Healthy mom, healthy baby.
The concept sounds simple enough, but a recent Northwestern Medicine study found the level of health literacy—how someone obtains, uses and understands health information—among pregnant people isn't where it needs to be, and it's having a negative impact on babies in utero and after birth, especially among people of color.
Of the 9,341 participants who completed the study's survey, 1,638 participants (17.5%) had scores indicative of inadequate health literacy. This included, for example, having trouble understanding their prescriptions or doctor's instructions; lacking the ability to interpret nutrition labels to make healthy decisions about their diet; having difficulty determining if a website was providing reputable health information; or having a hard time participating in counseling about medical decisions.
This lack of understanding about how to best care for one's nutrition, weight and overall health while pregnant appears to have a negative trickle-down effect on the mother and baby, the study found.
Study participants who had inadequate health literacy had greater odds of having their baby via cesarean section (c-section), having major vaginal tears, and their babies had a greater chance of being born at a low birth weight and receiving low Apgar scores immediately after delivery.
"We think our research sheds light on the important role of health literacy as a social determinant of health, but that much more research needs to be done to understand the underlying mechanism and ways we can improve health literacy," said lead study author Dr. Lynn Yee, assistant professor of maternal-fetal medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician.
Inadequate health literacy could include:
- Having trouble understanding prescriptions or doctor's instructions
- Lacking the ability to interpret nutrition labels to make healthy decisions about diet
- Having difficulty determining if a website is providing reputable health information
- Having a hard time participating in counseling about medical decisions
'Racial disparities in maternal medicine are profound'
Of the study participants with inadequate health literacy, 30.9% reported being non-Hispanic Black and 31.5% reported being Hispanic. In other areas of medicine, inadequate health literacy also has been more common among people with lower education and lower income, as well as people of color. Health literacy is thought to be another social determinant—like where one lives or what resources one has—that may be disproportionately challenging for people with fewer resources.
"Racial disparities in maternal medicine are profound, and it is possible that differences in health literacy may be one of many drivers of such disparities," Yee said. "We think addressing health literacy among reproductive-age and pregnant people may be one avenue to improve health for all, but especially individuals who have been most affected by the health sequelae of racism."
Pregnancy is understudied, leading to more questions than answers
Health literacy has been well-studied in adult populations such as geriatric populations and parents of young children, but pregnancy is a relatively understudied area. One reason for this is that pregnant individuals are largely young and healthy, and so the complex role of social determinants in pregnancy health is only beginning to be understood, Yee said.
"Although we were not surprised at how common inadequate health literacy was—since it is known to be common among Americans in general—I was somewhat surprised by the associations with negative neonatal outcomes," Yee said.
Yee said she'd like to better understand the health of individuals with diabetes during pregnancy. Diabetes during pregnancy requires complex behavior changes and adopting a new diet, new medications, and frequent involvement with the medical system, which all require health literacy skills.
"I was somewhat surprised that in our study, health literacy was not associated with gestational diabetes, but instead was associated with outcomes related to delivery and the baby," Yee said.
Where do we go from here?
One important strategy to improve health—not just at this critical time period but for life—would be to enhance health literacy throughout the life course, starting with young people and then readdressing it during important life events such as pregnancy, Yee said.
"An important public health and educational goal would be to improve the health literacy of adolescents and young people before they ever get pregnant," Yee said. "Pregnancy is still an important window of opportunity to improve health for the mother and her offspring, but our goal should be to help people be as healthy as possible before they ever achieve pregnancy."
More information: Lynn M. Yee et al, Association of Health Literacy Among Nulliparous Individuals and Maternal and Neonatal Outcomes, JAMA Network Open (2021). DOI: 10.1001/jamanetworkopen.2021.22576
Journal information: JAMA Network Open
Provided by Northwestern University