Maternal morbidity and mortality are key indicators of development and among the most challenging public health problems. One of the 17 sustainable development goals (SDGs) announced by the United Nations was focused on maternal mortality, targeting less than 70 maternal deaths per 100,000 live births globally by 2030. In 2016, the mortality rate of pregnant women in China decreased to 19.90 per 100,000 live births, marking the accomplishment of one of China's SDGs for 2030. In 2019, China launched the "Healthy China" action plan, a maternal and child health promotion initiative to reduce the maternal mortality ratio to less than 12 per 100,000 live births by 2030.
To address the need for updated detailed analyses of maternal disorders in China, investigators from Peking University First Hospital conducted a comprehensive analysis using Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 data. The study provides systematic estimates quantifying the trends and burden of maternal disorders among reproductive women aged 15–49 years in China. Their findings were made available online on August 10, 2026, and published in Chinese Medical Journal , in Volume 139, Issue 18, on September 20, 2026.
“Maternal morbidity and mortality are indicators of development and among the most challenging public health problems,” explains Prof. Huixia Yang, corresponding author of the study. “Reliable information on the trends and burden of maternal disorders in China is needed to identify areas of success and remaining challenges, and to assist in policy formulation as the country continues to prioritize maternal and reproductive health.”
The study analyzed the crude and age-standardized prevalence, mortality, and disability-adjusted life years (DALYs) for maternal disorders from 1990 to 2023, evaluating changing trends using the average annual percentage change (AAPC). The ranks of leading causes for maternal disorders in terms of prevalence, mortality, and DALYs in 1990, 2015, and 2023 were estimated to determine the impact of changes in China's fertility strategy on maternal disorder patterns.
In 2023, the age-standardized prevalence, mortality, and DALYs of maternal disorders among reproductive women aged 15–49 years in China were 193.04 (95% CI: 192.56–193.54), 0.30 (95% CI: 0.28–0.32), and 27.78 (95% CI: 27.59–27.97) per 100,000 population, respectively. The prevalence showed a declining trend with fluctuations, while mortality and DALYs both showed consistent decrease from 1990 to 2023, with AAPCs of -1.41 (95% CI: -1.92 to -0.90), -10.64 (95% CI: -11.18 to -10.11), and -9.37 (95% CI: -9.87 to -8.88), respectively.
Despite the overall decline in maternal disorders over the past 30 years, women aged 35–44 years showed increasing prevalence from 1990 to 2023, with the highest annual average percentage change in age-standardized prevalence. This trend coincided with the implementation of China's two-child policy in 2015, which encouraged childbirth among older women. Among the 90 million women targeted by the policy, approximately 60% were older than 35 years and 50% older than 40 years.
Maternal hemorrhage, the leading cause of maternal mortality in 1990 (3.53 per 100,000), declined to third place in 2015 and 2023. Similarly, its age-standardized DALY rate decreased from 210.04 to 3.45 per 100,000 between 1990 and 2023, indicating substantial improvements in intrapartum care. Maternal hypertensive disorders ranked second in prevalence in 2015 and 2023. Other direct maternal disorders became the leading causes of prevalence and DALYs, while indirect maternal deaths surpassed maternal hemorrhage in 2015, remaining the leading cause of mortality through 2023.
China experienced substantial reductions in maternal mortality and DALYs from 1990 to 2023. These improvements were supported by national initiatives, including the Reducing Maternal Mortality and Eliminating Neonatal Tetanus Program, the Free Prepregnancy Health Check Surveillance Program, and the National Five Strategies for Maternal and Newborn Safety. The latter introduced a pregnancy risk classification system to facilitate screening, monitoring, and appropriate care.
Despite these achievements, hypertensive disorders and indirect maternal deaths remain significant challenges, particularly among older pregnant women and those with chronic conditions. Future efforts should strengthen maternal healthcare systems through improved education, skilled personnel, specialized equipment, and effective referral mechanisms. Enhanced perinatal care and targeted interventions for older women are essential to further reduce maternal mortality and disease burden in China.
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Reference
Title of original paper: Trends and burden of maternal disorders in China from 1990 to 2023: Analysis of the Global Burden of Disease Study 2023
Journal: Chinese Medical Journal
DOI: 10.1097/CM9.0000000000004213
About Prof. Huixia Yang from Peking University First Hospital
Dr. Huixia Yang is a Professor, Chief Physician, Doctoral Supervisor, Director of the Center for Reproductive Medicine, and Head of the Department of Obstetrics and Gynaecology, Peking University First Hospital, Peking University, Beijing, China. She is an internationally recognized expert in maternal–fetal medicine, with extensive expertise in gestational diabetes mellitus and high-risk pregnancy problems. Prof. Yang has contributed significantly to standardizing screening, diagnosis, and management of gestational diabetes mellitus in China. She has published almost 700 peer-reviewed articles, served as Principal Investigator for several national and international clinical protocols, and contributed significantly to gestational diabetes care.
Funding information
1. National Natural Science Foundation of China (82470863)
2. Noncommunicable Chronic Diseases-National Science and Technology Major Project (2024ZD0532100)
3. Beijing Nova Program (2024010)
Chinese Medical Journal
Data/statistical analysis
People
Trends and burden of maternal disorders in China from 1990 to 2023: Analysis of the Global Burden of Disease Study 2023
20-Sep-2026