Background:rnIn the developing world pregnant women face diverse nutritional deficiencies with potentiallyrngrave consequences. The most prevalent deficiencies are assumed to be Protein EnergyrnMalnutrition (PEM), Iron Deficiency Anemia (IDA), Vitamin A (VA) Deficiency (D), IodinernDeficiency Disorders (IDD) and Zinc Deficiency (ZD). Nevertheless, currently limitedrninformation is available about the prevalence of prenatal zinc and vitamin A deficiencies inrnEthiopia. Previous studies which attempted to identify the correlates of the deficiencies and theirrneffects on birthweight ended up in equivocal conclusions.rnObjective:rnTo assess the prevalence, correlates and effect on birthweight of prenatal ZD and VAD in ruralrnSidama, Southern Ethiopia.rnMethods:rnThe study included a community based cross-sectional baseline study to assess the prevalencernand correlates of the deficiencies and a prospective cohort study to evaluate the effects of therndeficiencies on birthweight. The baseline study was conducted in January 2011 among 700rnrandomly selected pregnant women. Data on potential correlates of the deficiencies wererngathered using a structured questionnaire. Serum zinc, retinol, ferritin, hemoglobin and C -rnReactive Protein (CRP) concentrations were determined from venous blood following standardrnprocedures. In the cohort study 575 pregnant women who were in their second or third trimesterrnduring the baseline survey were successfully followed until delivery and birthweight wasrnmeasured within 72 hours of birth. Data were analyzed using linear, logistic and log-binomialrnregression models. The dissertation also incorporated a meta-analysis of Randomized ControlrnTrials (RCTs) so as to assess the effect of prenatal zinc supplementation on birthweight.rnRelevant studies were identified through web-based search. Effect Size (ES) was measured basedrnon standardized mean difference and pooled using a variant of random effect model.rnxiirnResults:rnAbout 53.0%, 37.9% and 17.4% of the subjects had ZD, VAD and Iron Deficiency (ID). Takingrnthe three deficiencies into consideration, 32.9% of the subjects had two or more concomitantrndeficiencies and 5.1% had three of the deficiencies.rnElevated CRP and gestational age were significant negative correlates of zinc status. ZD wasrnsubstantially higher among pregnant women from food insecured households and amongst thosernwho had low Dietary Diversity Score (DDS) in the preceding day of the survey. Illiterates andrnwomen devoid of self income had 1.71 (95% CI: 1.09-2.60) and 1.74 (95% CI: 1.11-2.74) timesrnincreased risk of ZD. The risk was also 1.65 (95% CI: 1.02-2.67) times higher among womenrnfrom maize staple diet category compared to Enset. Women aged 25-34 and 35-49 years werern1.57 (95% CI: 1.04-2.34) and 2.18 (95% CI: 1.25-3.63) times more likely to be deficient thanrnthose aged 15-24 years. Grand multiparas were 1.74 (95% CI: 1.09-3.23) times at risk thanrnnulliparas. Frequency of coffee intake was negatively associated to zinc status. Positivernassociation was noted between serum zinc and hemoglobin concentrations.rnElevated CRP was associated with 22.5% reduction in serum retinol concentration. Women atrntheir third trimester had 2.59 (95% CI: 1.23-5.48) times increased risk of VAD compared tornthose at the first trimester. The risk of VAD was significantly higher among illiterates andrnwomen without their own income. Women aged 35-49 years had 2.23 (95% CI: 1.31-3.81) timesrnhigher risk compared to those aged 15-24 years. Women with low DDS were 1.94 (95% CI:rn1.17-3.19) times more likely to be deficient than their counterparts with high DDS. Compared tornnulliparas, multiparas had 2.25 (95% CI: 1.20-4.22) times increased risk of VAD. VAD and ZDrnwere associated to each other with adjusted OR of 1.80 (95% CI: 1.28-2.53).rnThe mean birthweight among babies born to women who were at their second or third trimesterrnat the time of exposure assessment was 2896 g and 16.5% (95 % CI: 13.5-19.6%) had LBW.rnPrenatal ZD and VAD were not significantly associated to LBW with Adjusted Relative Riskrn(ARR) of 1.25 (95 CI: 0.86-1.82) and 1.27 (95% CI: 0.86-1.87), respectively. The occurrences ofrnZD and VAD, neither in the second nor third trimester, were associated to LBW. Therndeficiencies did not show synergetic interaction in causing LBW with SI of 1.04 (95% CI: 0.17-rn6.28). Significant determinants of LBW were maternal illiteracy, maternal thinness and stunting,rnprimiparity, female sex of the baby and elevated CRP during pregnancy.rnxiiirnAmong 17 RCTs included in the meta-analysis, 3 reported positive association between zincrnsupplementation and birthweight, 1 had marginally negative association where as 13 found nornassociation. Based on DerSimonian and Lairdâ€™s random effect model, the pooled ES was 0.071rn(95% CI: 0.162 to -0.019) and it remained insignificant after stratification was made based on therndose of supplementation (optimal or high dose), design of the studies (community or healthrninstitution-based), and development status of the study country (developed or developing).rnConclusion:rnZD and VAD are of public health concern in the area. Key correlates of ZD were household foodrninsecurity, low DDS, dependency on maize as a staple diet and low level of consumption ofrnanimal source foods. Illiterates and women devoid of self income had increased risk of ZD.rnGrand multiparity, old age pregnancy and frequent consumption of coffee were negativerncorrelates. Pertaining to VAD, advanced gestational age elevated CRP were negativelyrnassociated with serum retinol level. Advanced maternal age, inferior socio-economic status,rndependence on poorly diversified and plant based diet, ZD and history of too close and too manyrnbirths were pertinent correlates of VAD. Prenatal ZD and VAD occurring neither in the secondrnnor third trimester were not associated to LBW. Further, the deficiencies did not show synergeticrninteraction in causing LBW. Based on the meta-analysis, prenatal zinc supplementation did notrnshow positive effect on birthweight.rnRecommendation:rnZinc and VA deficiencies should be combated through food-based approach as it is a sustainablernstrategy to prevent multiple micronutrient deficiencies. Approaches that focus on dietaryrndiversification like backyard gardening and poultry production should be promoted. The existingrnefforts to improve womenâ€™s awareness about optimal nutrition prior and during pregnancyrnshould be strengthened through building the capacity of health extension workers and voluntaryrncommunity health promoters. Strong intersectoral collaboration must be established between thernhealth and agriculture sectors so as to address the root causes of malnutrition. Use of householdrnbased phytate reduction techniques, utilization of zinc containing fertilizers should be consideredrnas potential strategies to combat ZD. Expansion of family planning coverage, livelihoodrnpromotion and socio-economic empowerment of women shall have affirmative influence.rnKey Words:rnPrenatal zinc deficiency, prenatal vitamin A deficiency, low birthweight.