Effect of nutrition education and counseling intervention on the dietary diversity practice of pregnant women in Ethiopia: a systematic review and meta-analysis

A diversified diet plays a crucial role in decisive pregnancy outcomes and the future health of the child. In Ethiopia, inadequate dietary diversity among pregnant women remains a significant public health concern, contributing to maternal undernutrition, low birth weight, and poor infant development. Nutritional education and counseling intervention during pregnancy are the best strategies to improve dietary diversity practice of pregnant women. This systematic review and meta-analysis aimed to estimating the pooled effects of nutrition education and counseling intervention on the pregnant women dietary diversity practice in Ethiopia. The relevant studies searched from distinct databases such as (PubMed, Google scholar, Scopus, web of science, Embase, Seince direct and the institutional repository of Ethiopian universities were used. Data were extracted using Microsoft Excel, and analysis was performed using STATA-17. A random-effects model was used to estimate the overall effect size of nutritional education and counseling intervention on the dietary diversity practice of pregnant women. The pooled effect size was expressed as a risk ratio (RR) with a 95% CI. $${I}^{2}$$-test statistics were used for assessing heterogeneity between included studies. Egger’s test and funnel plot were used for assessing publication bias. A total of nine peer-reviewed studies that met the inclusion criteria with a total of 3739 pregnant women were involved in this study. The pooled effect of nutritional education and counseling intervention was RR: 1.78 with 95% CI (1.44, 2.18). There was a high heterogeneity ($${I}^{2}$$ = 91.1%) observed between includes studies. Nutrition education during pregnancy have a positive effect in improving dietary diversity practice of pregnant women. Therefore, we recommend that health care providers and stakeholders offer nutrition education and counseling alongside routine services for pregnant women, ensuring they are equipped with essential knowledge about healthy dietary behaviors during pregnancy. Registered on the PROSPERO database (CRD42025106769).