Maternal Complications and Adverse Pregnancy Outcomes associated with urinary tract infection in Central Ethiopia; A Multicenter facility-based Age Matched Prospective Cohort Study

Pregnancy-related maternal complications (MCs) and adverse pregnancy outcomes (APOs) are among the most pressing public health challenges in low- and middle-income countries, including Ethiopia. Despite their significance, evidence on the burden of APOs and MCs associated with urinary tract infections (UTIs) during pregnancy in Ethiopia remains limited. This study aimed to determine the magnitude of APOs and MCs among a cohort of pregnant women with UTIs compared to those without UTIs in central Ethiopia. An age-matched prospective cohort study design was employed to follow pregnant women diagnosed with UTIs and their counterparts without UTIs. Participants were monitored throughout pregnancy to assess the occurrence of APOs and MCs. Inferential statistical methods were applied to examine the association between UTIs and the occurrence of APOs and MCs. A significant proportion of women who acquired UTIs developed MCs (n= 54; 30%), which was 1.4 times higher than in women without UTIs, and APOs were observed in 46 women with UTIs (25.6%), also 1.4 times higher than in their counterparts. The most common MC among women with UTIs was postpartum pyrexia (n= 37; 20.6%), which is 1.5 times more frequently than in women without UTIs. The leading APO was preterm birth (n= 39; 21.7%), which was 1.6 times higher compared to their counterparts. Maternal complications most strongly associated with APOs included pregnancy-induced hypertension (n= 3; 60.0%; 1.2 times higher), antepartum hemorrhage (n= 4; 57.1%; 1.2 times higher), and pre-labor rupture of membranes (n= 7; 30.4%; 1.4 times higher). Multivariable logistic regression analysis further revealed that among women with UTIs, being nulli/primiparous (p= 0.02) and attending antenatal care fewer than two times (p= 0.01) were significantly associated with APOs. Additionally, comorbidity with chronic diseases was strongly associated with perinatal deaths (p= 0.01). The higher occurrence of MCs and APOs among women who acquired UTIs during pregnancy highlights the need for targeted interventions. Strategies should focus on addressing key predictive factors such as obstetric history, and comorbid to chronic conditions in order to reduce the burden of MCs and APOs in this population.