The Effect of Nutrition Education on Hemoglobin Levels among Pregnant Women: A Systematic Review and Meta-Analysis

Why Hemoglobin in Pregnancy Matters

Anemia in pregnancy remains one of the most pressing global maternal health challenges, affecting around 40% of pregnant women worldwide. Its consequences go far beyond “feeling tired”—low hemoglobin increases the risks of preterm birth, low birth weight, postpartum hemorrhage, infections, delayed fetal growth, and long-term developmental issues in children. Despite iron–folic acid (IFA) programs and antenatal supplementation policies, many women continue to start pregnancy with poor nutritional status, limited diet diversity, and low awareness of anemia prevention.

Against this backdrop, the systematic review and meta-analysis “The Effect of Nutrition Education on Hemoglobin Levels among Pregnant Women” by Qotrunnada, Fauzi, and Mahmudiono (2025) offers important evidence on whether structured nutrition education can meaningfully improve hemoglobin levels and reduce anemia in pregnancy. The authors screened over 300 records following PRISMA 2020 guidelines and included seven interventional studies (four randomized controlled trials and three quasi-experimental studies) published between 2019 and 2025, encompassing 1,120 pregnant women from countries such as Ethiopia, Indonesia, Egypt, Malaysia, and Nepal.

The primary outcome was the change in maternal hemoglobin (Hb) level between intervention (nutrition education) and control groups, measured in grams per deciliter (g/dL). Secondary outcomes included nutrition knowledge, dietary intake, IFA adherence, and anemia prevalence. Using a random-effects meta-analysis, the review provides pooled estimates of the effect of nutrition education, while addressing heterogeneity and performing sensitivity analyses to ensure robustness.

This blog post breaks down the key findings of this meta-analysis, explores how different forms of nutrition education (from mobile apps to home visits) influence hemoglobin levels, and offers practical implications for program designers, clinicians, and public health policymakers.

Tags: nutrition education in pregnancy, hemoglobin levels, anemia in pregnancy, maternal nutrition, antenatal care, iron folic acid, systematic review, meta-analysis, dietary counseling

Key Highlights from the Meta-Analysis

The meta-analysis found a clear and statistically significant benefit of nutrition education on hemoglobin levels among pregnant women. Across seven studies with 1,120 participants, women who received structured nutrition education experienced an average hemoglobin increase 0.73 g/dL higher than those in the control groups (mean difference 0.73 g/dL; 95% CI 0.62–0.84; p<0.00001). This magnitude of improvement is clinically meaningful, particularly in populations where baseline Hb levels are close to anemia thresholds (often 11 g/dL in pregnancy).

Despite the positive pooled effect, the authors reported high heterogeneity (I²=94%), indicating substantial variation across studies in design, population, intensity and duration of education, and delivery modes. To address this, they explored subgroups and found that multi-component, integrated education (e.g., combining face-to-face counseling with digital tools and visuals) achieved greater Hb improvements (MD 0.85 g/dL; 95% CI 0.71–0.99) compared with lecture-only approaches (MD 0.52 g/dL; 95% CI 0.41–0.64).

Beyond hemoglobin, nutrition education consistently improved maternal nutrition knowledge, dietary diversity, and intake of iron-rich and vitamin C-rich foods, while also enhancing adherence to iron–folic acid supplementation. For example, some interventions reduced anemia prevalence from 27.8% to 7.2% in the intervention group, alongside significantly higher IFA compliance (odds ratio 2.26; 95% CI 1.55–3.29; p<0.001). These behavioral and physiological gains suggest that education influences both what women know and what they actually do.

Sensitivity analyses confirmed that no single study disproportionately drove the overall effect; removing each study in turn did not materially change the pooled mean difference. This adds confidence that the observed benefits of nutrition education on hemoglobin levels are robust across settings and study designs.

In short, the primary keyword “effect of nutrition education on hemoglobin levels among pregnant women” is strongly supported by this body of evidence: well-designed educational interventions during pregnancy lead to statistically and clinically significant improvements in Hb, along with better knowledge, diet, and supplement adherence.

What the Studies Show: Designs, Settings, and Interventions

The seven included studies span diverse geographical contexts and health system realities, yet they share core features: all enrolled pregnant women (mostly aged 18–40 years) in the first or second trimester, and all implemented structured nutrition education as a central component of the intervention. Study designs included four randomized controlled trials (RCTs) and three quasi-experimental studies (often cluster-based), providing both high internal validity and real-world implementation insights.

Eligibility criteria tended to exclude women with multiple pregnancies, gestational diabetes, chronic hematologic conditions, or severe obstetric complications, focusing instead on healthy pregnant women with normal or mild anemic status. Intervention durations ranged from six weeks to twelve months, with most delivered by trained health workers such as midwives, nurses, or nutritionists. These providers often received specific training in behavior-change communication and the theoretical models underpinning the interventions.

Delivery modes varied:

- Mobile app–based education (e.g., MyPinkMom in Malaysia) used interactive videos, quizzes, and meal tracking to teach dietary diversity, iron, and vitamin C intake, and anemia prevention over six weeks.

- Group sessions in Ethiopia integrated the Health Belief Model (HBM) and Theory of Planned Behavior, with six midwife-led education sessions woven into routine antenatal care over nine months.

- Hybrid clinic plus SMS interventions combined face-to-face counseling with weekly text reminders about iron-rich diets and supplement adherence across twelve months.

- Multimedia programs in Egypt used PowerPoint presentations, booklets, and WhatsApp groups to reinforce anemia prevention messages over three months.

- Home-visit programs in Indonesia used pictorial flipcharts to deliver anemia and nutrition counseling during two structured home visits.

- Individual counseling in Nepal focused on local, affordable iron-rich foods and personalized dietary plans over three months.

Across these designs, most interventions were grounded in behavior change theories such as the Health Belief Model or other cognitive-behavioral frameworks, emphasizing risk perception, perceived benefits, self-efficacy, and cues to action. Educational content centered on iron-rich and vitamin C-rich food sources, inhibitors of iron absorption (such as tea/coffee around meals), proper use of IFA tablets, and culturally adapted meal planning.

Data extraction and statistical synthesis followed rigorous standards. The authors captured study details, intervention components, delivery channels, sample sizes, pre/post Hb values, and standard deviations, then used Review Manager (RevMan 5.4) to calculate weighted mean differences and forest plots under a random-effects model. Heterogeneity was quantified using Cochran’s Q and I² statistics, and robustness tested via sensitivity analyses.

This level of methodological transparency makes the evidence particularly helpful for practitioners seeking to replicate or adapt similar programs in their own antenatal services.

How Nutrition Education Changes Hemoglobin Levels and Behaviors

The effect of nutrition education on hemoglobin levels among pregnant women operates through several interconnected pathways. First, education increases awareness about anemia, its risks, and the importance of specific nutrients (iron, folate, vitamin B12, and vitamin C), helping women understand why they need to change their diets and adhere to supplements. Second, it equips them with practical skills—how to design affordable iron-rich meals, when to take iron tablets, what to avoid near iron consumption (like tea/coffee), and how to minimize side effects.

For example, one Ethiopian quasi-experimental study guided by the Health Belief Model combined nutrition education with IFA supplementation. At baseline, barely half the women in both intervention and control groups had adequate understanding of anemia and IFA; after the intervention, 84.5% of women in the intervention group demonstrated good nutritional understanding versus 62.9% in the control group (p<0.001). Hemoglobin increased by about 0.8 g/dL in the intervention group, and IFA adherence rose from 33.8% to 79.4%, compared with a more modest increase from 32.4% to 40.6% in controls (p<0.001).

In a Malaysian trial using the MyPinkMom mobile app, pregnant women receiving six weeks of theory-based digital education showed significant increases in hemoglobin, anemia knowledge, and intake of iron- and vitamin C-rich foods, along with reduced tannin intake from tea/coffee. The effect on hemoglobin was large (partial eta-squared 0.268) and accompanied by very large gains in knowledge (ηp² 0.622). These results highlight how digital tools can reinforce learning and behavior change between clinic visits.

An Egyptian RCT using multimedia education (including WhatsApp support) reported an Hb increase from 10.9±1.01 to 11.75±0.93 g/dL in the intervention group, with statistically significant effect sizes and improved supplement adherence. The program’s success was attributed to ongoing WhatsApp education, interactive presentations, regular antenatal visits, and family engagement.

In Indonesia, picture-guided home counseling improved anemia status, knowledge, food intake, and iron tablet compliance among anemic pregnant women. The approach was particularly valuable in low-literacy settings, where visual tools helped overcome reading barriers and made complex concepts easier to grasp. Similarly, a Nepalese quasi-experiment combining in-person and telephone counseling achieved greater hemoglobin gains and knowledge scores versus standard care.

Taken together, these studies show that the effect of nutrition education on hemoglobin levels among pregnant women is strongest when the intervention is:

- Structured and repeated (not one-off lectures)

- Behavior change–oriented, not merely informational

- Multimodal (face-to-face + digital/visual aids)

- Contextualized to local foods, culture, and socioeconomic realities

- Integrated into routine antenatal care with trained providers.

Implications for Practice and Policy: Turning Evidence into Action

The findings of this systematic review and meta-analysis have direct implications for designing antenatal care programs, especially in low-resource settings where anemia in pregnancy remains pervasive. First, they support integrating structured nutrition education as a core component of routine antenatal services, rather than treating it as an optional add-on. This means building counseling protocols, training providers, and allocating clinic time specifically for diet and supplement adherence education.

Second, the evidence suggests that multi-channel, theory-based interventions outperform one-off lectures, so program planners should prioritize blended approaches that combine:

- Face-to-face counseling (individual and/or group sessions)

- Visual and print materials (flipcharts, pictorial handbooks, culturally tailored menus)

- Digital tools (mobile apps, SMS, WhatsApp groups, interactive videos).

Third, targeting women early in pregnancy (first or early second trimester) appears beneficial, as behavior patterns and supplement adherence can be established earlier. Interventions should also consider maternal age, parity, education level, and cultural practices (such as dietary taboos and tea/coffee habits) when tailoring messages.

For policymakers, the effect of nutrition education on hemoglobin levels among pregnant women strengthens the case for including nutrition counseling indicators in national antenatal care guidelines, monitoring frameworks, and funding priorities. This might include:

- Standardizing nutrition counseling content across facilities

- Ensuring health worker training includes behavior-change communication skills

- Leveraging community health workers for home-based or community-based education

- Developing national or regional digital platforms for maternal nutrition education.

For researchers, the high heterogeneity (I² up to 94–99% in some outcomes) signals the need for more nuanced subgroup analyses and standardized reporting of intervention components, timing, and context. Future trials should clarify which combinations of intensity, modality, and theoretical framework yield the greatest Hb improvements and adherence in different populations.

Ultimately, this meta-analysis suggests that if health systems want to reduce anemia in pregnancy, they cannot rely solely on distributing iron–folic acid tablets; they must pair supplementation with systematic, context-sensitive nutrition education.

The systematic review and meta-analysis by Qotrunnada and colleagues provides strong, multi-country evidence that structured nutrition education significantly improves hemoglobin levels and related behaviors among pregnant women. With a pooled mean difference of 0.73 g/dL in favor of intervention groups and consistent gains in knowledge, dietary diversity, and IFA adherence, the effect of nutrition education on hemoglobin levels among pregnant women is both statistically robust and clinically important.

The most effective interventions are not one-off lectures, but comprehensive programs that blend face-to-face counseling with digital tools, visual aids, and behavior change frameworks. When implemented early and integrated into routine antenatal care, these interventions can reduce anemia prevalence, improve maternal and fetal outcomes, and enhance health literacy at the household and community level.

Conclusion: Why Nutrition Education Belongs at the Heart of Antenatal Care

At a time when global health agendas emphasize equity, prevention, and primary care, this evidence supports prioritizing nutrition education as a cost-effective, scalable strategy to tackle pregnancy-related anemia. For clinicians, public health practitioners, and policymakers, the takeaway is clear: robust antenatal care must address not only what women are prescribed, but also what they understand, eat, and practice daily.