Maternal hypertensive disorders in East Asia, 1990-2023: incidence, deaths, DALYs and maternal mortality in women aged 20-54 years using GBD 2023.

OBJECTIVE Hypertensive disorders of pregnancy (HDP) are a major cause of illness and death and it can be prevented.

METHODS We analysed Global Burden of Disease (GBD) 2023 estimates for maternal hypertensive disorders (ICD-10 O10-O16) in six locations (China, Japan, Democratic People's Republic of Korea [DPRK], Republic of Korea, Mongolia, and Taiwan [Province of China]) from 1990-2023 among women aged 20-54 years, reporting counts and age-standardised rates (per 100 000 population) for incidence, deaths and disability-adjusted life years (DALYs), and the maternal mortality ratio (MMR; per 100 000 live births), with 95% uncertainty intervals (UIs).

RESULTS In 2023, incident HDP cases were highest in China (654 396; 95% UI 446 312-949 988), while the age-standardised incidence rate peaked in Mongolia (419.03; 388.67-450.37). Mortality and disability burden were greatest in DPRK (age-standardised death rate 0.393; 0.184-0.749; DALY rate 25.73; 12.92-48.12; MMR 31.61; 13.23-60.86), followed by Mongolia, and lowest in Japan and the Republic of Korea. Across 1990-2023, rates declined markedly in all locations; for example, China's age-standardised death rate fell from 1.15 (0.82-1.57) to 0.03 (0.02-0.05) and its DALY rate from 80.08 (58.66-106.68) to 4.73 (3.04-6.87).

CONCLUSION With the increasing proportion of advanced maternal age, we must optimize antenatal risk stratification, adopt context-appropriate prevention and treatment, strengthen emergency obstetric care, and establish systematic postpartum cardiovascular follow-up to reduce HDP incidence.