Introduction: Globally, anima affects 37% of pregnant women causing adverse pregnancy outcomes such as low birth weight, stillbirth, and preterm birth, maternal and perinatal deaths, among many others.  

Objective: To assess the impact of maternal anaemia on pregnancy outcome and its predictors among pregnant women on antenatal care follow-up in Ilubabor and Buno Bedelle zones, southwest Ethiopia, 2024. 

Methods: A facility-based prospective cohort study was conducted among 492 pregnant women on follow-up at general hospitals of Ilubabor and Buunnoo Beddelle Zones, Preliminary screening was done using (Hemocue Hb 301) to identify anemia status. Systematic random sampling used to select study participants. Data was analysed using SPSS V.23. Bivariable and multivariable modified Poison regression analysis was run to identify predictors of adverse pregnancy outcomes at p-value of less than 0.05 and relative risk was used to assess the strength of the association.  

Result: 492 (92.5%) respondents participated in this study. 102 (20.70%) of the study participants had adverse pregnancy outcomes; low birth weight 38 (7.72%), stillbirth 29 (5.9%), neonatal loss 18 (3.65%), and preterm 13 (2.6%). The risk of adverse pregnancy outcome was five times higher among anemic pregnant women than non-anemic [(aRR = 5.0, 95% CI (2.6-9.6)]. Predictors of adverse pregnancy outcome were co-morbidity [aRR = 2.7, 95% CI (1.4, 5.0)], birth interval of < 2 years [aRR = 2.1; 95% CI (1.033, 4.2)], severity of anemia) [aRR = 2.66; 95% CI (1.119, 6.304)], obstetric complications during pregnancy and during delivery respectively [aRR = 2.7, 95% CI (1.3, 5.5)], [aRR = 2.6, 95% CI (1.16, 5.90)]. 

Conclusion and recommendations: The incidence of adverse pregnancy outcomes was much higher among anemic pregnant women than non-anemic. Health care providers and health managers should take intervention actions focusing on enhancing obstetric care quality, and early detection and treatment of comorbidity.  

Keywords: Anemia, Pregnancy, Adverse pregnancy outcome, Stillbirth, Neonatal loss