Maternal health is regarded as a global public health priority as it serves as a crucial indicator of the performance of national healthcare systems and a measure of house-hold and population-level health status. Maternal mortality, which is often preventable, reflects social disparities, resource limitations, and systemic inequities that impact the quality of care across various stages of pregnancy1,2,3,4. These disparities can result from delayed access to care, lack of skilled personnel, inadequate infrastructure, and the absence of respectful care. The current landscape is conducive to implementing interdisciplinary, evidence-based strategies that address the multifaceted challenges of maternal health. Thus, maternal health outcomes should be improved through a comprehensive, evidence-based approach integrating biological, technological, social, and policy considerations5,6,7,8,9,10,11,12.

In this editorial, we present findings from studies that revolve around five key factors that affect maternal health: vascular dysfunction in hypertensive pregnancies5, maternal lifestyle-related health risks (6), influence of structural and social determinants7,8, technological innovations to support clinical decision-making and emergency care9,10, and the increased vulnerability of maternal outcomes during public health crises11,12.

Viana-Mattioli et al.5 investigated the mechanisms by which plasma collected from patients with gestational hypertension and preeclampsia influences endothelial cells under different shear stress conditions. Notably, the authors reported that plasma from women with hypertensive disorders of pregnancy induced inflammatory and proliferative endothelial responses, especially in preeclampsia-derived samples, even under atheroprotective laminar flow. These findings provide mechanistic insights into the interaction between biomechanical forces and circulating factors, which cause endothelial dysfunction. Furthermore, these findings would aid in the development of biomarkers and targeted therapies for preeclampsia.

Adeoye et al.6 evaluated the influence of maternal obesity on adverse pregnancy outcomes, a crucial but underprioritized issue, in Ibadan, Nigeria. The authors reported a maternal obesity prevalence rate of 19.3%; advanced maternal age, parity, and income were identified as risk factors. Regular physical activity was found to be beneficial against obesity. However, maternal obesity was associated with an increased risk of pregnancy-related complications such as gestational diabetes, birth asphyxia, cesarean section, and macrosomia. Thus, prenatal interventions that promote physical activity and a healthy diet are required to reduce maternal obesity. However, these aspects are underprioritized in the healthcare sectors of many low- and middle-income countries (LMICs).

Claridy et al.7 examined the effect of residential settings (rural, micropolitan, or urban) and community income levels on racial and ethnic disparities in severe maternal morbidity (SMM)-associated delivery hospitalizations in the United States between 2016 and 2019. They observed that the likelihood of developing SMM was higher in non-Hispanic Black than in non-Hispanic White women in all residential settings and income levels. Thus, social and structural factors are associated with SMM, and appropriate health policies should be developed to address these issues.

Żyrek et al.8 investigated the potential association between social support during antenatal and postpartum depression among Polish mothers using a web-based prospective study. They reported that pregnant women who received adequate social support had a reduced risk of developing antenatal and postpartum depression. Thus, in contexts where professional mental health support is limited, social and community-based support systems may help prevent or mitigate antenatal and postpartum depression.

Candidori et al.9 developed a new, affordable uterine balloon tamponade kit to address postpartum hemorrhage, which is a leading cause of maternal mortality in LMICs. The authors demonstrated the efficacy of the device in arresting postpartum hemorrhage in a simulated scenario. They also highlighted the potential for the adoption of this kit in LMICs from economic and manufacturing perspectives. This initiative emphasizes the importance of developing locally adaptable solutions to address maternal health issues.

Ferreira et al.10 applied AI models to predict the mode of delivery (vaginal vs. cesarean) following labor induction. Although the most accurate single model was initially developed solely based on clinical data, ensemble model approaches integrating ultrasound images of the fetal head, abdomen, and femur were subsequently constructed. Notably, the best-performing ensemble model, which combined clinical data with ultrasound images of the femur, demonstrated improved prediction of cesarean deliveries; however, some vaginal deliveries were misclassified. Nevertheless, this approach highlights the potential of AI to enhance obstetric decision-making and enable individualized patient counseling.

Cambou et al.11 examined the trajectory of maternal and late maternal deaths in Brazil during the coronavirus disease 2019 (COVID-19) pandemic using publicly available data and two forecasting models. The authors reported that the observed comprehensive maternal mortality ratio in 2021 exceeded that in their predictions. Significant regional disparities in maternal mortality rates were also observed owing to the exacerbation of existing vulnerabilities during the pandemic. These findings emphasize the importance of improving the available resources to optimize the delivery of high-quality prenatal, maternal, and postpartum care in vulnerable regions. Furthermore, maternal health surveillance is crucial during emergencies, such as pandemics.

Kracht et al.12 analyzed the impact of the COVID-19 pandemic on adverse pregnancy outcomes at a large hospital in Louisiana, USA, from 2017 to 2022. Among approximately 28,000 pregnancies, the incidence of gestational diabetes increased during the early stages of the pandemic. Notably, the risks of preeclampsia and hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome remained high throughout the pandemic. These findings suggest that (i) pregnant women are more vulnerable to crises, particularly during early gestation, and (ii) COVID-19 may have had a substantial impact on pregnancy outcomes compared with that caused by other major stressors. Thus, targeted clinical support should be provided to mitigate maternal morbidity.

Collectively, the findings from these studies5,6,7,8,9,10,11,12 illustrate the complexity of maternal health challenges, which range from psychosocial stressors and obesity-related complications to maternal hemorrhage-related emergencies and hypertensive conditions. Furthermore, the findings also emphasize the need for a concerted, evidence-based effort across healthcare systems, policies, and community interventions, as well as prioritization of maternal health in these contexts by all stakeholders, including clinicians, researchers, policymakers, and advocates worldwide. We believe that this undertaking would help ensure equitable access to high-quality maternal care and comprehensive support.