Methods and Findings
A prospective cohort of pregnant women (n = 670) in their first trimester of pregnancy was
enrolled and followed until birth. Socio-demographic, clinical, and anthropometric factors,
along with access to toilets and sanitation practices, were recorded at enrolment (12th
week of gestation). A trained community health volunteer conducted home visits to ensure
retention in the study and learn about study outcomes during the course of pregnancy.
Unadjusted odds ratios (ORs) and adjusted odds ratios (AORs) and 95% confidence intervals
for APOs were estimated by logistic regression models. Of the 667 women who were
retained at the end of the study, 58.2% practiced open defecation and 25.7% experienced
APOs, including 130 (19.4%) preterm births, 95 (14.2%) births with low birth weight, 11
(1.7%) spontaneous abortions, and six (0.9%) stillbirths. Unadjusted ORs for APOs (OR:
2.53; 95% CI: 1.72–3.71), preterm birth (OR: 2.36; 95% CI: 1.54–3.62), and low birth weight
(OR: 2.00; 95% CI: 1.24–3.23) were found to be significantly associated with open defecation
practices. After adjustment for potential confounders such as maternal socio-demographic
and clinical factors, open defecation was still significantly associated with increased
odds of APOs (AOR: 2.38; 95% CI: 1.49–3.80) and preterm birth (AOR: 2.22; 95% CI: 1.29–