# Maternal nutrition literacy and associated factors as determinant of micronutrient supplementation adherence among Chinese pregnant women: a multi-center cross-sectional study

## TL;DR

This study finds that Chinese pregnant women with better nutrition knowledge are more likely to follow micronutrient supplement guidelines, suggesting improved education could boost adherence and health outcomes.

## Contribution

The study identifies maternal nutrition literacy as a modifiable and significant determinant of micronutrient supplementation adherence in Chinese pregnant women.

## Key findings

- 58.2% of pregnant women had good nutrition literacy, while 36.3% had poor literacy.
- Adequate nutrition literacy was associated with a 3.42 times higher likelihood of adhering to micronutrient supplements.
- Older maternal age and receiving nutrition information from healthcare providers also predicted higher adherence.

## Abstract

Maternal nutrition literacy may be a key but underexplored determinant of adherence to recommended micronutrient supplementation during pregnancy in China. This study examined the level of maternal nutrition literacy and its associated factors, and evaluated their relationship with adherence to prescribed micronutrient supplements among pregnant women.

A multi-center cross-sectional survey was conducted among 471 pregnant women attending antenatal care clinics in three hospitals in Eastern, Southwestern, and Northern China. Maternal nutrition literacy was assessed using the validated Nutrition Literacy Assessment Instrument for Pregnant Women (NLAI-P). Adherence to iron folic acid or multiple micronutrient supplements was measured using 30 day self-reported recall and categorized as adherent (≥80% of prescribed doses) or non-adherent (< 80%). Logistic regression was used to identify independent predictors of adherence.

The mean NLAI-P score was 48.25 ± 10.14 out of 76 (63.5%), with 5.5% of women classified as having excellent nutrition literacy, 58.2% good, and 36.3% poor. Overall, 62.4% of participants were adherent to micronutrient supplementation. Adherence was significantly higher among women with adequate nutrition literacy (good or excellent) compared with those with poor literacy (75.3% vs. 39.8%, p < 0.001). In multivariate analysis, adequate nutrition literacy (AOR 3.42, 95% CI 2.15–5.44), older maternal age (AOR 1.09 per year, 95% CI 1.03–1.16), and receiving nutrition information from healthcare providers (AOR 1.85, 95% CI 1.15–2.98) were independent predictors of high adherence.

Maternal nutrition literacy is a strong and modifiable determinant of gestational micronutrient supplementation adherence among Chinese pregnant women. Integrating nutrition literacy assessment and targeted counseling into routine antenatal care may improve supplement adherence and support better maternal and neonatal outcomes.