bayesian age-period-cohort models were applied to predict the burden of MSMIs attributable to iron deficiency by 2050.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 1990 to 2021, the global mortality and DALYs of MSMIs attributable to iron deficiency declined, with an EAPC of \u22122.49 (95% confidence interval (CI): \u22122.91 to \u22122.06) and \u22122.51 (95% CI: \u22122.92 to \u22122.10), respectively. The decrease of ASMR was the most in the high-middle SDI regions, while for age-standardized DALY rate, the most decrease was in the low-middle SDI regions. In 2021, Somalia represented the greatest burdens on deaths and DALYs, with an ASMR of 2.98 per 100,000 persons (95% uncertainty interval (UI): 1.30\u20135.12) and an age-standardized DALY rate of 177.38 per 100,000 persons (95% UI: 76.95\u2013299.71). East Asia had the most decreases in the burdens of deaths and DALYs. Moreover, Equatorial Guinea represented the largest decreases in ASMR and age-standardized DALY rate. In 1990 and 2021, the peaks of MSMIs-related deaths (1,124 cases and 724 cases) and DALYs (82,593 cases and 53,355 cases) were found in the 20\u201324 years age group. The ASMR and age-standardized DALY rate of MSMIs attributable to iron deficiency were negatively correlated with SDI. Projections indicated a continued decrease in the burden of MSMIs attributable to iron deficiency by 2050.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Over the past 30 years, the global burden of MSMIs attributable to iron deficiency has been decreasing, which is predicted to continually decrease by 2050. Targeted strategies for improving management in MSMIs attributable to iron deficiency should focus on 20\u201324 years population.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1658505","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T05:35:31Z","timestamp":1756964131000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Trends in the disease burden of maternal sepsis and other maternal infections attributable to iron deficiency from 1990 to 2021 and its projection until 2050"],"prefix":"10.3389","volume":"13","author":[{"given":"Chunfeng","family":"Zhu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyuan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyun","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunyan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e30599","DOI":"10.1097\/MD.0000000000030599","article-title":"Epidemiology and clinical features of maternal sepsis: a retrospective study of whole pregnancy period","volume":"101","author":"Zhong","year":"2022","journal-title":"Medicine."},{"key":"B2","doi-asserted-by":"publisher","first-page":"3727265","DOI":"10.1155\/2023\/3727265","article-title":"Urinary tract infection and associated factors among pregnant women receiving antenatal care at a primary health care facility in the northern region of Ghana","volume":"2023","author":"Vicar","year":"2023","journal-title":"Int J Microbiol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1093\/ibd\/izac088","article-title":"Increased risk of postpartum infections after caesarian and vaginal delivery in women with inflammatory bowel disease: a danish nationwide cohort study","volume":"29","author":"Friedman","year":"2023","journal-title":"Inflamm Bowel Dis."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.1111\/1471-0528.17073","article-title":"Listeriosis in pregnancy: an umbrella review of maternal exposure, treatment and neonatal complications","volume":"129","author":"Khsim","year":"2022","journal-title":"BJOG Int J Obstet Gynaecol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s12941-024-00681-8","article-title":"Aetiology and use of antibiotics in pregnancy-related infections: results of the Who Global Maternal Sepsis Study (GLOSS), 1-week inception cohort","volume":"23","author":"Ribeiro-do-Valle","year":"2024","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"B6","doi-asserted-by":"publisher","first-page":"166768","DOI":"10.1016\/j.bbadis.2023.166768","article-title":"Pregnancy, infection, and epigenetic regulation: a complex scenario","volume":"1869","author":"Pradhan","year":"2023","journal-title":"Biochim Biophys Acta Mol Basis Dis."},{"key":"B7","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1186\/s12884-025-07409-2","article-title":"The global, regional, and national burdens of maternal sepsis and other maternal infections and trends from 1990 to 2021 and future trend predictions: results from the Global Burden of Disease study 2021","volume":"25","author":"Hu","year":"2025","journal-title":"BMC Pregnancy Childbirth."},{"key":"B8","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1002\/ijgo.14944","article-title":"Iron deficiency, pregnancy, and neonatal development","volume":"162","author":"Ataide","year":"2023","journal-title":"Int J Gynaecol Obstet."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1806","DOI":"10.1016\/j.scib.2021.02.010","article-title":"The role of iron homeostasis in remodeling immune function and regulating inflammatory disease","volume":"66","author":"Mu","year":"2021","journal-title":"Sci Bull."},{"key":"B10","doi-asserted-by":"publisher","first-page":"2637","DOI":"10.1007\/s00277-023-05481-2","article-title":"Pathophysiology and management of iron deficiency anaemia in pregnancy: a review","volume":"103","author":"Kirthan","year":"2024","journal-title":"Ann Hematol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1428271","DOI":"10.3389\/fpubh.2024.1428271","article-title":"Trends and predictions of maternal sepsis and other maternal infections among women of childbearing age: a systematic analysis for the Global Burden of Disease Study 2019","volume":"12","author":"Qian","year":"2024","journal-title":"Front Public Health."},{"key":"B12","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1111\/nep.14137","article-title":"Gender and socioeconomic disparities in global burden of chronic kidney disease due to glomerulonephritis: a global analysis","volume":"28","author":"Bai","year":"2023","journal-title":"Nephrology."},{"key":"B13","doi-asserted-by":"publisher","first-page":"04025","DOI":"10.7189\/jogh.14.04025","article-title":"Burdens of stomach and esophageal cancer from 1990 to 2019 and projection to 2030 in China: findings from the 2019 Global Burden of Disease Study","volume":"14","author":"Jiang","year":"2024","journal-title":"J Glob Health."},{"key":"B14","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1186\/s12916-018-1146-z","article-title":"Iron deficiency during pregnancy is associated with a reduced risk of adverse birth outcomes in a malaria-endemic area in a Longitudinal Cohort Study","volume":"16","author":"Fowkes","year":"2018","journal-title":"BMC Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"3361","DOI":"10.3390\/nu15153361","article-title":"Prevalence and risk factors for iron deficiency anemia among children under five and women of reproductive age in Pakistan: findings from the National Nutrition Survey 2018","volume":"15","author":"Habib","year":"2023","journal-title":"Nutrients"},{"key":"B16","doi-asserted-by":"publisher","first-page":"eabq4469","DOI":"10.1126\/sciadv.abq4469","article-title":"Iron Regulatory Protein (IRP)-mediated iron homeostasis is critical for neutrophil development and differentiation in the bone marrow","volume":"8","author":"Bonadonna","year":"2022","journal-title":"Sci Adv."},{"key":"B17","doi-asserted-by":"publisher","first-page":"e0196921","DOI":"10.1371\/journal.pone.0196921","article-title":"Cell iron status influences macrophage polarization","volume":"13","author":"Agoro","year":"2018","journal-title":"PLoS ONE."},{"key":"B18","doi-asserted-by":"publisher","first-page":"111709","DOI":"10.1016\/j.isci.2024.111709","article-title":"Relationship between iron deficiency and severity of tuberculosis: influence on T cell subsets","volume":"28","author":"Wang","year":"2024","journal-title":"iScience."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1074","DOI":"10.1186\/s12879-021-06779-0","article-title":"The global burden and trends of maternal sepsis and other maternal infections in 204 countries and territories from 1990 to 2019","volume":"21","author":"Chen","year":"2021","journal-title":"BMC Infect Dis."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Vos","year":"2020","journal-title":"Lancet."},{"key":"B21","doi-asserted-by":"publisher","first-page":"151978","DOI":"10.1016\/j.semperi.2024.151978","article-title":"Sepsis as a driver of excess severe maternal morbidity and mortality in the rural United States","volume":"48","author":"Brakebill","year":"2024","journal-title":"Semin Perinatol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1767","DOI":"10.1055\/s-0044-1780538","article-title":"Infection and sepsis trends during United States' delivery hospitalizations from 2000 to 2020","volume":"41","author":"Liu","year":"2024","journal-title":"Am J Perinatol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1001\/jama.2019.9818","article-title":"Incidence of maternal sepsis and sepsis-related maternal deaths in the United States","volume":"322","author":"Hensley","year":"2019","journal-title":"JAMA."},{"key":"B24","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s12978-017-0437-8","article-title":"The global maternal sepsis study and awareness campaign (Gloss): study protocol","volume":"15","author":"Bonet","year":"2018","journal-title":"Reprod Health."},{"key":"B25","doi-asserted-by":"publisher","first-page":"Cd004736","DOI":"10.1002\/14651858.CD004736.pub5","article-title":"Daily oral iron supplementation during pregnancy","volume":"2015","author":"Pe\u00f1a-Rosas","year":"2015","journal-title":"Cochrane Database Syst Rev."},{"key":"B26","doi-asserted-by":"publisher","first-page":"04130","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":"B27","doi-asserted-by":"publisher","first-page":"2204","DOI":"10.1016\/S0140-6736(24)00685-8","article-title":"Burden of disease scenarios for 204 countries and territories, 2022-2050: a forecasting analysis for the Global Burden of Disease Study 2021","volume":"403","author":"Vollset","year":"2024","journal-title":"Lancet."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e036338","DOI":"10.1136\/bmjopen-2019-036338","article-title":"Early evaluation of the \u2018stop sepsis!' who global maternal sepsis awareness campaign implemented for healthcare providers in 46 low, middle and high-income countries","volume":"10","author":"Brizuela","year":"2020","journal-title":"BMJ Open."},{"key":"B29","doi-asserted-by":"publisher","first-page":"e0296747","DOI":"10.1371\/journal.pone.0296747","article-title":"Multilevel analysis of anemia and associated factors among women of reproductive age (15-49 years) in liberia: evidence from the 2019\/20 liberia demographic and health survey data","volume":"19","author":"Adugna","year":"2024","journal-title":"PLoS ONE."},{"key":"B30","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1093\/nutrit\/nuac066","article-title":"The interplay between maternal-infant anemia and iron deficiency","volume":"81","author":"Davidson","year":"2023","journal-title":"Nutr Rev."},{"key":"B31","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1111\/ejh.13870","article-title":"The incidence, complications, and treatment of iron deficiency in pregnancy","volume":"109","author":"Benson","year":"2022","journal-title":"Eur J Haematol."},{"key":"B32","first-page":"646","article-title":"Normocytic anemia in pregnant women: a scoping review","volume":"79","author":"Sharief","year":"2024","journal-title":"Med J Malaysia."},{"key":"B33","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1080\/23744235.2017.1341055","article-title":"Maternal obesity, obstetric interventions and post-partum anaemia increase the risk of post-partum sepsis: a population-based cohort study based on Swedish medical health registers","volume":"49","author":"Axelsson","year":"2017","journal-title":"Infect Dis."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e0001828","DOI":"10.1371\/journal.pgph.0001828","article-title":"The prevalence and risk factors associated with iron, vitamin B12 and folate deficiencies in pregnant women: a cross-sectional study in Mbeya, Tanzania","volume":"3","author":"John","year":"2023","journal-title":"PLOS Global Public Health"},{"key":"B35","doi-asserted-by":"publisher","first-page":"S9","DOI":"10.6133\/apjcn.202012_29(S1).02","article-title":"Nutritional contributors to maternal anemia in indonesia: chronic energy deficiency and micronutrients","volume":"29","author":"Lipoeto","year":"2020","journal-title":"Asia Pac J Clin Nutr"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e0213982","DOI":"10.1371\/journal.pone.0213982","article-title":"Effect of nutrition education on hemoglobin level in pregnant women: a quasi-experimental study","volume":"14","author":"Sunuwar","year":"2019","journal-title":"PLoS ONE."},{"key":"B37","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1080\/01443615.2020.1754367","article-title":"Age differentials in pregnancy-related deaths in selected african countries","volume":"41","author":"Izugbara","year":"2021","journal-title":"J Obstet Gynaecol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"280s","DOI":"10.1093\/ajcn\/72.1.280S","article-title":"Nutrition in pregnancy: mineral and vitamin supplements","volume":"72","author":"Ladipo","year":"2000","journal-title":"Am J Clin Nutr."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1658505\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T05:35:32Z","timestamp":1756964132000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1658505\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,4]]},"references-count":38,"alternative-id":["10.3389\/fpubh.2025.1658505"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1658505","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,4]]},"article-number":"1658505"}}