A total of 397 pregnant women were included in the study. The mean age was 28.4 ± 5 years (range: 17 - 44 years). Women aged 20 - 30 years accounted for 62.5% of the participants. The vast majority were married (74.5%) and lived in urban areas (94.5%). Secondary education was the most common educational level (44.6%), followed by primary education (24.7%) and higher education (21.6%). Trading was the main occupation for 33.0% of the women, followed by handicrafts (19.6%) and civil service employment (18.9%) (Table 3).

Table 3.Sociodemographic characteristics of the surveyed pregnant women at Parakou in 2025.

Paucigravidae accounted for 46.4% of the participants, followed by multigravidae (29.5%) and primigravidae (24.2%). A similar pattern was observed for parity, with a predominance of pauciparous women (46.1%). The mean number of antenatal care (ANC) visits was 4.75 ± 2.5: 65.0% of pregnant women had attended 4 to 9 ANC visits, whereas only 32.7% had attended 1 to 3 visits. One-quarter of the women (25.7%) had received nutritional counseling during antenatal care, and 46.6% were taking iron and folic acid supplementation at the time of the survey. Healthcare workers were the main source of nutritional information (60.2%), followed by social media and the internet (48.4%), and family members (37.8%) (Table 4).

Table 4.Antenatal care and access to nutritional information among the pregnant women surveyed at Parakou in 2025.

Regarding the first domain, 77.8% of pregnant women recognized that nutritional requirements increase during pregnancy. The main objectives of a balanced diet identified by the participants were fetal development (78.8%) and maintenance of maternal health (78.6%), whereas prevention of anemia and congenital anomalies was mentioned by only 33.3% of women. Regarding meal frequency, 39.3% recommended four to five meals or food intakes per day, while 35.3% recommended three meals with a snack, corresponding to a total of 74.6% of adequate responses. The recommendation for daily fluid intake (1.5 - 2 liters of water) was known by 76.1% of participants.

Fruits and vegetables were the most frequently identified food group (82.9%), followed by cereals and tubers (66.8%), dairy products (47.6%), and meat, fish, and eggs (46.9%). Fats and oils were mentioned by only 12.6% of women. Regarding foods that are sources of micronutrients, 42.1% identified poultry liver as an iron-rich food, 32.0% identified legumes, and only 23.7% identified moringa, a local food particularly rich in iron, calcium, and vitamins. More than one-third of pregnant women (33.5%) reported that they did not know of any food specifically rich in iron, calcium, or folic acid (Table 5).

Table 5.Knowledge of food groups and key nutrients during pregnancy at Parakou in 2025.

Among foods recommended during pregnancy, leafy green vegetables (73.8%) and fresh fruits (68.8%) were the most commonly identified, whereas animal protein sources were less frequently mentioned: fish or lean meat (38.3%), eggs (33.3%), and milk (27.7%). Regarding foods to avoid, alcohol (83.4%) and excessive coffee consumption (81.4%) were widely recognized, whereas the risks associated with raw or unpasteurized products were considerably less well known: raw meat (32.5%), unpasteurized milk (26.2%), and raw or smoked fish (22.9%).

The maternal consequences of malnutrition most commonly recognized were anemia (74.3%) and fatigue (42.8%), whereas difficult labor was mentioned by only 37.0% of women. Regarding fetal consequences, low birth weight (64.0%) and congenital anomalies (62.0%) were frequently mentioned, but intrauterine growth restriction was recognized by only 28.7% of pregnant women. With regard to local dietary practices, 38.0% of women reported that they did not know of any local nutrient-rich food. Knowledge of the consequences of fasting and dietary restrictions during pregnancy was incomplete in nearly one-third of participants.

Assessment by domain showed contrasting results. Pregnant women demonstrated an acceptable level of knowledge regarding general nutritional requirements (86.7% with an acceptable level) and the risks of malnutrition (85.9%). Conversely, knowledge of local dietary practices (53.9% with a low level) and foods to consume or avoid (53.4% with a low level) showed the most substantial deficits (Table 6).

Table 6.Distribution of knowledge level by thematic domain at Parakou in 2025.

Overall assessment of nutritional knowledge showed that 45.4% of pregnant women had poor knowledge (lack of knowledge), while 28.7% had an inadequate level of knowledge. The overall prevalence of inadequate knowledge of nutritional requirements was therefore 45.4% (95% CI: 40.6% - 50.3%). In other words, nearly one in two pregnant women in Parakou did not have adequate knowledge of pregnancy-specific nutritional recommendations (Table 7).

Table 7.Overall distribution of nutritional knowledge levels among pregnant women at Parakou in 2025.

The sociodemographic profile of the pregnant women included in our study indicates a predominantly young population (mean age: 28.4 ± 5 years), mostly married (74.5%) and living in urban areas (94.5%), with secondary education being the most common educational level (44.6%). This profile is consistent with that described by Demisew et al. in 2024 [6] in the Minjar Shenkora district of Ethiopia, identified education as a major determinant of nutritional knowledge. Similarly, Seif in 2025 [12], in a study conducted in Tanzania, reported that the predominant age group was 25 - 34 years (46.4%), which was comparable to our cohort. However, the educational profile observed in our study remains concerning: nearly one-third of pregnant women (33.8%) had only primary education or no formal education, which is consistent with the profile of low-income populations described by Marian et al. in 2025 [13] in the cities of Oaxaca, Mexico, where maternal education strongly influences dietary practices during pregnancy.

The obstetric profile, characterized predominantly by paucigravidas (46.4%) and pauciparas (46.1%), is consistent with profiles observed in comparable African settings, particularly in the study by Mudasir et al. in 2024 [8] in southwestern Ethiopia. The mean number of antenatal care (ANC) visits was 4.75 ± 2.5, with 65.0% of pregnant women attending 4 - 9 ANC visits. This finding reflects a relative improvement in access to antenatal care, in accordance with current WHO recommendations, but remains insufficient given that nearly one-third of women (32.7%) attended only 1 - 3 ANC visits. Merga et al. in 2025 [14], in a case-control study conducted in Bule Hora, Ethiopia, demonstrated that having ≥4 ANC visits increased the likelihood of adherence to iron and folic acid supplementation by 7.84-fold (95% CI: 3.34 - 18.41), highlighting the critical importance of optimal use of antenatal care services.

A concerning finding emerged from our study: only 25.7% of pregnant women had received nutritional counseling, and only 46.6% were actually taking iron and folic acid supplements. These figures are similar to those reported by Mabuza et al. in 2021 [15] in Eswatini, where optimal iron-folic acid consumption during the first trimester was only 10.3%, increasing to 37% - 40% during subsequent trimesters. The low proportion of pregnant women receiving nutritional counseling is also consistent with findings reported by Jackson et al. in 2025 [16] in the United States, where only 49.8% of women surveyed recalled receiving nutritional advice during pregnancy. This gap in nutritional counseling has direct consequences: Olloqui-Mundet et al. in 2024 [17], in a systematic review of 68 original articles, identified the lack of structured nutrition education as the main barrier to adopting healthy dietary practices during pregnancy, largely attributing this gap to inadequate planning of nutrition education by healthcare providers. The main sources of nutritional information in our study-healthcare providers (60.2%), followed by social media and the internet (48.4%), and family members (37.8%)-reflect a pattern documented globally. Zhang et al. in 2024 [18][19], in Tianjin, China, reported a similar proportion of pregnant women (72.11%) who preferred to obtain nutritional information from healthcare professionals. Jamal et al. in 2025 [20] found in Lebanon that 73.5% of pregnant women used the internet, particularly Google, to obtain information about nutrition and recommended dietary supplements. However, Marian et al. in 2025 [13] emphasized in their qualitative study in Mexico that female family members often constitute a primary source of nutritional knowledge, which may transmit information that is sometimes inadequate or inconsistent with clinical recommendations. The gap between easy access to information (33.8%) and difficult or no access (16.6%) in our cohort reflects a concerning inequality in access to educational resources.

With 77.8% of pregnant women recognizing that nutritional requirements increase during pregnancy and 86.7% achieving an acceptable knowledge level in this domain, our participants demonstrated a relatively satisfactory foundation of general nutritional knowledge. This finding is consistent with that reported by Nawabi et al. in 2022 [21][22], in which more than 85% of pregnant women correctly answered most general questions regarding lifestyle during pregnancy. Similarly, Olloqui-Mundet et al. in 2024 [17] concluded that most pregnant women are aware of the importance of nutrition during pregnancy, although this awareness does not always translate into appropriate behaviors.

However, this apparently satisfactory level of general knowledge masks substantial gaps. Although 78.8% of pregnant women identified fetal development as an objective of a balanced diet, only 33.3% mentioned the prevention of anemia and congenital anomalies. Kostecka et al. in 2022 [23], in a Polish study involving 325 respondents, also identified major gaps regarding the relationship between maternal weight and fetal development. Estrada et al. in 2026 [24], in an assessment of 894 students, reported a mean pregnancy nutrition knowledge score of only 34/100, with particularly important gaps regarding energy requirements during the first trimester, for which only 6% of participants provided correct answers. This discrepancy between general awareness and specific knowledge represents a major challenge for educational interventions.

Although 82.9% of pregnant women identified fruits and vegetables as an essential food group, substantial gaps were observed regarding critical micronutrient sources. Only 42.1% identified poultry liver as an iron-rich food, 32.0% identified legumes, and, particularly concerning, only 23.7% identified moringa, a local food in Benin recognized for its high content of iron, calcium, and vitamins. Even more concerning, 33.5% of pregnant women reported that they did not know of any food rich in iron, calcium, or folic acid.

This lack of knowledge regarding micronutrients is consistent with several previous studies. Rizk et al. in 2024 [7], in Lebanon, showed that among five domains of nutritional knowledge assessed in 410 pregnant women, the lowest scores concerned the importance of iodine and omega-3 fatty acids (28.4%), as well as listeriosis contamination (45.9%). Similarly, Estrada et al. in 2026 [24] reported that only 9% of respondents correctly identified iodine recommendations. Nakkeeran et al. in 2025 [25], in a questionnaire-based study conducted in India, reported an even more striking finding: only 11% of pregnant women surveyed were aware of the benefits of folic acid, and 52% were not taking supplements during the first two trimesters. This lack of knowledge regarding locally available micronutrient-rich foods, particularly moringa in the Beninese context, is consistent with observations by Uwase et al. in 2024 [26] in Rwanda, where despite the availability of nutritious local foods, only 44.1% of pregnant women achieved adequate dietary diversity, with nutritional knowledge score being an independent predictor (adjusted OR = 1.45; 95% CI: 1.21 - 1.74).

This domain represents one of the major weaknesses identified in our study, with 53.4% of pregnant women having a low level of knowledge. Although foods to avoid during pregnancy were relatively well identified in relation to alcohol (83.4%) and excessive coffee consumption (81.4%), the risks associated with raw or unpasteurized products remained largely unknown: raw meat (32.5%), unpasteurized milk (26.2%), and raw or smoked fish (22.9%). This finding is not isolated. Rizk et al. in 2024 [7] reported in Lebanon that fewer than half of pregnant women (47.8%) were able to identify the types of fish considered safest to consume during pregnancy. Similarly, Estrada et al. in 2026 [24] in California reported that knowledge of recommendations concerning alcohol was relatively well established, whereas knowledge of other dietary recommendations remained limited. This asymmetry in knowledge suggests that public health messages addressing certain topics, such as alcohol and tobacco, may have been more effectively disseminated, whereas other dietary recommendations remain insufficiently communicated. Regarding recommended animal protein sources, these were insufficiently identified in our study: fish or lean meat (38.3%), eggs (33.3%), and milk (27.7%). This finding is consistent with that reported by Uwase et al. in 2024 [26] in Rwanda, where eggs (16.4%) and dairy products (18.5%) were among the least frequently consumed food groups. Similar findings were reported by Seif in 2025 [12] in Tanzania, who identified substantial barriers related to the availability and cost of iron-rich foods such as eggs and dairy products.

Assessment of knowledge regarding the risks of malnutrition revealed an overall acceptable level (85.9%), with anemia (74.3%) and low birth weight (64.0%) being the most frequently cited consequences. However, intrauterine growth restriction was recognized by only 28.7% of pregnant women, and difficult labor by only 37.0%. Dutta et al. in 2023 [27], in their review of anemia during pregnancy in India, emphasized that inadequate intake of essential nutrients remains common among pregnant women in low- and middle-income countries, contributing to high maternal and infant mortality rates and underscoring the importance of raising awareness among pregnant women about the consequences of malnutrition.

The domain of local dietary practices showed the greatest deficit, with 53.9% of women having a low level of knowledge and 38.0% reporting that they did not know of any local nutrient-rich food. This limited recognition of nutritious local foods represents an important educational opportunity. Eyasu et al. in 2022 [10], in a qualitative study conducted in rural areas of Ofla Woreda in northern Ethiopia, identified multiple misconceptions about foods during pregnancy, including avoidance of animal-source foods such as eggs, which were perceived as causing “large babies” and consequently difficult deliveries. Kumsa et al. in 2026 [11], in Jimma, southwestern Ethiopia, confirmed that pregnant women do not necessarily modify their diets to meet nutritional requirements but instead adjust their food intake according to cultural taboos, aversions, and cravings. These taboos are perpetuated through intergenerational transmission and social learning. Alamirew et al. in 2023 [28], in the Amhara region of Ethiopia, reported that only 26.8% of women of reproductive age consumed five or more food groups per day (MDD-W), with cultural beliefs representing a significant community-level determinant. Although our study did not qualitatively investigate these taboos, the low level of knowledge regarding nutritious local foods suggests their possible presence and warrants further investigation.

The most striking finding of our study was the overall prevalence of inadequate knowledge regarding nutritional requirements, which reached 45.4% (95% CI: 40.6% - 50.3%), corresponding to nearly one in two pregnant women. When the 28.7% of women with an inadequate level of knowledge are also considered, 74.1% of pregnant women in Parakou had an inadequate overall level of nutritional knowledge. This finding is consistent with the conclusions of the scoping review by Oladebo et al. in 2025 [5], which, based on 11 included studies, concluded that nutritional knowledge and literacy among pregnant women were generally low, with education and income being the most influential determinants. Demisew et al. in 2024 [6] reported an even higher proportion of women with inadequate knowledge (69.2%) in the Minjar Shenkora district of Ethiopia, with a significant association between educational level and access to nutritional information. Beyond the African context, Khair et al. in 2023 [29] in the United Arab Emirates also documented substantial gaps among 526 pregnant women regarding appropriate gestational weight gain and complications associated with overweight and obesity.

The near absence of a good level of knowledge in our cohort (only 4.5%) warrants attention. Several hypotheses may help explain this finding. First, the low proportion of women receiving nutritional counseling (25.7%) deprives the majority of pregnant women of a professional source of information. Olloqui-Mundet et al. in 2024 [17] suggested that inadequate nutritional knowledge among pregnant women may be partly related to poorly planned nutrition education by healthcare providers. Second, as demonstrated by Katenga-Kaunda et al. in 2021 [9] in Malawi through a randomized controlled trial, additional nutrition education interventions and tailored dietary counseling significantly improve nutritional knowledge, dietary diversity, and nutritional behaviors during pregnancy. Finally, difficult or no access to nutritional information among 16.6% of our participants may further contribute to inequalities in health learning.

The main strength of this study lies in the rigor of its design: proportional stratified sampling ensuring representation across study centers, a pretested questionnaire administered face-to-face by the principal investigator, a standardized assessment tool consisting of 14 operational items scored out of 25 points, and double quality checks of the collected data. The use of a multidimensional composite score provides a nuanced assessment of nutritional knowledge beyond simple self-reported knowledge.

The main limitations are as follows. First, the cross-sectional design does not allow temporal relationships between potential determinants and knowledge level to be established. Second, self-reported responses are susceptible to social desirability bias, as participants may tend to provide answers they believe are expected rather than reflecting their actual knowledge. Third, the high proportion of urban residents (94.5%) limits the generalizability of the findings to all pregnant women in the Borgou-Alibori region, where a substantial proportion of the population lives in rural areas. Finally, the use of a single assessor, although ensuring consistency in data collection, did not allow inter-rater reliability to be assessed.