Nutritional knowledge and health literacy among pregnant women in the Northern Border Region of Saudi Arabia: a cross-sectional study

Abstract Maternal nutrition is central to healthy pregnancy, yet region-specific evidence on pregnancy-related nutritional knowledge and its relationship with health literacy remains limited in Saudi Arabia. This study assessed nutritional knowledge among pregnant women in the Northern Border Region of Saudi Arabia, identified associated sociodemographic and clinical factors, and examined its relationship with health literacy. This cross-sectional study analyzed 536 pregnant women aged ≥ 18 years residing in the Northern Border Region of Saudi Arabia after excluding four submitted questionnaires from women who declined electronic consent. Participants completed an anonymous, self-administered online Arabic-language questionnaire adapted from a previously published instrument. Nutritional knowledge was assessed using 40 dichotomously scored items and categorized as poor (< 50%), moderate (50–75%), or good (> 75%). Four health-literacy domains available in the final electronic survey were analyzed. Associations were examined using chi-square tests followed by multinomial logistic regression with good knowledge as the reference category. Among 536 consenting participants, 63.1% had poor nutritional knowledge, 30.8% had moderate knowledge, and 6.2% had good knowledge. Knowledge level differed significantly across age, education, employment, marital status, income, chronic disease status, and supplement use in bivariate analyses, although age and income did not show monotonic gradients. All four analyzed health-literacy domains were significantly associated with knowledge level in bivariate analyses. In multinomial regression, chronic disease was associated with higher odds of moderate versus good knowledge (OR 5.08, 95% CI 1.56–16.51) and poor versus good knowledge (OR 6.38, 95% CI 2.00–20.31). Supplement use was associated with lower odds of moderate (OR 0.13, 95% CI 0.03–0.58) and poor knowledge (OR 0.10, 95% CI 0.02–0.42), while higher educational level was associated with lower odds of poor versus good knowledge (OR 0.26, 95% CI 0.07–0.93). The total health-literacy score was not independently significant in category-specific adjusted comparisons. Pregnancy-related nutritional knowledge was generally suboptimal and was independently associated with education, chronic disease status, and supplement use. These findings support structured, culturally appropriate antenatal nutrition education that addresses micronutrient requirements, supplementation, food safety, and practical dietary decision-making. Because of the cross-sectional design, the observed relationships should be interpreted as associations rather than causal effects.