Inadequate health literacy leads to adverse maternal, neonatal outcomes

Poor health literacy in nulliparous women who are engaged in early prenatal care often leads to adverse maternal and neonatal outcomes, according to a study, adding that this must be considered a social determinant of perinatal health.

A total of 9,341 women completed the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF), of whom 1,638 (17.5 percent) were found to have inadequate health literacy. Multiple sociodemographic characteristics differed between women with inadequate and those with adequate health literacy.

Inadequate health literacy correlated with an increased risk of caesarean delivery and major perineal laceration after accounting for potential confounders including educational attainment. Moreover, neonates of women with poor health literacy had a higher frequency of preterm birth <34 weeks, admission to newborn intensive care unit, 5-minute Apgar score <4, low and very low birthweight, small for gestational age status, and macrosomia.

Multivariable analyses controlling for potential confounders revealed a consistently higher odds of 5-minute Apgar score <4, low birthweight and small for gestational age status for women with inadequate health literacy.

This was a secondary analysis of a large, multicentre prospective cohort study, which included 10,038 nulliparous women receiving obstetrical care at eight centres in the US. Participants underwent three antenatal study visits and had detailed maternal and neonatal data abstracted.

Health literacy was evaluated between 16 and 21 weeks using the REALM-SF, a validated 7-item word recognition test. Results were then dichotomized as “inadequate” (ie, less than a high school level of health literacy) and “adequate” (ie, high school or greater level).

Multivariable logistic regression was carried out to examine the association of inadequate health literacy with maternal and neonatal outcomes.

“Health literacy is an important social determinant of health and may function independently of formal educational attainment,” the authors noted.