ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
Maternal Nutrition Literacy and Associated Factors as Determinant of Micronutrient Supplementation Adherence among Chinese Pregnant Women: A Multi-Center Cross-Sectional Study
Provisionally accepted
- 1The Fourth Affiliated Hospital of Soochow University, suzhou, China
- 2Zoucheng People’s Hospital, zou cheng, China
- 3The Fourth Affiliated Hospital of Soochow University, su zhu, China
- 4West China Second University Hospital, cheng du, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: 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. Methods: 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. Results: 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. Conclusion: 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.
Keywords: adherence, China, Health Literacy, Maternal health, Micronutrient supplementation, Nutrition literacy, Pregnancy
Received: 30 Nov 2025; Accepted: 09 Feb 2026.
Copyright: © 2026 Shi, Wang, Pu, Zuo, Zhang and Meng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jia Shi
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.