Burden and Predictors of Fetal Growth Restriction in a Tertiary Hospital in Hawassa, Southern Ethiopia: A Cross-Sectional Study

Abstract Background: Fetal growth restriction (FGR) has an adverse impact on fetal, neonatal, and adult life and is a significant cause for perinatal morbidity and mortality, particularly in low- and middle-income countries. Evidence from tertiary care settings in Ethiopia using standardized diagnostic criteria remains limited. This study aimed to assess the burden of FGR at birth and its associated factors. Methods: An institution-based cross-sectional study was conducted from April to September 2024 among 358 women who gave birth at Hawassa University Comprehensive Specialized Hospital. A systematic sampling technique was applied to select the required samples. Data was collected through interviews and medical record reviews. Binary and multivariable logistic regression analyses were used to identify factors independently associated with fetal growth restriction. Results: The magnitude of fetal growth restriction was 22.6% (95% CI: 15.5–29.7). After controlling for potential confounding variables women who were unable to read and write (AOR = 8.06; 95% CI: 2.01–32.31), pre-pregnancy BMI < 18.5 kg/m² (AOR = 7.63; 95% CI: 2.30–25.29), hypertensive disorders of pregnancy (AOR = 3.27; 95% CI: 1.13–9.50), and preterm delivery (AOR = 2.85; 95% CI: 1.31–6.20) predicted fetal growth restriction. Conclusion: Low maternal educational status, pre-pregnancy BMI < 18.5 kg/m², hypertensive disorders of pregnancy, and preterm delivery were independently associated with fetal growth restriction. These findings highlight the need for targeted antenatal interventions focusing on maternal nutrition and hypertension management.