Prevalence and risk factors associated with adverse birth outcome in Ethiopia: systematic review and meta-analysis

BackgroundDespite the reduction of neonatal morbidity and mortality, is one of the third Sustainable Development Goal to end the death of children, the burden of the problem still the major challenge in Ethiopia. Globally, the most common causes of neonatal morbidity and mortality are adverse fetal outcomes (low birth weight, stillbirth, prematurity, congenital defect). Therefore this systematic review and meta-analysis aimed to estimate the pooled prevalence of adverse fetal outcomes and its associated factors in Ethiopia.MethodInternational databases (PubMed, Google scholar, web of science and science direct) were searched. Seventeen articles were included, among these, fourteen were cross-sectional and three of them were case-control studies. Publication bias was employed using a funnel plot and eggers test. The I2 statistic was computed to check the heterogeneity of studies. Subgroup analysis was performed for the evidence of heterogeneity.ResultA total of 11,280 study participants were used to estimate the pooled prevalence of adverse fetal outcomes. The overall pooled prevalence of adverse fetal outcomes in Ethiopia was 26.88% (95% CI; 20.73–33.04). Low birth weight 10.06% (95% CI; 7.21–12.91) and prematurity 8.76% (95% CI; 5.4–12.11) were the most common adverse birth outcome at the national level. Rural in residency (AOR = 2.31; 95% CI: 1.64–3.24), lack of antenatal care follow up (AOR = 3.84; 95% CI: 2.76–5.35), pregnancy-induced hypertension (AOR = 7.27; 95% CI: 3.95–13.39), advanced maternal age ≥ 35(AOR = 2.72; 95% CI: 1.62–4.58, and having current complication of pregnancy (AOR = 4.98; 95% CI: 2.24–11.07) were the factors associated with adverse birth outcome.ConclusionThe pooled prevalence of adverse fetal outcomes in Ethiopia was high. Rural in residency, lack of antenatal care follow up, pregnancy-induced hypertension, advanced maternal age ≥ 35, and having current complications of pregnancy were the factors associated with adverse fetal outcomes.PROSPERO protocol registrationCRD42020149163.

Anxiety is the most common complication of pregnancy and childbirth and is reported to have a plethora of adverse maternal, birth, and childhood outcomes. There is a lack of studies that looked at the association between pregnancy-related anxiety and the risk of adverse birth outcomes in Ethiopia. We conducted a community-based prospective cohort study in Gondar Town to explore the link between anxiety symptoms during pregnancy and the risk of adverse birth outcomes (low birth weight (LBW), preterm, and stillbirth). We used the three questions listed in the Edinburgh Postnatal Depression Scale (EPDS-3 A) to assess the presence of anxiety symptoms during pregnancy. We explored both association and causal effects using modified Poisson regression and the Targeted Maximum Likelihood Estimation (TMLE), respectively. We also calculated the population impacts of risk factors significantly associated with adverse birth outcomes. Of 916 mothers who made up a cohort, 895 completed follow-ups and were included in the final analysis. No evidence of an association was found between anxiety symptoms during pregnancy and: LBW (Adjusted incidence rate ratio (aIRR) = 1.20; 95%CI: 0.49, 2.94), preterm birth (aIRR = 0.77; 95%CI: 0.36, 1.64), and stillbirth (aIRR = 3.29; 95%CI: 0.96, 11.29, p = 0.058). However, other psychosocial factors such as maternal fearful thoughts about delivery and poor stress-coping ability contributed to 34.9% (95% CI: 10.3, 52.7) and 38.3% (95% CI: 12.6, 56.5) of preterm births, respectively. Supportive husbands, on the other hand, averted about 14.7% (95% CI: 5.1, 27.1) of premature births. About 90.0% (95%CI: 82.2, 94.4) and 54.1% (95%CI: 15.0, 75.2) of the risk of LBW was attributed to preterm birth and smoking in pregnancy. There was no evidence of an association between anxiety symptoms during pregnancy and adverse birth outcomes. Other psychosocial factors contributed to or averted adverse birth outcomes. Early screening followed by providing proven psychological interventions is key for reducing individual and population-level impacts of psychosocial risk factors associated with adverse birth outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-19379-8.

This study aimed to analyze major predictors of adverse birth outcomes in very low birth weight (VLBW) infants including particulate matter concentration (PM10), using machine learning and the national prospective cohort. Data consisted of 10,423 VLBW infants from the Korean Neonatal Network database during January 2013–December 2017. Five adverse birth outcomes were considered as the dependent variables, i.e., gestational age less than 28 weeks, gestational age less than 26 weeks, birth weight less than 1000 g, birth weight less than 750 g and small-for-gestational age. Thirty-three predictors were included and the artificial neural network, the decision tree, the logistic regression, the Naïve Bayes, the random forest and the support vector machine were used for predicting the dependent variables. Among the six prediction models, the random forest had the best performance (accuracy 0.79, area under the receiver-operating-characteristic curve 0.72). According to the random forest variable importance, major predictors of adverse birth outcomes were maternal age (0.2131), birth-month (0.0767), PM10 month (0.0656), sex (0.0428), number of fetuses (0.0424), primipara (0.0395), maternal education (0.0352), pregnancy-induced hypertension (0.0347), chorioamnionitis (0.0336) and antenatal steroid (0.0318). In conclusion, adverse birth outcomes had strong associations with PM10 month as well as maternal and fetal factors.

Evidence indicates that pregnant women's exposure to polluted air adversely affects the growing fetus leading to adverse birth outcomes including preterm birth, low birth weight, and stillbirth. There is a lack of evidence on the effects of air pollution and adverse birth outcomes in Ethiopia. This study examined the relationship between cooking fuel use and adverse pregnancy-related outcomes. The paper used data from pregnancy surveillance in Child Health and Mortality Prevention Surveillance in eastern Ethiopia form July 2021 to June 2023. A total of 15,778 women whose pregnancy outcomes were known were included in this analysis. Data were collected using Research Data Capture (Redcap) and analyzed using STATA 17. Self-reported fuel use for cooking was classified as "clean" (petroleum, biogas, and electricity) and "polluting (firewood, charcoal, crop residue, sawdust, and straw/shrubs/grass). A modified Poisson regression model was used to examine the association between adverse birth outcomes (preterm birth, stillbirth, low birth weight) and cooking fuel use. Women using polluting cooking fuel had higher rates of stillbirth (3.1%), preterm delivery (6.1%), and low birth weight (10.5%) compared to those using clean fuel (1.9%, 2.8%, and 8.3%, respectively). Utilization of polluting fuel had a significant effect on the occurrence of preterm birth Adjusted risk ratio (ARR): 2.16, 95% Confidence Intervals (CI): 1.16, 2.89), stillbirth (ARR: 1.50, 95% CI: 1.09, 2.06), and low birth weight (ARR: 1.23, 95% CI: 1.06, 1.43) respectively. The findings indicated that using polluting fuel during pregnancy has a strong association with adverse pregnancy outcomes. It is essential to provide education during ANC regarding the dangers of using polluting fuels and methods to reduce excessive exposure to them.

BackgroundA dolutegravir (DTG)-based antiretroviral regimen has been rolled out for pregnant women in low- and middle-income countries since 2020. However, available safety data are limited to a few clinical trials and observational studies. Hence, we present real-world pregnancy and birth outcome safety data from a large sample multicenter cohort study in Ethiopia.MethodsA retrospective cohort study was conducted in fourteen hospitals across Ethiopia from 2017 to 2022. HIV-infected pregnant women were followed from the date of prevention of mother-to-child transmission (PMTCT) care enrolment until the infant was 6–8 weeks old. The primary safety outcome was a composite of adverse pregnancy events comprising spontaneous abortion, intrauterine fetal death (IUFD) before onset of labor, preterm birth, and maternal death. Additionally, a composite adverse birth outcome was assessed, comprising intrapartum fetal demise, low birth weight, and neonatal death. Finally, a composite of adverse pregnancy or birth outcome was also investigated. The exposure of interest was the antiretroviral treatment (ART) regimen used during pregnancy for PMTCT of HIV.ResultsDuring the study period, 2643 women were enrolled in routine PMTCT care. However, 2490 (92.2%) participants were eligible for the study. A total of 136/1724 (7.9%, 95% CI: 6.7–9.3%) women experienced adverse pregnancy outcomes. Fewer women in the DTG-based group (5.4%, 95% CI: 3.7–7.5%) had adverse pregnancy outcomes than in the Efavirenz (EFV)-based group (8.3%, 95% CI: 6.6–10.3%), P = 0.004. After controlling for baseline differences, the DTG group had a 43% lower risk of adverse pregnancy outcomes (adjusted odd ratio (AOR), 0.57; 95% CI, 0.32–0.96%) and a 53% lower risk of preterm birth (AOR, 0.47; 95% CI, 0.22–0.98%) compared to the EFV group. A total of 103/1616 (6.4%, 95% CI: 5.2–7.7%) women had adverse birth outcomes. Although the difference was not statistically significant, fewer women in the DTG group (30/548; 5.5%, 95% CI: 3.7–7.7%) than in the EFV group (57/830; 6.9%, 95% CI: 5.2–8.8%) had adverse birth outcomes.ConclusionsIn this study, we observed that DTG-based regimens were associated with better pregnancy and birth outcome safety profiles, reaffirming the WHO recommendation. However, a prospective study is recommended to assess uncaptured maternal and perinatal adverse outcomes, such as congenital abnormalities, and infant growth and neurocognitive development.

Neonatal mortality and morbidity are often caused by preterm birth and lower birth weight. Gestational diabetes mellitus (GDM) and gestational hypertension (GH) are the most prevalent maternal medical complications during pregnancy. However, evidence on effects of air pollution on adverse birth outcomes and pregnancy complications is mixed. Singleton live births conceived between January 1st, 2000, and December 31st, 2015, and reached at least 27 weeks of pregnancy in Kansas were included in the study. Trimester-specific and total pregnancy exposures to nitrogen dioxide (NO2), particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5), and ozone (O3) were estimated using spatiotemporal ensemble models and assigned to maternal residential census tracts. Logistic regression, discrete-time survival, and linear models were applied to assess the associations. After adjustment for demographics and socio-economic status (SES) factors, we found increases in the second and third trimesters and total pregnancy O3 exposures were significantly linked to preterm birth. Exposure to the second and third trimesters O3 was significantly associated with lower birth weight, and exposure to NO2 during the first trimester was linked to an increased risk of GDM. O3 exposures in the first trimester were connected to an elevated risk of GH. We didn’t observe consistent associations between adverse pregnancy and birth outcomes with PM2.5 exposure. Our findings indicate there is a positive link between increased O3 exposure during pregnancy and a higher risk of preterm birth, GH, and decreased birth weight. Our work supports limiting population exposure to air pollution, which may lower the likelihood of adverse birth and pregnancy outcomes.

Previous research has focused on the risk factors of adverse birth outcomes and its short-term and long-term consequences. However, study on the temporal trends of adverse birth outcomes is few. Furthermore, the population-level correlation between the rate of advanced maternal age (AMA) and the prevalence of adverse birth outcomes remains underexplored. This study aimed to provide the most recent temporal trends of adverse birth outcomes in Shanghai, China, and analyze the correlation between the prevalence of AMA and the prevalence of these adverse birth outcomes. A total of 173,690 birth data was collected from four regionally influential hospitals in Shanghai from 2010 to 2023. The prevalence of adverse birth outcomes (including preterm birth, low birth weight, small for gestational age, and birth defect) was calculated. Joinpoint regression analysis was conducted to estimate the temporal trends and calculate the Average Annual Percentage Change (AAPC) and Annual Percentage Change (APC) of adverse birth outcomes and AMA. A correlation study design was employed to evaluate the population-level correlation between the prevalence of adverse birth outcomes and AMA. There were 13,445 (7.74%) preterm birth (PTB), 10,226(5.89%) low birth weight (LBW), 7,152 (4.12%) small for gestational age (SGA), and 3,227 (1.86%) birth defects (BD) over the past 14 years. Sex differences were observed across different adverse birth outcomes. The prevalence of PTB (AAPC = 0.87%, P = 0.045) and LBW (AAPC = 2.94%, P < 0.001) showed significant upward trends from 2010 to 2023. The prevalence of SGA (APC = 2.42%, P < 0.001) presented an increasing trend from 2012 to 2023, while the prevalence of BD (AAPC = 5.73%, P = 0.227) remained relatively stable. The rate of AMA (AAPC = 10.14%, P < 0.001) also showed a significant upward trend from 2010 to 2023. Additionally, this study found a strong positive correlation between the rate of AMA and the prevalence of LBW (r = 0.89, P < 0.001) and BD (r = 0.92, P < 0.001). Moderate positive correlations were observed between AMA and the prevalence of PTB (r = 0.61, P = 0.022) and SGA (r = 0.75, P = 0.002). The overall prevalence of PTB, LBW, and SGA has shown an increasing trend, aside from BD. AMA also has risen annually and was significantly associated with these adverse birth outcomes. This suggests that enhancing support for advanced-age mothers could potentially mitigate adverse birth outcomes. Besides, gender differences on these adverse birth outcomes demonstrate the implementation of gender-specific healthcare strategies.

Maternal Nutritional Deficiencies and Interventions

Adverse Birth Outcomes Among Women of Advanced Maternal Age With and Without Health Conditions in Maryland.

Background: One of the sustainable development goals for 2030 is to reduce infant mortality. Unfavourable birth outcomes are the main cause of infant morbidity and mortality. This study looked into the factors associated with adverse foetal outcomes in Bangladesh. Methods: The case-control study was conducted in BIRDEM general Hospital over 210 singleton pregnant women following 1975 Helsinki declaration and its later amendment. Cases (n=105) were considered as having any adverse birth outcome, while controls (n=105) had none of the adverse birth events. Data were recorded in separated case-record form and analyzed by SPSS-24. Results: Mean age of cases and controls were 28.98±5.48 (SD) years and 28.65±4.65 years, respectively (p=0.635). Preterm labour (64.8%), low birth weight (LBW, 41.9%) and neonatal intensive care unit (NICU) admission (31.4%) were the common adverse outcomes. Cases had significantly higher prevalence of obesity (24.8% vs 13.3%, p=0.035), gestational diabetes mellitus (49.5% vs 33.3%, p=0.017), pregnancy-induced hypertension (PIH, 40% vs 17.1%, p&lt;0.001) and premature rupture of membrane (PROM, 15.2% vs 4.8%, p=0.011). Maternal age &gt;35 years (adjusted odds ratio=3.77, 95%CI=1.12-12.65), PIH (AOR=3.602, 95%CI=1.7977.22), and PROM (AOR=5.74, 95%CI=1.83-18.00) were the significant risk factors for adverse foetal outcome. Besides, PIH had significant odds ratio for preterm labour (AOR=2.21, 95%CI=1.13-4.33), LBW (AOR=4.19, 95%CI=1.93-9.12) and NICU (AOR=8.93, 95%CI=3.7321.38). Maternal age &gt;35 years (AOR=3.21, 95%CI=1.04-9.88) and PROM (OR=3.65, 95%CI=1.18-11.3) were associated with LBW, while previous caesarian section (CS) was responsible for preterm labour (AOR=2.298, 95%CI=1.09-4.87). Conclusion: Pregnancy with advance maternal age, PIH, previous CS and PROM were the determinants of adverse birth outcomes. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(1): 32-38

Background: Low birth weight is an alarming problem in developing countries and has severe future complications. Aim of the study: Our study aimed to compare the risk factors among mothers with low and normal birth weight babies. Materials and Methods: A cross-sectional study was carried out on 1000 mothers with normal and low birth weight babies (500 per group) over two years. Maternal parameters including age, hemoglobin levels, gravida, maternal weight gain, height, pregnancy-induced hypertension, etc., were collected along with anthropometric data of the child. We compared risk factors among the low and normal birth weight babies using the chi-square test, determining statistical significance at p&lt;0.05, and high statistical significance at p&lt;0.01. Results: Highly statistically significant associations were observed between low birth weight and seven variables: maternal age (p=0.0074), maternal height (p&lt;0.0001), weight (p&lt;0.0001), weight gain (p&lt;0.0001), hemoglobin (p&lt;0.0001), severe anemia (p&lt;0.0001), and pregnancy-induced hypertension (p&lt;0.0001). Conclusion: Our study observed significant modifiable risk factors like weight gain, weight, hemoglobin, and anemia among mothers with low birth weight babies. If we focus on raising awareness surrounding these risk factors, there may be an improvement in the birth weight of babies in this population.

Studies of determinants of adverse birth outcomes (ABOs) were conducted in Ethiopia; however, there is a lack of a single study considering the factors operating at multiple levels (individual, interpersonal, organisational, environmental and policy levels). Therefore, this study identified combined determinants of ABOs at all levels in Ethiopia by analysing the Demographic and Health Survey data guided by the Ecological model, considering that birth outcomes are shaped by the interaction between a mother's environment and her biological and psychological health. This study aims to identify combined determinants of ABOs at all levels in Ethiopia by analysing the Demographic and Health Survey data guided by the Ecological model. A cross-sectional study design based on interviewer-administered questionnaires was used for the respective Demographic and Health Surveys. We used data from the 2016 Ethiopian and Demographic Health Survey, a stochastically national representative study with inclusive information on ABOs, to examine how various levels of influence from individual behaviours to environmental-level factors are affecting birth outcomes. An effective number of 11 023 live births within the 5 years preceding the survey. ABOs, including low birth weight and preterm birth. Multivariable multilevel mixed-effects logistic regression was used to identify determinants of ABOs through five hierarchical models in Stata V.14. Model I was the null model; models II, III, IV and V sequentially included intrapersonal, interpersonal, organisational and environmental variables, respectively. Statistical significance was determined using ORs with 95% CIs at p<0.05. The weighted prevalence of ABOs in Ethiopia is 27.0% (95% CI 25.7% to 28.3%). The final model of the multivariable multilevel mixed-effects logistic regression identified several predictors of ABOs at the intrapersonal or individual level, including maternal age of 15-24 completed years (adjusted OR (AOR)=1.24, 95% CI 1.02 to 1.51); poorest (AOR=1.41, 95% CI 1.01 to 2.00), poorer (AOR=1.42, 95% CI 1.02 to 2.01) and middle wealth quintiles (AOR=1.45, 95% CI 1.02 to 2.06); first-born twin (AOR=2.61, 95% CI 1.31 to 5.21) and second-born twin (AOR=4.05, 95% CI 2.16 to 7.61); and female childbirth (AOR=1.41, 95% CI 1.22 to 1.63). On the other hand, intimate partner physical violence (AOR=1.19, 95% CI 1.07 to 1.34) was the only factor associated with ABOs at the interpersonal level; cluster altitudes of 180-1500 m (AOR=1.28, 95% CI 1.05 to 1.55) and 2501-3455 m (AOR=1.51, 95% CI 1.15 to 1.99) were found to be an exposure of ABOs at the environmental level. The prevalence of ABOs in Ethiopia is high. Factors associated with ABOs at the individual level include maternal age, wealth quintile, twin birth and female birth. In contrast, exposure variables at the interpersonal level comprise intimate partner violence, and those at the environmental level include cluster altitude. To improve ABOs and consequently reduce neonatal mortality, maternal and child health investment and future studies should act at all levels.

Intimate partner violence is a significant public health issue that affects maternal and neonatal health worldwide. Several studies have been conducted to investigate the prevalence of intimate partner violence during pregnancy as well as the factors that contribute to it. As a result, the purpose of this study was to determine the impact of intimate partner violence on birth outcomes. International databases including Scopus, PubMed, Google Scholar, Embase, and CINAHL were used to search primary studies. The quality and strength of the included studies were evaluated using the Newcastle-Ottawa Scale quality assessment tool. The studies heterogeneity and publication biases were assessed using I2 statistics and Egger's regression test. The Meta-analysis was carried out using STATA version 16 software. A total of nine hundred and fifty-eight articles were retrieved from various databases, and seventeen articles were included in the review. The pooled prevalence of intimate violence during pregnancy in Ethiopia was 32.23% (95% CI 28.02% -36.45%). During pregnancy, intimate partner violence was a significant predictor of low birth weight (AOR: 3.69, 95%CI 1.61-8.50) and preterm birth (AOR: 2.23, 95%CI 1.64-3.04). One in every three pregnant women experiences intimate partner violence. Women who experienced intimate partner violence during their pregnancy are more likely to experience adverse outcomes such as premature delivery and low birth weight infants.

In Virginia, Black women experience higher rates of adverse birth and labor outcomes that may not be explained solely by risky behaviors or social standing. Previous studies have found an association between racial discrimination and adverse birth outcomes; however, their findings may be underpowered due to small sample sizes. The purpose of this study was to examine the relationship between racial discrimination and poor birth outcomes. VA PRAMS (2016-2018) was used for this secondary data analysis of mothers age 15-44. The exposure was measured using two VA PRAMS questions on racial discrimination and information on the outcomes were extracted from birth certificate data. Simple logistic regression was used obtain an association between experiencing racial discrimination and adverse birth outcomes (i.e. preterm birth, low birth weight, and small for gestational age) and to identify risk factors for experiencing racial discrimination. Multivariate logistic regressions were performed after controlling for other covariates. Virginia women (N = 2634) who experienced racial discrimination had statistically significant increased odds of having a low birth weight infant (OR 2.27; 95% CI 1.18, 4.38); however, when stratified by race, only non-Hispanic Black (n = 540) women had statistically significant increased odds of preterm birth and low birth weight (PTB OR 7.18; 95% CI 2.28, 22.65; LBW OR 3.56; 95% CI 1.28, 9.91). Non-Hispanic Black women in Virginia who experience racial discrimination are more likely to have low birth weight and preterm births. Efforts to effectively reduce adverse birth outcomes and eliminate racial inequities must consider upstream, holistic approaches beyond the biomedical model.

Background and Aim: Advanced maternal age pregnancy could be referred to as pregnancy after 35 years or older. The prevalence of postponing pregnancies is increasing day by day worldwide. However, limited evidence was found on advanced maternal age pregnancy association with fetal adverse outcomes. The present study aimed to evaluate the frequency of advanced maternal age selected fetal adverse pregnancy outcomes. Place and Duration: Obstetrics &amp; Gynaecology department of Alkhidmat Hospital Kohat and Qazi Hussain Ahmad Medical Complex, Nowshera for duration of six months from November 2020 to April 2021. Materials and Methods: This single-centered retrospective study was conducted on 220 postpartum women in the study group (≥35 years) and 170 control group postpartum women (20-34 years) who delivered at Obstetrics &amp; Gynaecology department of Alkhidmat Hospital Kohat and Qazi Hussain Ahmad Medical Complex, Nowshera after 28 gestational weeks. Individuals who met the inclusion criteria were enrolled and sampled based on randomized control sampling technique for both control and study groups. Data extraction checklist and pretested questionnaire were used for data collection from the maternal charts. Adverse pregnancy outcome and advanced maternal age was correlated adjusted relative risks and strength with a 95% confidence interval. SPSS version 20 was used for data analysis and considered p-value &gt;0.05 as a statistical standard. Results: The adverse neonatal outcomes include low birth weight, preterm birth, and stillbirth with a prevalence 38 (17.4%), 46 (20.8%), and 31 (14.2%) respectively in the study group. In the control group, the incidence of low birth weight, preterm birth, and stillbirth was 21 (12.6%), 15 (14.6%) and 6 (3.5%) respectively. The stillbirth (ARR=3.16 95% CI (1.29–6.03) and preterm deliveries (ARR=2.71 95% CI (1.79–3.86) risk had significantly higher prevalence compared to control group advanced age pregnancy. Insignificance association was found between low birth weight and advanced maternal age. Conclusion: Stillbirth and preterm birth was the adverse fetal outcome significantly related with advanced maternal age pregnancy. There was no significant association between low birth weight and advanced maternal age. Keywords: Maternal age, Fetal Adverse Pregnancy Outcomes