Early Adverse Neonatal Outcomes Among Women With Diabetes in Pregnancy in Uganda: Incidence, Distribution and Associated Factors in a Multicenter Prospective Cohort Study

ABSTRACT Background and Aims Diabetes in pregnancy increases neonatal metabolic, respiratory, and growth‐related complications, but prospective Ugandan evidence is limited. We determined the incidence and distribution of early adverse neonatal outcomes and assessed associated maternal factors. Methods We conducted a multicentre prospective cohort study at Jinja, Hoima, and Lira Regional Referral Hospitals in Uganda. Pregnant women with diabetes were enrolled at admission for delivery, and their newborns were followed until hospital discharge or 7 days of life, whichever occurred first. The composite outcome comprised macrosomia, 5‐min Apgar score < 7, neonatal hypoglycemia, respiratory distress, or early neonatal death. Cumulative incidence was reported with a 95% confidence interval (CI). Modified Poisson regression with robust standard errors was used to estimate crude and adjusted risk ratios. Results The analysis included 145 mother–newborn pairs. Overall, 102 newborns experienced at least one early adverse neonatal outcome, corresponding to a cumulative incidence of 70.3% (95% CI: 62.2%–77.6%). Macrosomia occurred in 55/145 newborns (37.9%), 5‐min Apgar score < 7 in 51/145 (35.2%), neonatal hypoglycemia in 38/145 (26.2%), respiratory distress in 31/145 (21.4%), and early neonatal death in 21/145 (14.5%). Neonatal‐unit admission, reported separately as a healthcare‐utilization indicator, occurred in 40/145 newborns (27.6%). After adjustment, women reporting no exercise had a lower risk of the composite outcome than those reporting exercise (adjusted risk ratio 0.68, 95% CI: 0.51–0.91; p = 0.009). Maternal body mass index, residence, and antenatal‐care attendance were not clearly associated with the outcome. Conclusion Early adverse neonatal outcomes were common among newborns of women with diabetes in pregnancy. The unexpected association with reported exercise may reflect exposure misclassification, reverse causation, or residual confounding and should not be interpreted as evidence that avoiding exercise is beneficial. Strengthened glycemic monitoring, delivery planning, and preparedness for neonatal metabolic and respiratory complications are warranted.