Factors linked to early adverse neonatal outcomes in diabetic pregnant women at selected Ugandan hospitals: A prospective cohort study

Abstract Background Diabetes mellitus during pregnancy is associated with increased risks of adverse neonatal outcomes. Understanding the incidence and factors contributing to these outcomes is crucial for improving maternal and neonatal health in low-resource settings. Methods This prospective cohort study enrolled 150 pregnant women with diabetes mellitus delivering at Jinja, Hoima, and Lira Regional Referral Hospitals in Uganda. Data on socio-demographic characteristics, obstetric history, and neonatal outcomes were collected using standardized protocols. Logistic regression analyses were performed to assess associations between maternal characteristics and adverse neonatal outcomes. Results The incidence of adverse neonatal outcomes was 69.3%. Specific outcomes included macrosomia (45.3%), low APGAR scores (4–6: 28.0%, < 3: 7.3%), NICU admission (27.3%), hypoglycaemia (25.3%), respiratory distress (20.7%), early neonatal death (14.0%), birth injuries (7.3%). Significant factors associated with adverse outcomes included unemployment (aOR = 5.94, 95%CI = 1.70-20.67, p = 0.005), fewer than four antenatal care visits (aOR = 1.63, 95%CI = 1.24–16.49, p = 0.035), preterm delivery (aOR = 3.57, 95%CI = 1.06–12.03, p = 0.040), and not receiving treatment for maternal diabetes (aOR = 1.93, 95%CI = 1.05–4.36, p = 0.016). In contrast, a monthly income of ≥ 150,000 was protective against adverse outcomes (aOR = 0.18, 95%CI = 0.06–0.57, p = 0.004). Conclusions The study revealed a high incidence of adverse neonatal outcomes among mothers with diabetes, highlighting the urgent need for improved care. Key factors linked to these adverse outcomes included unemployment, fewer antenatal care visits, preterm delivery, and lack of maternal diabetes treatment, while higher monthly income was protective. Targeted interventions, such as enhanced antenatal care and effective diabetes management, are essential to reduce adverse neonatal outcomes. Future research should focus on evaluating specific interventions to mitigate these risks and improve maternal and neonatal health in similar low-resource settings.