Maternal mortality due to hypertensive disorders of pregnancy: an ecological time-series study in Brazil, 2000-2024

Maternal mortality remains a major public health problem and an indicator of health inequities, despite global and national reduction targets. In Brazil, hypertensive disorders of pregnancy (HDP) are the leading cause of maternal deaths, particularly among socially vulnerable groups. However, limited analyses of temporal trends and sociodemographic disparities hinder the development of policies and prevention strategies.

To analyze maternal mortality due to HDP in Brazil by temporal trend and sociodemographic distribution from 2000 to 2024.

We conducted an ecological time-series study using secondary data from the Mortality Information System (SIM) and the Live Birth Information System (SINASC). We analyzed deaths from direct obstetric causes related to hypertension. Time-series analyses were performed for Brazil's five major geographic regions from 2000 to 2024.

In Brazil, 9,011 maternal deaths due to HDP were recorded, with an HDP-related maternal mortality ratio (MMR) of 12.48 per 100,000 live births. Eclampsia was the leading cause (46.33%). Black women had an HDP-related MMR 4.16 times higher than White women, and Indigenous women 2.52 times higher. Women older than 40 years had an HDP-related MMR 4.50 times higher than those aged 20-29 years. Nationally, the MMR trend was decreasing (average annual percent change [APC] = 0.61%; p < 0.001), driven by the Southeast and Southern Regions. However, the Northern Region showed an increasing trend (APC = 0.93%; p = 0.007), while the Northeastern and Central-West Regions remained stable.

Despite the national-level reduction, regional and racial disparities persist. The predominance of eclampsia indicates gaps in prenatal care and obstetric emergency services, reinforcing the need for equity-oriented policies and appropriate management of hypertensive complications.