Maternal dietary diversity and associated factors among pregnant women visiting public health institutions for antenatal care in Addis Ababa, Ethiopia

Background Pregnancy is a critical stage with major physiological and biochemical changes, increasing nutritional needs for maternal and fetal growth. These demands make women highly vulnerable to malnutrition. Dietary practices observable eating behaviors are key to meeting these needs and are classified as good or poor. Compared to other life stages, pregnancy carries a higher risk of deficiencies influenced by eating habits. Objective This study aimed to assess maternal dietary practices and identify factors associated with good dietary diversity among pregnant women attending public health institutions in Addis Ababa, Ethiopia, in 2024. Methods An institution-based cross-sectional study was conducted among 333 pregnant women attending ANC in Addis Ababa from April 24 to May 23, 2024. Data were collected using interviewer-administered questionnaires and a 24-hour dietary recall. Analysis was performed in SPSS version 27, applying descriptive statistics and bivariate logistic regression to identify candidate variables, followed by multivariable logistic regression to determine independent predictors of dietary practice. Result The mean age of respondents was 27.91 years (SD ± 4.74). The overall prevalence of good dietary practice was 39% (95% CI: 38.5–39.4), indicating that less than half of the participants met the minimum dietary diversity standard. Multivariable logistic regression identified several significant predictors of good dietary practice. Women without a habit of eating snacks were 72% less likely to achieve good dietary diversity (AOR = 0.28; 95% CI: 0.09–0.81). Conversely, consumption of specific food groups strongly increased the likelihood of good dietary practice: Pulses: AOR = 6.59 (95% CI: 3.36–12.92), Nuts and seeds: AOR = 34.24 (95% CI: 5.23–223.94) and other fruits: AOR = 33.14 (95% CI: 8.74–125.64). These findings underscore the critical role of nutrient-rich foods in achieving dietary diversity. Additionally, 75.2% of participants reported consuming protein-rich foods and fresh fruits within the previous 24 h, suggesting some positive dietary behaviors despite overall low diversity. Conclusion and recommendation This study found that the prevalence of good dietary practice among pregnant women was moderate, with several factors significantly influencing outcomes. Positive predictors included husband's occupation (government employment), food cravings, snack consumption, and intake of protein-rich foods, pulses, and meat, poultry, and fish. Conversely, meal skipping during pregnancy was associated with reduced odds of good dietary practice. Policymakers and health planners should strengthen routine screening and counseling on maternal dietary practices during ANC visits. Nutrition education programs should emphasize the importance of diverse food consumption and discourage meal skipping to improve maternal and fetal health outcomes.