The Effect of Nutrition Counselling Intervention on Fruit and Vegetable Consumption and Its Association with Gestational Hypertension and Some Biochemical Parameters among Pregnant Women Attending Health Facilities in Accra, Ghana.

Abstract

Background: Gestational hypertension (GH) is a global health issue. Often, Pharmacological interventions manage symptoms, but overlook underlying dietary and lifestyle factors, necessitating complementary behavioural nutrition counselling. Objective: To assess the effectiveness of nutrition counselling intervention in promoting fruit and vegetable consumption among pregnant women with or without GH attending government clinics in the La Dadekotopon and Ledzokuku-Krowor municipalities, Accra, Ghana. Methods: A two-arm, matched-pairs study (n=493) was conducted using purposive sampling. Pregnant women (18+ years, 20–26 weeks gestation) were recruited into intervention (n=275) or control (n=218) groups across six health facilities. A 12-week "5As Model" counselling was implemented. Data collected by structured interviews included demographics, food frequency, and clinical assessments (blood pressure, lipids, minerals). Differences in knowledge, attitudes, practices (KAP), and hypertension prevalence were analysed using t-tests and difference indifferences logistic regression. Results: Mean ages: 30.16 ± 5.26 years (control) and 28.06 ± 4.96 years (intervention). KAP score difference-in-differences (DiD): +16.7 percentage points; 95% CI: 4.2 to 29.2; p = 0.009. Attitudes declined in both groups, with a DiD estimate of −9.2 percentage points (95% CI: −17.7 to −0.7; p = 0.033). Fruit/vegetable consumption remained low-to-moderate in the intervention group. Orange, banana, and watermelon intake increased from a baseline range of 3.5–6.2 to 23.5–41.6 at endline (p < 0.05). Carrot intake increased, while other vegetables remained low. Hypertension prevalence (control: 5.9% to 15.1%; intervention: 12.0% to 13.5%). Systolic/diastolic pressure increased by (2.5/1.7) mmHg (intervention) and (5.3/3.6) mmHg (control). Predicted BMI increased with blood pressure (BP) (DiD: 2.67; 95% CI: 0.13 to 0.83). SBP rose in both groups, but less in the intervention group (DiD: −4.5 mmHg; 95% CI: −8.35 to −0.65; p = 0.022). DBP was lower in the intervention group (DiD: −2.4 mmHg; 95% CI: −4.77 to −0.03; p = 0.047). Hypertension prevalence was lower in the intervention group (DiD: −7.7 percentage points; 95% CI: −14.6 to −0.8; p = 0.028). Predictors of SBP and DBP: LDL, total cholesterol, BMI, sodium, and potassium levels remained significant (p < 0.05). LDL was weak for DBP, but total cholesterol remained the strongest (β = 2.01, p < 0.05). Age was not a significant predictor (p = 0.214). Conclusion: The nutritional counselling intervention improved KAP scores, moderated blood pressure elevation and hypertension, and controlled serum sodium and cholesterol levels through recommended fruit and vegetable consumption. Its impact on long-term nutritional knowledge, attitudes, and practices warrants further exploration.