Dietary diversity and associated factors among pregnant women in Ethiopia: a systematic review with meta-analysis.

Background: Dietary diversity (DD) is the consumption of a variety of different and healthy foods that promote an adequate supply of nutrients, a high-quality diet, and the maintenance of optimal health. It is critical to identify the factors that influence pregnant women's eating habits so that relevant interventions can be developed. We estimated the pooled odds ratio of appropriate dietary practices to identify factors that affect the dietary practices of pregnant women. Methods: We conducted an electronic-based systematic search for observational studies conducted in Ethiopia and published in English. We retrieved published articles up to the last search date on 1 July 2022, from databases, including the Web of Science, PubMed, EMBASE, Cochrane library, CINHAL, and HINARI. Grey literature was included from Google and Google scholar searches. The measure of effect was a pooled odds ratio examining the association between the risk factors and adequate dietary diversity among pregnant women. The Cochran's-Q statistic and I2 statistic tests with corresponding P-values were used to determine the existence of heterogeneity between studies. Publication bias was tested using a funnel plot of symmetry and further investigated using Egger and Begg tests. The results were presented using forest plots, funnel plots, tables, and figures. Results: We included 29 articles with maximum and minimum sample sizes of 759 and 241, respectively. Among the included articles, 13 were facility-based cross-sectional studies;16 studies were community-based cross-sectional studies. The pooled proportion of adequate DD was 42.48% (95% confidence interval (CI) = 31.82, 53.14). Knowledge of DD (OR = 3.10; 95% CI = 1.92, 4.99), income (OR = 0.35; 95% CI = 0.14, 0.85), and nutritional information (OR = 1.91; 95% CI = 1.15, 3.17) were predictors for adequate DD practice among pregnant women. Conclusions: The pooled proportion of adequate DD among pregnant women was low. Knowledge of DD, household income, and nutritional information were associated factors with the adequate dietary diversity of pregnant women. We recommend focusing on interventions that will enhance the knowledge of dietary diversity through improved nutritional awareness and enhance access to food resources through existing maternal health initiatives. Registration: PROSPERO: CRD42022298172.