Distinct Five-Year Latent Class Trajectories and Predictors of Functional Cognitive Independence Following Traumatic Brain Injury: A TBI Model Systems Study.

Maternal mortality, defined as the death of a woman during pregnancy or within 42 days after the termination of pregnancy from causes related to or aggravated by the pregnancy or its management, remains a critical indicator of a country’s health system and women’s health status. While considerable global progress has been made in reducing maternal mortality over the last two decades, maternal deaths remain unacceptably high in many parts of the world. According to the latest estimates, the global maternal mortality ratio (MMR) declined from 328 per 100,000 live births in 2000 to 197 in 2023, representing a 40% reduction. Despite this improvement, the average annual rate of reduction (ARR) remains far below what is needed to achieve the Sustainable Development Goal (SDG) 3.1 target of reducing the global MMR to fewer than 70 per 100,000 live births by 2030. Achieving this goal would require an accelerated ARR of 14.8%—a rate far above the current 1.6% observed from 2016 to 2023. Maternal deaths are broadly classified into two categories: direct and indirect causes. Direct maternal deaths result from obstetric complications such as hemorrhage, hypertensive disorders, obstructed labor, or sepsis. In contrast, indirect maternal deaths result from pre-existing medical conditions or diseases that develop during pregnancy and are not directly related to obstetric causes but are worsened by the physiological changes of pregnancy. These include conditions such as cardiovascular diseases ( valvular disease, cardiomyopathy, and myocardial infarction), anemia, hepatic and pulmonary diseases, infections including HIV, anesthesia complications, intracranial hemorrhage, and transfusion-related acute lung injury. According to global health data, indirect causes now account for ∼23% of all maternal deaths, a substantial and growing share. Importantly, while attention has traditionally focused on reducing direct causes of maternal death, less emphasis has been placed on understanding and addressing indirect causes, despite their increasing significance. The decline in HIV-related maternal mortality, for example, reflects progress in managing specific indirect causes, but many others remain poorly tracked, underdiagnosed, and underreported—especially in low-resource settings where diagnostic capabilities are limited. Moreover, health systems often lack integrated services capable of managing chronic or complex conditions in pregnant women, leading to preventable deaths that fall outside the scope of traditional maternal care.