Life course perspectives of adverse pregnancy outcomes in Kersa, Eastern Ethiopia: Accelerated Cohort Design

Introduction: Every year, millions of induced abortions, stillbirths, and preterm births occur worldwide. Ethiopia has high rates of stillbirths and unsafe abortions contribute to maternal deaths. Preterm births are the leading cause of death among children under five. Despite interventions, adverse pregnancy outcomes remain prevalent, especially in low-income and middle-income countries. The life course perspective is vital for understanding the impact of social factors on pregnancy outcomes, including early life exposure to famine. This study aims to explore these relationships in in Kersa, Eastern Ethiopia to mitigate the burden of adverse pregnancy outcomes. Methods: : An accelerated cohort design utilized to capture all reproductive age mothers in Kersa, Eastern Ethiopia. A total 7,286 pregnant women with 13,299 complete observations from Kersa Health and Demographic Surveillance System (HDSS) dataset were analyzed. The generalized linear mixed-effects model was conducted using STATA version 17.0, specifying the family as binomial and the link function as logit. Result: Adverse pregnancy outcomes varied significantly among three distinct birth cohorts, indicating the impact of early-life famine exposure throughout the maternal life course. Women who experienced the famine at birth (Adjusted Odds Ratio [AOR] = 1.50, 95%, C.I [1.27, 1.77]), who experienced the famine throughout childhood (AOR = 1.84, 95% C.I [1.40, 2.43]), women who had never attended formal education (AOR = 1.57, 95% C.I [1.30, 1.90]), those who gave birth before age of 18 (AOR = 1.44, 95% C.I [1.26, 1.66]), mid-upper arm circumference less than 21cm (AOR = 2.49, 95% C.I [2.01, 3.09]), those 21-23cm (AOR = 1.54, 95% C.I [1.32, 1.79]), compared to greater than 23cm. Conclusion: Adverse pregnancy outcomes varied significantly among three birth cohorts, indicating the impact of early-life famine exposure. Factors such as famine at birth or throughout childhood, lack of formal education, giving birth before age 18, and low mid-upper arm circumference were associated with higher odds of adverse outcomes. Addressing these factors is crucial for improving pregnancy outcomes.