Comparative analysis of maternal nutritional status, dietary intake, and nutrition-related KAP among urban and rural pregnant women in Delhi

Background: Maternal nutrition plays a crucial role in determining pregnancy outcomes; however, India continues to experience a dual burden of malnutrition, with persistent undernutrition in rural areas and rising overweight in urban populations. This study aimed to compare the nutritional status, dietary intake, and nutrition-related knowledge, attitudes, and practices (KAP) among urban and rural pregnant women in Delhi. Methods: A cross-sectional survey was conducted in 2020 among 100 third-trimester pregnant women (50 urban and 50 rural) in West Delhi. Sociodemographic data, anthropometric measurements, dietary intake (24-hour recall), and KAP were collected using a structured questionnaire. Nutritional status was assessed using body mass index (BMI) based on World Health Organization (WHO) criteria and gestational weight gain according to Institute of Medicine (IOM) guidelines. Dietary adequacy was evaluated against the Indian Council of Medical Research (ICMR, 2020) Recommended Dietary Allowances (RDAs). Group differences were analyzed using independent t tests and Chi-square (χ 2 ) tests. Results: Urban women had a higher prevalence of overweight (20%) and no undernutrition, whereas 28% of rural women were underweight. Both groups demonstrated low mean gestational weight gain (~5.3 kg) and inadequate dietary intake, with energy and key micronutrients such as iron (~20 mg/d) and calcium (~715 mg/d) falling below RDA recommendations. Urban women exhibited significantly better nutrition practices (56% vs . 44%) and more positive attitudes (54% vs . 48%) compared to rural women ( P < 0.05), while knowledge scores were similar across groups. Among rural participants, age and education were significantly associated with KAP outcomes. Conclusions: The findings highlight a dual burden of malnutrition and widespread nutrient inadequacy among both urban and rural pregnant women. Despite moderate levels of knowledge and attitudes, nutrition practices remain suboptimal. Strengthened, context-specific antenatal nutrition education—particularly in rural settings—is urgently needed to improve maternal nutritional status and pregnancy outcomes.