Maternal Mortality and Cardio-Kidney-Metabolic Risk Factors Across High-Income Countries

Cardiovascular disease (CVD) is the leading cause of death in women worldwide and a primary contributor to maternal mortality in the United States.

We compared prevalence and trends in CVD, cardio-kidney-metabolic (CKM) risk factors, and maternal mortality among women of reproductive age (15-49 years) in the United States, relative to other high-income countries.

Using Global Burden of Disease 2023 data, we evaluated CVD prevalence and disability-adjusted life years (DALYs), CKM risk factors, maternal mortality rates, and hypertensive disorders of pregnancy-associated mortality in the United States compared with other high-income countries from 2003 to 2023.

From 2003 to 2023, the United States saw a decline in CVD prevalence (3.7% to 3.1%) and DALY rates (by 20%) among women of reproductive age. However, CVD burden remained higher than in other high-income countries. DALY rates attributable to CKM risk factors were 4-fold higher for body mass index >21 kg/m², 3-fold higher for fasting plasma glucose >95 mg/dL, and 2-fold higher for systolic blood pressure >115 mm Hg in the United States compared to other high-income countries. In 2023, the United States and Southern Latin America had the highest maternal mortality rates (33.8 and 65.2 per 100,000 live births), and mortality rates attributed to hypertensive disorders of pregnancy (2.8 and 8.9 per 100,000 live births) compared to other high-income countries.

The U.S. women of reproductive age face a disproportionate burden of CVD, CKM factors, and maternal mortality rates compared with other high-income countries. Integrating early CVD and CKM screening and management into U.S. health care should be an urgent national priority.