Rehel Anteneh ¹ Getayeneh Antehunegn Tesema ² Ayenew Molla ² Sefineh Fenta Feleke ^3*

• ¹ Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
• ² Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia
• ³ Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia

Background: Adverse birth outcomes are unfavorable outcomes of pregnancy that are particularly common in middle-and low-income countries. At least one ultrasound is recommended to predict adverse birth outcomes in an earlier pregnancy. However, in low-income countries, imaging equipment and trained manpower are scarce. According to our search of the literature, there is no validated risk prediction model for predicting adverse birth outcomes in Ethiopia. Hence, we developed and validated a model and risk score to predict adverse birth outcomes using maternal characteristics during pregnancy, for use in resource-limited settings.: A retrospective follow-up study was conducted from January 1, 2016 to May 31, 2021, and a total of 910 pregnant women were included in this study. Participants were selected using a simple random sampling technique. Stepwise, backward multivariable analysis was done. The model's accuracy was assessed by density plots, discrimination, and calibration. The developed model was assessed for internal validity by bootstrapping techniques and evaluated for clinical utility using decision curve analysis across various threshold probabilities. Results: Premature Rapture of Membrane, number of fetuses, residence, Pregnancy Induced Hypertension, Ante Partum hemorrhage, hemoglobin level, and labor onset remained in the final multivariable prediction model. The AUC of model was 0.77 (95% Confidence Interval: 0.73, 0.812). The developed risk Prediction model had a good performance, well-calibrated and valid. The decision curve analysis indicated the model provides a higher net benefit across ranges of threshold probabilities. 3 Conclusion: In general, this study showed the possibility of predicting adverse birth outcomes using maternal characteristics during pregnancy. The risk prediction model using a simplified risk score helps identify high-risk pregnant women for specific interventions. A feasible score would reduce neonatal morbidity and mortality and improve maternal and child health in low-resource settings.