Burden of maternal disorders in China, 1990-2021: a comparative analysis with global data based on GBD 2021

Maternal disorders (MDs) remain a major global public health concern. However, comparative assessments integrating the long-term burden of MD subcategories at both global and national levels, particularly in China, and their associations with demographic and policy-related factors remain limited. This study aimed to evaluate temporal trends in MD burden and investigate key drivers, with a focus on women of advanced maternal age.

Data on incidence, disability-adjusted life years (DALYs), and corresponding age-standardized rates (ASIR and ASDR) for six MD categories were obtained from the Global Burden of Disease (GBD) Study 2021. Temporal trends were examined using Joinpoint regression. Age-period-cohort (APC) models were applied to assess age, period, and cohort effects. Decomposition analysis was conducted to quantify the contributions of population growth, population aging, and epidemiologic changes to the increasing MD burden among pregnant and postpartum women aged 30-54.

From 1990 to 2021, China achieved substantial reductions in ASIR and ASDR across all six MD categories, exceeding global declines. Nevertheless, incidence burden increased among women aged ≥30, particularly those aged 30-34 and older, driven by positive local drifts. Globally, DALY rates associated with miscarriage and abortion increased among women younger than 30. APC analyses indicated sustained declines in mortality and disability severity worldwide, whereas China experienced periodic increases in incidence risk beginning with the 2010 period and the 1997 birth cohort. Decomposition analysis identified population growth as the primary contributor to the rising MD burden among Chinese women aged 30-54.

Despite marked progress in reducing MD burden, China may face emerging challenges from the shifting MD burden patterns in specific population subgroups, likely related to fertility policy changes, delayed childbearing, lifestyle and cultural factors, and population expansion. Strengthened screening, targeted interventions for high-risk populations, and age-specific reproductive health strategies are urgently needed.