Sources of dietary recommendations and adherence to clinical guidelines in pregnant women in Germany

Abstract

Background: Nutrition during pregnancy affects the health of both the mother and the child with potential long-term consequences. Consequently, educating pregnant women about recommended nutritional practices is essential. This cross-sectional study examined dietary information sources used by pregnant women in Germany and evaluated their adherence to clinical guidelines.

Methods: Pregnant women (≥ 6th week of gestation) were recruited nationwide via social media (January–June 2022), and completed an online questionnaire assessing sources and content of their nutritional information. The data were subsequently analyzed for their alignment with guidelines provided by the Germany-wide Healthy Start Network of the Federal Center for Nutrition and the German Nutrition Society. Chi-square and t-tests were used to explore associations, and multivariable logistic regression was conducted to identify significant predictors of supplement use and dietary practices, considering sociodemographic and behavioral factors.

Results: Of 3,363 participants, 68.66% reported dietary changes during pregnancy, yet 82.76% received limited or no counseling from healthcare providers. Most women (77.70%) sought information online. While 89.03% took dietary supplements, this percentage was significantly higher among pregnant women with higher income (OR = 1.55, CI 1.18–2.03, p < 0.001) and higher educational levels (OR = 1.47, CI 1.15–1.88, p = 0.001). Although most of the women (87.87%) supplemented with folic acid, only 66.10% supplemented with iodine. However, when considering dosage and supplementation period, at least 37.08% of women for folic acid and 46.06% for iodine did not meet recommendations or did not supplement at all.

Conclusions: While recommendations to avoid specific foods and to take a folic acid supplement are widely recognized, the dietary practices of pregnant women frequently deviate from professional guidelines. These results emphasize the importance of targeted education and standardized counseling by qualified professionals to ensure optimal nutrition during pregnancy and reduce potential risks to both mother and child. Future research should identify strategies to effectively address these problems.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12884-025-08228-1.

Keywords: Dietary counseling; Fetal health; Health information sources; Maternal nutrition; Nutrition guideline adherence; Nutrition guidelines; Nutritional recommendations; Pregnancy; Prenatal care; Social media.

Fig. 1

Proportion of participants (n = 2,333) receiving dietary counseling from different health care provider types. Multiple responses were possible

Fig. 2

Various online and offline sources used by the participants to obtain nutritional information. Multiple responses were allowed. Percentages are relative to the total sample (n = 3,363)

Fig. 3

Number of evidence-based avoided foods among participants with (n = 2762) and without (n = 601) midwife care. Participants receiving midwife care showed significantly more evidence-based avoidance than those without (p < 0.001)

Fig. 4

Percentage of participants avoiding foods not recommended for complete abstinence according to guidelines (n = 3,363). Multiple responses were possible

Fig. 5

Multivariable associations of sociodemographic and counseling factors with maternal dietary restrictions for allergy prevention. ORs and 95% CIs are presented (n = 3,363)

Fig. 6

Sociodemographic, behavioral, and counseling predictors of prenatal supplement intake. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs) (n = 3,363)

Fig. 7

Percentage of participants supplementing with folic acid, categorized by supplementation status: no supplementation (n = 408), unknown dosage (n = 747), insufficient dosage (n = 839), and recommended dosage (n = 1,369)

Fig. 8

Sociodemographic, behavioral, and counseling predictors of recommended folic acid intake during pregnancy. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs) (n = 3,363)

Fig. 9

Percentage of participants supplementing with iodine, categorized by supplementation status: no supplementation (n = 1,140), unknown dosage (n = 504), insufficient dosage (n = 409), and recommended dosage (n = 1,310)

Fig. 10

Factors associated with iodine supplement intake in pregnancy. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs) (n = 3,363)