(1145) Association between health literacy and cardiovascular health at 2-7 years after first birth

Objective: Inadequate health literacy (HL) is associated with worse cardiovascular health (CVH) in non-pregnant individuals and, among pregnant individuals, adverse pregnancy outcomes (APO). We aimed to study the association between HL in early pregnancy and CVH at 2-7 years after first birth.

Study Design: In this secondary analysis of longitudinal data from a large, multi-site cohort of nulliparous people enrolled in a prospective observational study at 8 US medical centers, we included participants who completed an assessment of HL. HL, assessed using the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF), was categorized as inadequate if the REALM-SF score was < 7 and adequate if score 7 or greater. The primary outcome was CVH, quantified by the American Heart Association’s Life’s Essential 8 (LE8) score, a validated marker of CVH in which lower scores indicate worse CVH. Multivariable linear regression models were performed to evaluate the association of inadequate HL in early pregnancy (6-13 weeks of gestation) with LE8 score at 2-7 years after first birth.

Results:

Of the 4,424 participants who completed the REALM-SF in early pregnancy and had 2-7 year follow-up data, 825 (18.6%) had REALM-SF scores representative of inadequate HL. People with adequate HL were older, less likely to identify as non-Hispanic Black or Hispanic, had higher incomes and education, and were less likely to have public insurance. Participants with adequate HL in early pregnancy had higher postpartum LE8 scores [80.5 ± 13.3 vs. 73.2 ± 13.8, p< 0.001; mean difference 7.3 (95% CI, 3.5-11.1)] compared to those with inadequate HL. When adjusted for age, insurance type, and family income, this relationship persisted (aβ 3.3, 95% CI 0.4-6.2). Findings were driven by higher scores for the body mass index, diet, physical activity, nicotine exposure, and sleep subcomponents of the LE8 (Table).


Conclusion: Adequate HL in early pregnancy is associated with better CVH scores at 2-7 years after first birth, suggesting interventions to optimize maternal HL should be evaluated as a strategy for long-term CVH promotion.