Maternal Morbidity and Adverse Fetal Outcomes in a Prospective North Indian Pregnancy Cohort

Despite declining maternal mortality in India, pregnancy-related morbidity remains high, with potential implications for fetal growth and development in a population undergoing rapid epidemiological transition. This study estimated the prevalence of major maternal complications and adverse fetal outcomes and examined their independent and combined associations in a post-pandemic cohort in New Delhi, North India.

In this prospective cohort study (2023-2025), 1005 pregnant women (≤ 12 weeks gestation) were recruited from a tertiary-care public hospital in New Delhi, North India; 596 (59.3%) were followed to pregnancy outcome. Maternal complications ascertained were gestational diabetes mellitus (GDM), gestational hypertension (GHTN), intrahepatic cholestasis of pregnancy (IHCP), and prelabor rupture of membranes (PROM). Adverse birth outcomes, assessed among live births, comprised preterm birth and small-for-gestational-age (SGA) while adverse pregnancy outcomes included pregnancy loss and stillbirth. Multivariable logistic regression examined independent and combined associations, adjusting for maternal age, body mass index (BMI), and co-morbid complications.

Pregnancy complications affected 51.3% of women, including GDM (28.7%), GHTN (13.8%), IHCP (13.2%), and PROM (8.9%). IHCP prevalence was nearly three times higher than previous North Indian estimates. Pregnancy loss occurred in 21.1% of women, while adverse birth outcomes were observed in 37.9% of live births, primarily SGA (24.5%) and preterm birth (13.5%). GHTN was the only complication independently associated with adverse birth outcomes (adjusted odds ratio [aOR] 1.92; 95% CI 1.12-3.29) and preterm birth (aOR 2.54; 95% CI 1.26-5.14). Coexisting GDM and GHTN markedly amplified risk, with aORs of 2.70 (95% CI 1.17-6.21) for adverse birth outcomes and 4.64 (95% CI 1.74-12.36) for preterm birth.

GHTN was the sole independent predictor of adverse fetal outcomes, with risk substantially amplified by coexisting GDM. The unexpectedly high IHCP prevalence warrants multicenter investigation. These findings highlight the importance of maternal health for fetal outcomes and support integrated first-trimester screening for hypertensive and metabolic disorders.