Life Course Perspectives of Adverse Pregnancy Outcomes in Kersa, Eastern Ethiopia: Accelerated Cohort Design

Adverse pregnancy outcomes (APOs) are major drivers of maternal and child mortality, especially in low-income countries like Ethiopia. Studies examining such inequities from a life course lens are lacking. Hence, this study investigates generational disparities in the risk of APOs.

An accelerated cohort design was utilized, recruiting 7,286 women from three birth cohorts (1970s, 1980s, and 1990s) in Kersa, Eastern Ethiopia. A generalized linear mixed-effects model using STATA version 17.0 was used.

Pregnancy outcomes varied across generations. Stillbirths were highest in earlier life course (13.8%) and lowest in later (7.3%). Preterm births declined slightly (9.5% to 8.1%), but risks were greater in later life course. Miscarriages were lowest in Cohort 2 (2.9%). Poor maternal nutrition (MUAC <21 cm; AOR = 2.87 for preterm birth, AOR = 1.71 for stillbirth) and high gravidity (AOR = 2.26 for preterm birth, AOR = 1.51 for stillbirth) were strongly associated with adverse pregnancy outcomes, while lack of maternal education (AOR = 1.45) also increased risk of preterm birth. In contrast, later age at first birth (AOR = 0.43 for preterm birth) and higher household wealth (medium AOR = 0.73; highest AOR = 0.63 for preterm birth) were protective factors. These findings underscore the importance of maternal nutrition, reproductive history, and socioeconomic conditions in determining pregnancy outcomes.

Generational disparities highlight the need for multilevel strategies addressing social determinants and maternal care. Future studies to elucidate the biological pathways, such as epigenetic changes, linking early-life exposures to pregnancy outcomes are recommended.

· Adverse pregnancy outcomes were observed.. · Study used an accelerated cohort design. · Findings were interpreted through life course perspectives..