Dietary Diversity Practices during Pregnancy and Adverse Pregnancy Outcomes among Women Attending Public Hospitals in Gambella Town, Southwest Ethiopia

Background: Inadequate dietary diversity during pregnancy is associated with adverse pregnancy outcomes (APOs), such as hypertensive disorders in pregnancy (HDP), preterm delivery (PTD), low birth weight (LBW), and low maternal hemoglobin (Hb) with substantial maternal and neonatal effects. Despite nutrition interventions, inadequate dietary practices and APOs remain public health concerns. This study aimed to assess maternal dietary diversity practices and risks of APOs among women attending public hospitals in Gambella Town, Southwest Ethiopia. Methods: An institution-based prospective cohort study was conducted among 254 pregnant women enrolled and followed from July 25, 2024, to March 10, 2025, in two hospitals. A structured interviewer-administered questionnaire was used to collect data. Modified Poisson regression models were used to estimate risk ratios and 95% confidence intervals, with statistical significance defined at p-value < 0.05. Results: Among 254 pregnant women enrolled, 232 completed follow-ups, with a 91.3% response rate. Inadequate dietary diversity practice significantly increased risk of low maternal Hb (ARR=1.79; 95% CI: 1.18–2.71), PTD (ARR=2.66; 95% CI: 1.34–5.28), LBW (ARR=3.81; 95% CI: 1.58–9.20), but not HDP (ARR=0.626; 95% CI: 0.259–1.511). Conclusion: Inadequate maternal dietary diversity practice increases risks of low maternal Hb, PTD, and LBW. Improving maternal DD practices by strengthening policy on the implementation of nutrition education and counselling on meal frequency and dietary diversification during antenatal care is essential to improve pregnancy outcomes.