(1144) Association between health literacy and cardiovascular health in early pregnancy

Inadequate health literacy (HL) has been associated with adverse pregnancy outcomes, yet it is not well understood to what extent HL is associated with early pregnancy cardiovascular health (CVH). We aimed to understand the association between inadequate HL and CVH in early pregnancy.


Study Design: In this secondary analysis of cross-sectional data from a large, multi-site cohort of nulliparous people enrolled in a prospective observational study conducted at 8 US medical centers, we included participants who completed an assessment of HL at 6 to 13 weeks of gestation. 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 (8
^th

grade level or lower) and adequate if score 7 or greater. The primary outcome was CVH at 6-13 weeks of gestation, quantified by a modified (i.e., non-fasting) version of 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 was performed to evaluate the association of inadequate HL with early pregnancy modified LE8 score.

Results: Of the 4,424 participants who completed the REALM-SF, 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 had higher early pregnancy LE8 scores [79.0 ± 13.3 vs. 73.0 ± 14.2, p< 0.001; mean difference 7.1 (95% CI 5.2-8.8)] compared to participants with inadequate HL. This association persisted after adjustment for age, insurance type, and family income (aβ 3.8, 95% CI 2.2-5.5). The overall association between adequate HL and better CVH was driven by the glucose, diet, physical activity, and sleep subcomponents of the LE8 (Table).

Conclusion: Adequate HL was associated with better CVH scores in early pregnancy. These findings highlight the importance of optimizing HL prior to pregnancy which might promote CVH in the peripartum period.