Health literacy and cardiovascular health in early pregnancy and postpartum
Onyinye Ohamadike, Xiaoning Huang, Sadiya S. Khan, William A. Grobman, Philip Greenland, David M. Haas, Uma M. Reddy, George R. Saade, Lynn M. YeeAbstract
Introduction
Health literacy is a key social determinant of health. Adequate health literacy has been associated with better obstetric and general adult health outcomes. However, its relationship with cardiovascular health during and after pregnancy is not well known. We aimed to estimate associations between health literacy and cardiovascular health in early pregnancy and postpartum.
Methods
This is a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers‐to‐be (nuMoM2b) study and its prospective follow‐up phase, the nuMoM2b Heart Health Study. Participants who completed the Rapid Estimate of Adult Literacy in Medicine–Short Form (REALM‐SF) in the second trimester (16–21 weeks of gestation) and a 2–7 year postpartum study visit were included. Health literacy was classified as inadequate (REALM‐SF score <7) or adequate (≥7) using standard scoring procedures. The primary outcomes were cardiovascular health in early pregnancy and 2–7 years after the first birth, assessed using a modified Life's Essential 8 (LE8) score, which includes health behaviors (diet, physical activity, sleep health, and nicotine exposure) and health factors (body mass index, blood pressure, blood glucose, and lipid levels). Secondary outcomes included LE8 subcomponents. Multivariable linear regression models, which adjusted for maternal age, insurance type, and family income, were used to evaluate associations of health literacy with LE8 overall scores and its subcomponents.
Results
Among 4424 participants eligible for analysis, 3599 (81.4%) had adequate health literacy. Those with adequate health literacy were older, more likely to identify as non‐Hispanic White, and more likely to have higher income, higher education, and private insurance coverage. Participants with adequate health literacy had higher early pregnancy LE8 scores (79.9 ± 13.3 vs. 73.0 ± 14.2, p < 0.001), a relationship that persisted after adjustment (aβ 3.6, 95% confidence interval [CI], 1.8–5.4). This association was driven by body mass index, diet, physical activity, and sleep subcomponents. Similarly, LE8 scores 2–7 years after birth were higher among those with adequate health literacy (80.1 ± 13.8 vs. 72.9 ± 14.6, p < 0.001; aβ 3.2, 95%, CI, 0.8–5.6), primarily due to healthier measures of body mass index, diet, physical activity, nicotine exposure, and sleep.
Conclusion
Among nulliparous women, adequate health literacy scores in early pregnancy were associated with better cardiovascular health during pregnancy and several years after first birth.