Assessing the Impact of Nutrition Education on Antenatal Nutrition Knowledge of Women in Lebanon: an Interventional Study

doi:10.21203/rs.3.rs-2595635/v1

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Assessing the Impact of Nutrition Education on Antenatal Nutrition Knowledge of Women in Lebanon: an Interventional Study

https://doi.org/10.21203/rs.3.rs-2595635/v1

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Background

Nutrition education during pregnancy has significant impact on improving knowledge and dietary habits of pregnant women, which in turn leads to enhanced postpartum maternal and birth outcomes. The aim of this study is to evaluate the impact of antenatal nutrition education on the knowledge of women of childbearing age in Lebanon.

Method

A quantitative quasi-experimental study design was adopted. Online antenatal nutrition education sessions were provided to a group of women of childbearing age. The online session was ninety minutes long and covered antenatal weight gain and its composition, nutrition in the preconception and the antenatal periods, food safety, and nutrition intervention for nutrition related pregnancy complications. Participants’ antenatal nutrition knowledge was assessed before and directly after the session through an online self-administered questionnaire. Descriptive and inferential statistics were employed to analyze the results, using SPSS 28®.

Results

A total of 5 virtual sessions on antenatal nutrition were given by a licensed dietitian and attended by 91 participants. Fifty nine percent of participants had previously received antenatal nutrition information, of which 27.5% were obtained from dietitians and 22% were obtained from the internet. Mean scores for pretest and posttest were 27 ± 6.5 and 37 ± 4.1 respectively, and their difference was statistically significant (t=-31.6; P < 0.001). In the pretest, the lowest score was 6 and the maximum score was 39 ± 6.5. However, the lowest score in the posttest was 21 and the highest was 41 ± 4.1. The statement related to the recommended amount of caffeine consumption among pregnant women received the lowest percentage of correct answers (3%). However, in the posttest, this number improved and increased to 85% correct answers. On the other hand, 99% of answers were correct regarding nutrition affecting pregnancy outcomes, making it the highest percentage of correct answers at pretest.

Conclusion

Antenatal nutrition education may improve knowledge and practice of women during pregnancy. Thus, attention should be directed towards promoting nutrition education of women of childbearing age.

antenatal nutrition

education

knowledge

women of childbearing age

Lebanon

intervention

Nutrition has significant implications on a persons’ health status throughout their life and more specifically during periods of development including fetal growth during pregnancy [1]. An adequate antenatal dietary regimen supports normal fetal development and may help prevent complications such as congenital malformations, premature birth, low birth weight (LBW) and future development of chronic diseases [2]. The antenatal diet should provide necessary energy and nutrients, including vitamins and minerals, to meet the nutritional needs of the mother as well those of the fetus[3].

Substandard dietary intake during antenatal period is mainly associated with low socio-economic status, lack of knowledge about healthy eating patterns, suboptimal dietary intake, as well as incorrect handling, and storage of food [4]. Nutrition education and counselling is a commonly used approach to improve the nutritional status of women before and during pregnancy. It promotes ideal gestational weight gain, reduces the risk of foodborne illness, improves birth weight, and decreases the risk of preterm delivery [5]. Scientific evidence indicates that nutrition education during pregnancy has significant impact on improving knowledge and dietary habits of pregnant women, leading to enhanced maternal and birth outcomes [5].

A study in Istanbul aimed at evaluating the effect of nutrition education sessions on nutrition knowledge of pregnant women [4]. Participants filled a nutrition knowledge questionnaire before and after receiving the educational sessions. Knowledge scores increased significantly after the intervention. Fallah conducted a quasi-experimental study that aimed at determining the impact of antenatal nutrition education on nutritional knowledge of a group of 100 pregnant women in Western Iran, through a nutritional education program [1]. Knowledge of pregnant women about healthy antenatal nutrition increased significantly from 3–31% after the antenatal nutrition education (paired test p < 0.001)[1].

Harb assessed antenatal nutrition knowledge, attitude, and practices (KAP) among postpartum Syrian refugee women residing in Lebanon [6]. Results showed that 56% of participants lacked knowledge about maternal nutrition during pregnancy, 25% had a negative attitude toward antenatal care services and nutrition during pregnancy and 47% had undesirable dietary practices during pregnancy [6].

In Lebanon, interventional programs providing evidence-based information on antenatal nutrition is lacking. Increasing women’s knowledge on the matter and guiding their practices during pregnancy will positively impact postpartum outcomes.

The aim of this study is to evaluate the impact of antenatal nutrition education on the knowledge of women of childbearing age in Lebanon.

Study design and population

A quasi-experimental design done in collaboration with Lactica Association was adopted to for this study. Lactica Association is a Lebanese based Non-Governmental Organization whose mission is to promote, protect and support breastfeeding in Lebanon during the period of 2019 and 2020. The target population was adult, Arabic speaking women of childbearing age (18 to 44 years). A non-probability voluntary sampling technique was employed.

Ethical considerations

The study protocol was reviewed and approved by the scientific committee of the Saint George Hospital University Medical Center (study No. 10-2021). The study was conducted following the Declaration of Helsinki and all methods were carried out in accordance with relevant guidelines and regulations in the declaration - Ethics approval and consent to participate section.

Development of material used for the intervention.

The material was developed using prominent references in antenatal care and were displayed as a visual presentation with images and small texts that were elaborated by the presenter. [2, 7–10]

The session’s during was of ninety minutes, and was divided into six sections:

Weight gain during pregnancy,
Composition of weight gained during pregnancy,
The importance of nutrition in the preconception period
The importance of antenatal nutrition,
Food safety during pregnancy,
Nutrition intervention during nutrition related pregnancy complications.

The material and information of the session were tailored to fit the Lebanese dietary and cultural habits and included foods and beverages typically consumed by the Lebanese population. For example, according to Lactica Association, in some areas in Lebanon, it is common practice to buy fresh cow’s milk and boil it to drink it as is or make dairy products from it. Hence, during the presentation, the difference between pasteurization and boiling the milk was explained and attendees were provided with the right technique to pasteurize fresh milk at home.

Study procedure

Due to COVID 19 pandemic, the country was on lockdown and the intervention was done online. An invitation poster was posted on different social media platforms with a link through which participants can register to take the session. The online sessions were scheduled ahead of time and participants were asked to fill the pretest questionnaire before the beginning of the session. A licensed dietitian introduced herself and the aim of the intervention and proceeded with the sessions. Posttests were administered online immediately after the sessions.

Pre and post tests

The pretest included questions regarding the participant’s sociodemographic characteristics, medical history, weight, and height, and antenatal nutrition knowledge and food security section. The posttest included all sections of the pretest except the sociodemographic part. Four experts in the field determined content validity. The survey was pilot tested with seven women who fit the study criteria, accepted the invitation, and attended the session.

Antenatal nutrition knowledge was assessed using 41 items coded as true/false//I do not know. These statements were developed in parallel with the material that was created for the sessions and covered all topics that were explained during the sessions: weight gain, the composition of weight gained, preconception nutrition, antenatal nutrition, food safety, nutrition intervention for certain antenatal complications, physical activity. Total scores ranged from 0 to 41 and were calculated by summing the number of correct answers.

The food security section was adapted from the U.S. Household Food Security Survey Module: Six-Item Short Form, a questionnaire designed and validated by the United States Department of Agriculture to determine households score on the food security scale and their classification by food security status level [11]. Food security consisted of 6 items measured on a scale ranging from 1 to 6 The answers “yes”, “often”, “sometimes”, and “almost every month” received a score of 1 while “no”, “never” and “prefer not to answer” received a score of 0. The total score consisted of summing all answers and ranged from 0–6. Scores 0 and 1 were considered high food security, 2 to 4 were considered low food security and 5 and 6 were classified as very low food security [11].

Data analysis

Google Sheets and SPSS^® version 28 were used for data management and analysis. Descriptive and inferential statistics were employed to analyze the results. Frequency and percent as well as mean, median, mode and standard deviation were used to describe results related to sociodemographic characteristics. The average knowledge score and standard deviation were calculated for the pretest and the posttest; then a one sample t-test was used to compare the mean score of the posttest with the mean score of the pretest. A p-value of less than 0.05 indicated significant results.

A total of five virtual sessions on antenatal nutrition were given by a licensed dietitian and attended by 91 participants. Ninety-one pretests and 67 post tests were filled. Participants’ sociodemographic characteristics are presented in Table 1. The mean age was 27 ± 5 years with a range of 18 to 41 years. Most attendees (96%) were Lebanese. Seventy-four percent of the participants were married. Among married women, around 78% were pregnant and 73% were pregnant with their first child. The mean pregnancy time was 22 ± 10.6 weeks. Almost half of the respondents had postgraduate degrees (45%) and a third (35%) had bachelor’s degrees. Moreover, 56% were employed or self-employed, 18% were students and 15% were housewives. Around half of participants resided in Mount Lebanon (48%) and a third were distributed between Beirut and Nabatieh (19% and 12% respectively). The rest of the participants (21%) were distributed among the other five governorates.

The mean weight, height and Body Mass Index (BMI) were 60 ± 13 kg, 163 ± 5 cm, and 22.4 ± 5 kg/m2 respectively. Sixty-five percent (65%) of the women had a normal BMI, 12% were underweight, 11% were overweight and 9% were obese.

Fifty nine percent of participants had previously received antenatal nutrition information, of which 27.5% were obtained from dietitians and 22% were obtained from the internet. The mean for food security status was 1 ± 1 point. Three quarters (74.7%) of the participants had high food security scores.

The mean scores for knowledge at pretest and posttest were 27 ± 6.5 and 37 ± 4.1 respectively and their difference was statistically significant (t=-31.6; p < 0.001). In the pretest, the lowest score was 6 and the maximum score was 39 ± 6.5 However, the lowest score in the posttest was 21 and the highest was 41 ± 4.1. The mean of “I do not know” answers before intervention and after intervention were 7.4 ± 7.9 and 0.6 ± 1.7 respectively. In relation to incorrect answers, pretest and posttest means were 6.7 ± 3.6; 3.6 ± 2.8 respectively.

Pretest scores were correlated with the sociodemographic characteristics, and it was found that higher pregnancy week was the only variable significantly associated with higher pretest scores (r = 0.296; p = 0.032).

Table 2 reflects the distribution of answers of participants in the pretest and in the posttest. The statement related to the recommended amount of caffeine consumption among pregnant women received the lowest percentage of correct answers (3%). However, in the posttest, this number improved and increased to 85% correct answers. On the other hand, 99% of answers were correct regarding nutrition affecting pregnancy outcomes, making it the highest percentage of correct answers at pretest.

In the food safety section, statements that received the lowest proportion of correct answers were related to storing raw meats in the fridge and washing poultry before cooking (34% and 45% respectively). Out of the 67 who filled the posttest, 90% answered correctly that raw meats should be stored in the bottom shelf and 91% answered correctly that poultry should not be washed. Also, participants recorded 96% correct answers that meat should be fully cooked before consumption. “Drinking fluids during mealtime may help with nausea” was the least knowledgeable information among participants at pretest, gathering 42% of “I do not know” answers. After the session, this proportion decreased to 4%. In the pretest, 49% correctly answered that “Baladi cheese” and “Ariche” may not be consumed during pregnancy. “Baladi cheese”, “Ariche” and “Shanklich” are dairy products mainly made with unpasteurized milk and thus should be avoided during pregnancy. Sixty-five percent of participants knew correctly that pregnant women cannot consume unpasteurized dairy products. In addition, only 34% knew that liver meat is not a good protein option for pregnant women. In the posttest, the proportion of correct answers in the “Baladi cheese” and “Ariche”, and liver meat statements was 90% and 85% respectively (Table 2).

Table 1

Sociodemographic Characteristics of Participants (n = 91)
Characteristic	Category	n (%)
Age	18–25 26–33 34–41	38 (42) 37 (41) 16 (17)
Nationality	Egyptian Jordanian Lebanese	1 (1) 3 (3) 87 (96)
Marital status	Married Never been married	24 (26) 67 (74)
Pregnancy status	Pregnant Not pregnant	52 (78) 15 (22)
Parity (n = 52)	Primiparous Multiparous	38 (73) 14 (27)
Education level	School, without a Baccalaureate Degree School, with a Baccalaureate Degree University, without a bachelor’s degree University, with a bachelor’s degree Postgraduate degree	1 (1) 3 (3) 14 (16) 32 (35) 41 (45)
Employment status	Unable to work Unemployed Self employed Housewife Student Employed	1 (1) 9 (10) 11 (12) 14 (15) 16 (18) 40 (44)
Residency (governorate)	Akkar North Lebanon Baalbeck-Hermel Bekaa South Lebanon Nabatieh Beirut Mount Lebanon	1 (2) 3 (3) 4 (4) 4 (4) 7 (8) 11 (12) 17 (19) 44 (48)

Table 2

Pretest and posttest distribution of survey answers
Statement		Pretest (n = 91)			Posttest (n = 67)
	Correct n (%)	Incorrect n (%)	Don’t know n (%)	Correct n (%)	Incorrect n (%)	Don’t know n (%)
Weight gain depends on preconception weight	48 (53)	20 (22)	23 (25)	60 (90)	7 (10)	0 (0)
Antenatal weight loss is safe.	46 (51)	21 (23)	24 (26)	62 (93)	4 (6)	1 (1)
Weight gained: only of the baby weight and fat	44 (48)	27 (30)	20 (22)	56 (84)	11 (16)	0 (0)
Caffeine:less than 400 mg per day	3 (3)	73 (80)	15 (16)	30 (45)	36 (54)	1 (1)
Full fat dairy: recommended	28 (31)	34 (37)	29 (32)	52 (78)	15 (22)	0 (0)
Processed meat is safe	30 (33)	43 (47)	18 (20)	29 (43)	38 (57)	0 (0)
One alcoholic drink per week is safe	57 (63)	19 (21)	15 (16)	63 (94)	3 (4)	1 (1)
Pasteurized milk is safe	63 (69)	3 (3)	25 (28)	67 (100)	0 (0)	0 (0)
Unpasteurized milk is safe	59 (65)	6 (7)	26 (28)	66 (99)	1 (1)	0 (0)
“Ariche” and baladi cheese are unsafe	44 (49)	26 (28)	21 (23)	60 (90)	5 (7)	2 (3)
All breads have the same nutritional value	54 (59)	21 (23)	16 (18)	56 (84)	10 (15)	1 (1)
All artificial sweeteners are safe	70 (77)	4 (4)	17 (19)	61 (91)	3 (4)	3 (4)
Energy drinks are safe	84 (92)	1 (1)	6 (7)	65 (97)	1 (1)	2 (2)
Liver meat is safe	31 (34)	34 (37)	26 (29)	57 (85)	8 (12)	2 (3)
Pasta, oats, and bulgur are proteins	53 (58)	27 (30)	11 (12)	52 (78)	14 (21)	1 (1)
Pregnant women are more immune to foodborne illnesses	58 (64)	4 (4)	29 (32)	60 (90)	6 (9)	1 (1)
Raw meats should be put in the bottom shelf in the fridge	31 (34)	27 (30)	33 (36)	61 (90)	7 (9)	2 (1)
Poultry should be washed	41 (45)	37 (41)	13 (14)	61 (91)	6 (9)	0 (0)
To thaw frozen food, you can put it on the counter overnight	71 (78)	7 (8)	13 (14)	64 (96)	2 (4)	2 (4)
Cooked food should be put in the fridge within 2 hours	63 (69)	18 (20)	10 (11)	63 (95)	3 (4)	1 (1)
Fresh fruit juices are safe	65 (71)	17 (19)	9 (10)	65 (97)	2 (3)	0 (0)
Meats should be fully cooked	87 (96)	2 (2)	2 (2)	66 (99)	0 (0)	1 (1)
Toxoplasma Gondii is a parasite	60 (66)	4 (4)	27 (30)	66 (99)	1 (1)	0 (0)
Managing heartburn: eating three large meals per day	51 (56)	23 (25)	17 (19)	56 (84)	9 (13)	2 (3)
Skipping breakfast will help reduce morning sickness	80 (88)	0 (0)	11 (12)	63 (94)	2 (3)	2 (3)
Ginger helps ease down nausea	46 (50)	19 (21)	26 (29)	58 (87)	6 (9)	6 (9)
Wearing tight clothing will increase the risk of heartburn	34 (37)	23 (25)	34 (37)	59 (87)	7 (9)	7 (9)
Elevating the bed can prevent heartburns	54 (59)	8 (9)	29 (32)	57 (85)	6 (9)	6 (9)
Consuming chocolate, may increase the risk of heartburn	42 (46)	18 (20)	31 (34)	60 (90)	5 (7)	5 (7)
Physical activity may help prevent constipation	79 (87)	4 (4)	8 (9)	66 (99)	0 (0)	0 (0)
Drinking fluids during mealtime may help with nausea	32 (35)	21 (23)	38 (42)	52 (78)	12 (18)	12 (18)
Drinking water may help prevent constipation	81 (89)	2 (2)	8 (9)	65 (97)	2 (3)	2 (3)
It is best to consume whole grains to prevent constipation	60 (66)	7 (8)	24 (26)	64 (96)	2 (3)	2 (3)

The study population consisted of adult women aged between 18 and 41 years and included a diversity of married and unmarried, as well as pregnant and non-pregnant women. Results showed that most of the participants (80%) held at least one university degree. This differs from other studies where the majority of participants had finished primary education [12] or high school [4]. More than half (56%) of the participants in this study were employed or self-employed while only 15% were housewives. This differed as well from other studies: results from Zelalem showed that 68% of their participants were housewives and 21% had other occupations [12]. The study sample also differed in terms of sources of previously acquired information on the topic of antenatal nutrition [12]. The main source of previous information in this study was dietitians (27.5%) with physicians, nurses, and midwives accounting for 8.7% of answers. However, doctors and nurses were the source of information in both Aktac and Zelalem making up 52% and 59% respectively [4, 12]. This may be indicative that dietitians in Lebanon are more involved in pregnant women’s nutritional health than other healthcare practitioners.

As for their BMI, results of this study were consistent with Aktac as over half of participants were at a healthy BMI (58.4%).

Knowledge of pregnant women on antenatal nutrition improved significantly, from 64–91% after the provision of nutrition education sessions. Results of this study are higher than those found by Zelalem where baseline knowledge of pregnant women on nutrition during pregnancy was 53.9%.

It was imperative to assess the study’s participants’ knowledge on certain high-risk nutritional practices, namely consumption of alcohol, unpasteurized dairy, energy drinks, and undercooked meat products. In relation to the following statement “Pregnant women can enjoy one alcoholic drink per week”, 63% answered correctly. While explaining about alcohol and its effect on pregnancy outcomes, several participants stated that their gynecologist allowed them to have one alcoholic drink occasionally during their pregnancy. In the posttest group, 94% answered this statement correctly.

In the food safety section, less than half of the participants correctly answered statements related to storing raw meats in the fridge and washing poultry before cooking. Recent studies in Lebanon documented prevalence of food contamination in households with different pathogens, which highlights the importance of tackling safe storage, preparation, and food safety among pregnant women in the country [13]. During the sessions, the food safety section covered essential topics on safe food storage and handling in households, that pregnant women should know about and apply in order to avoid food poisoning. There was resistance by some participants to agree with the statement that poultry should not be washed before cooking. Hence, this section was explained using evidence-based knowledge and visuals to persuade participants of the risk of washing poultry. Given the health risks associated with washing poultry, it was imperative that women’s knowledge regarding this topic was 91% at posttest compared to 45% at pretest.

The section that included statements on nutritional management of pregnancy complications had the highest percentage of “I do not know” answers, with an average of 24% in the pretest. This shows that women lacked nutritional knowledge that may help them alleviate pregnancy symptoms and improve the quality of the overall quality of their day and pregnancy experience.

Food security results showed that around 75% of participants had food security. The economic situation in Lebanon altered considerably in year 2020 when start of the economic crisis, exacerbated by the occurrence of the COVID-19 pandemic and the Beirut Port explosion, impacted all population groups. The ongoing depreciation of the Lebanese pound is making purchasing abilities more challenging for Lebanese households. Access, prices, and food availability remain a significant issue for most households [14]. This shows that the study sample may mirror Lebanese households in terms of food security status.

Data for the posttest was collected directly after the end of each session, hence results reflected immediate impact of the education provided. Teweldemedhin also assessed the immediate impact of their antenatal nutrition education and found that the mean knowledge scores significantly improved [15]. However, scores declined from immediate after intervention to sixth week follow-up by 1.79 (SE = 0.22). Although the score declined, knowledge at sixth week follow-up was still significantly greater than that of pre-intervention [15].

The study provided valuable insight on the effect of proper evidence base education and the improvement of antenatal nutrition knowledge, which may lead to improved practices and elevated overall maternal and child health. To the researcher’s knowledge, this is the only study that covered food safety as part of the education sessions. Adding more to its strengths, the intervention was culture-specific and was developed in accordance with the Lebanese diet and traditions, thereby providing direct benefit to participants and breaking common misconceptions about pregnancy and certain traditional foods. The addition of an “I do not know” option allowed the researchers to have a clear view about what participants knew about antenatal nutrition before the intervention and if this knowledge improved or not. By doing so, researchers had more insights on participants’ knowledge before and after the intervention, whether it is acquisition of information they did not know before or correction of wrong information.

A particular limitation of this study is the posttest response rate, reducing the number of data collected after the intervention. When pretests were sent to participants, it was explained that the survey will be followed by a posttest, and two reminders were sent after they received the posttest. This limitation may be attributed to the online nature of the intervention. Another limitation is the lack of matching between the pretest and the posttest thereby not allowing researchers to perform longitudinal analysis. Surveys were anonymous and collected online, making it difficult to match pretests with posttests. In order to adjust for this, one sample t-test was used to compare post-test score mean to the pretest mean, that was considered to threshold.

Future cohort studies may aim to follow up with pregnant participants and assess their practices and evaluate whether they are practicing the knowledge that they acquired from the sessions. Furthermore, national scale campaigns may aim to reach a larger part of the population and provide them with the needed information to have a healthy pregnancy with minimal risks related to behavior. Moreover, and since behavior change requires the participation of a multidisciplinary team with a unified knowledge and beliefs, it is crucial to conduct a similar study with healthcare professionals as participants.

Even though the knowledge questions were tailored for the purpose of this study and may not be compared with other studies, scores and observations made during the sessions allowed to make important deductions. More effort should be directed towards providing women of childbearing age with proper evidence-based information on preconception nutrition and antenatal nutrition. In addition, studies should be done to assess knowledge of healthcare providers on the topic of prenatal nutrition.

Nutrition education is a cornerstone of antenatal care for all women during pregnancy, and it is a topic that requires further attention from healthcare providers and public health practitioners. Women should receive appropriate evidence based nutritional and food safety information in both the preconception and the antenatal periods. This study responds to the need for improving maternal knowledge and practices on nutrition as a strategy to enhance their health and the health and development of future generations.

LBW: low birth weight

KAP: knowledge, attitude, and practices.

BMI: body mass index

Ethics approval and consent to participate.

A written informed consent was obtained from participants before entering the study. Participants were informed about the study; their participation was voluntary, and they had the right to withdraw at any moment. The study protocol was reviewed and approved by the scientific committee of the Saint George Hospital University Medical Center (study No. 10-2021).

Consent for publication

Not applicable.

Availability of data and materials

The data that support the findings of this study are not publicly available due to confidentiality of the participants but are available from the corresponding author [DD] upon reasonable request.

Competing interests

The authors have no conflicts of interest to declare.

Funding

There was no funding attributed to this study.

Authors' contributions

DD is the principal investigator of the project.

CC is the student who was assigned to the project, she did the literature review, the method, the intervention and wrote the manuscript.

JSY handled the statistical analysis of the results and guided CC through the interpretation of the results.

Authors' information

University Of Balamand, Faculty of Health Sciences, Department of Nutritional Sciences, Beirut Lebanon.

Saint Joseph University of Beirut, Higher Institute of Public Health, Lebanon.

Acknowledgment

Not applicable

Fallah F, Pourabbas A, Delpisheh A, Veisani Y, Shadnoush M: Effects of nutrition education on levels of nutritional awareness of pregnant women in Western Iran. International Journal of Endocrinology and Metabolism 2013, 11(3):175.
American College of
Obstetricians and Gynecologists. [https://www.acog.org/womens-health/faqs/nutrition-during-
pregnancy#:~:text=During%20pregnanc
y%20you%20need%20folic,below%20table%20for%20recommended%20a
mounts.&text=Fortified%20cereal%2C%20enriched%20br
ead%20and,vegetables%2C%20orange%20juice%2C%20beans.]
Blondin JH, LoGiudice JA: Pregnant women's knowledge and awareness of nutrition. Applied Nursing Research 2018, 39:167-174.
Aktaç S, Sabuncular G, Kargin D, Gunes FE: Evaluation of Nutrition Knowledge of Pregnant Women before and after Nutrition Education according to Sociodemographic Characteristics. Ecol Food Nutr 2018, 57(6):441-455.
Girard AW, Olude O: Nutrition education and counselling provided during pregnancy: effects on maternal, neonatal and child health outcomes. Paediatric and perinatal epidemiology 2012, 26:191-204.
Harb D, Abou Haidar M, Bou Yazbek E: Knowledge, attitude and practices toward nutrition and diet during pregnancy among recently delivered women of Syrian refugees. Journal of Refugee and Global Health 2018, 1(2):32-37.
Mahan K, Raymond J: Krause's food and the nutrition care process. Elsevier; 2017.
Meija L, Rezeberga D: Proper maternal nutrition during pregnancy planning and pregnancy: a healthy Start in life recommendations for health care professionals. World Health Organization 2017, 1-31.
Centers for Disease Control and Prevention. [https://www.cdc.gov/preconception/planning.html.]
U.S food and drug administration: Food safety for pregnant women, their unborn babies, and children under five. U.S food and drug administration 2017, 1-17.
Economic research service. [https://www.ers.usda.gov/media/8282/short2012.pdf]
Zelalem A, Endeshaw M, Ayenew M, Shiferaw S, Yirgu R: Effect of nutrition education on pregnancy specific nutrition knowledge and
healthy dietary practice among pregnant women in Addis Ababa. Clinics Mother Child Health 2017, 14(3).
Naja F, Nasreddine L, Al Thani AA, Yunis K, Clinton M, Nassar A, et al: Study protocol: Mother and Infant Nutritional Assessment (MINA) cohort study in Qatar and Lebanon. BMC pregnancy and childbirth 2016, 16(1):98.
Food Security Cluster. [https://fscluster.org/sites/default/files/documents/fsswg_dashboard_erp_final.pdf]
Teweldemedhin LG, Amanuel HG, Berhe SA, Gebreyohans G, Tsige Z, Habte E: Effect of nutrition education by health professionals on pregnancy-specific nutrition knowledge and healthy dietary practice among pregnant women in Asmara, Eritrea: a quasi-experimental study. BMJ Nutrition, Prevention & Health 2021, 4(1):181-194.

No competing interests reported.

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Assessing the Impact of Nutrition Education on Antenatal Nutrition Knowledge of Women in Lebanon: an Interventional Study

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Abstract

Background

Method

Results

Conclusion

Introduction

Method

Study design and population

Ethical considerations

Study procedure

Pre and post tests

Data analysis

Results

Discussion

Abbreviations

Declarations

References

Additional Declarations

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