Nutrition education plays a crucial role in improving the nutritional status of pregnant women, yet evidence of its impact in low-income settings like Ethiopia is limited. This study evaluated the effectiveness of facility-based nutrition education and counseling on pregnant women’s knowledge, dietary practices, and Fe-folic acid supplement use.

A cluster randomised controlled trial was conducted in Addis Ababa, Ethiopia, involving 683 pregnant women across twenty health centres assigned to intervention or control groups. Antenatal care providers in the intervention group received training on pregnancy nutrition and counseling, while the control group continued standard care per national guidelines. A total of 683 pregnant women were enrolled during their first and second antenatal care (ANC) visits. Mixed-effects linear regression was used to evaluate outcomes.

The study was conducted in Addis Ababa, Ethiopia, from August to December 2017.

Pregnant women attending ANC follow-ups and healthcare providers working in ANC units.

The intervention group demonstrated significant improvements in knowledge, including iodised salt use (difference-in-differences (DID) 23 %), correct Fe-folic acid supplementation duration (DID 68 %) and the need for additional meals during pregnancy (DID 49·9 %). Dietary practices improved with higher dietary diversity (DID 32·3 %), increased dairy consumption (MD 1·2 v. –0·1; DID 1·2 per week) and higher Fe-folic acid supplementation (MD 4·9 v. 1·6; DID 3·2 per week).

Nutrition education and counseling during ANC visits significantly improved pregnant women’s knowledge and dietary practices. Integrating and strengthening these interventions into routine ANC services could effectively enhance dietary intake and health outcomes.