Global incidence of maternal sepsis: A systematic review and meta-analysis

Abstract

Objective

This study investigates the global incidence of maternal sepsis, a life-threatening condition and major cause of maternal mortality. Through a systematic review and meta-analysis, we aim to provide a more precise estimation of its incidence, identify regional variations, and examine associated risk factors to inform improved prevention and management strategies.

Methods

This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of PubMed/MEDLINE, Scopus, Google Scholar, EMBASE, and the Web of Science was performed for studies published from inception to January 10, 2025. The methodological quality of the included studies was rigorously assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. The pooled incidence rate per 10,000 pregnancies was estimated using a random-effects meta-analysis model to account for study heterogeneity. Furthermore, the analysis also explored the risk factors that contribute to the development of maternal sepsis.

Results

A total of 44 studies, encompassing 141,200,302 pregnant women from 24 countries, were included in the analysis. The global cumulative incidence of maternal sepsis was found to be 13.16 per 10,000 pregnant women (95 % CI: 9.91–17.47). Regional variations were significant, with the highest crude incidence observed in the African region (129.17 per 10,000; 95 % CI: 67.05–248.85), while the lowest was recorded in the Region of the Americas (6.31 per 10,000; 95 % CI: 4.36–9.12). These findings were based on six studies from the African region and 17 from the Americas. Additionally, the study identified several factors, such as age ≥ 35, multiple pregnancies, gestational diabetes, preeclampsia/eclampsia, hypertension, diabetes mellitus, obesity, and cesarean delivery, that were linked to an increased risk of maternal sepsis.

Conclusion

This study provides global and regional estimates of maternal sepsis, with a cumulative incidence of 13.16 per 10,000 pregnancies, highlighting regional disparities. Key risk factors include multiple pregnancies, preeclampsia, hypertension, obesity, and cesarean delivery. The findings emphasize the need for improved healthcare access, better data collection, and early intervention to reduce maternal sepsis worldwide.