Early pregnancy overweight/obesity and adverse maternal outcomes among pregnant women in Eastern Ethiopia: an ambispective cohort study

Introduction Maternal overweight/obesity is among the most prevalent modifiable risk factors for maternal adverse outcomes globally. Evidence is scarce on the association between maternal overweight/obesity and adverse outcomes among pregnant women in Ethiopia. Objective This study aimed to assess the association between early pregnancy overweight/obesity and adverse maternal outcomes among pregnant women in eastern Ethiopia from 2023 to 2024. Design An ambispective cohort design was employed. Setting This study was conducted in six public hospitals located in Dire Dawa, Harar and Jigjiga cities in eastern Ethiopia from August 2023 to April 2024. Participants Pregnant women who initiated their antenatal care (ANC) visit in the first 16 weeks of gestation and delivered in selected hospitals were selected using one-stage cluster sampling. Data were collected through maternal interviews, medical record reviews and anthropometric measurements. Primary and secondary outcomes The primary outcome was adverse maternal outcomes associated with maternal overweight/obesity. The secondary outcome was validation of mid-upper arm circumference to predict the adverse maternal outcomes. Separate Firth-penalised logistic regression analyses were fitted for each adverse maternal outcome independently. Results A total of 511 overweight/obese, 1692 normal BMI and 274 underweight women participated in this study. The overall prevalence of adverse maternal outcomes was 59.55% (95% CI 57.58 to 61.49), which was significantly higher among women who were overweight or obese. Maternal overweight/obesity was significantly associated with all major adverse maternal outcomes, with the strongest associations observed for induction of labour (adjusted OR (AOR) 2.62; 95% CI 1.52 to 4.51), hypertensive disorders of pregnancy (AOR 2.29; 95% CI 1.63 to 3.22), hyperglycaemia in pregnancy (AOR 2.17; 95% CI 1.20 to 3.91) and overall adverse maternal outcome (AOR 1.52; 95% CI 1.22 to 1.92). Significant associations were also observed for prenatal hospital admission, prolonged labour, caesarean delivery, late initiation of breastfeeding and prolonged hospital stay. Conclusion Early pregnancy overweight/obesity was independently associated with diverse adverse maternal outcomes during prenatal, intrapartum and immediate postnatal periods. Health professionals should carefully screen, follow and monitor women who were overweight/obese for adverse maternal outcomes at any time during ANC, labour and postnatal period.