Maternal and neonatal diseases pose major global public health challenges with disproportionate burdens across socioeconomic settings. This study systematically evaluates global epidemiological trends and future projections of these diseases. Using Global Burden of Disease (GBD) data from 1990 to 2021 across 204 countries, we analyzed age-standardized prevalence, incidence, mortality, and disability-adjusted life years (DALY) rates. Stratification was based on the Socio-Demographic Index (SDI). Medium-term trends (2022–2031) were forecasted using ARIMA models. Globally, age-standardized prevalence increased (EAPC = 0.48), while incidence, mortality, and DALY rates declined significantly (EAPC: −0.97, −1.64, and −1.42, respectively). Low SDI regions, particularly sub-Saharan Africa, bore the heaviest mortality and DALY burdens—exceeding high SDI regions by more than tenfold. South Asia showed the highest prevalence. Males under 5 years and females aged 20–34 were identified as high-risk groups. Forecasts indicate continued prevalence rise and substantial mortality reduction by 2031, with persistent inequalities. Despite global progress, marked inequalities persist. Differentiated health policies, strengthened primary care in low-resource settings, and multi-sector collaboration are urgently needed to reduce maternal and neonatal health inequities.