Peer-reviewed article
Maternal health literacy as a potential determinant of infant and early childhood health: a systematic review.
Li Z, Li J, Yao W, Ma L ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined how maternal health literacy—the ability of mothers to understand and act on health information—affects infant and early childhood health up to age three. The review found that mothers with higher health literacy had better outcomes for their babies, particularly in areas that depend on mothers recognizing symptoms and seeking care, such as reducing jaundice readmission and diaper rash. The evidence suggests maternal health literacy works mainly through behavioral pathways where mothers make health decisions for their children, and may help prevent nutritional deficiencies and developmental delays.
Key points
- Eight studies from seven countries involving 13,407 participants were included in the review
- Higher maternal health literacy was consistently associated with favorable birth weight
- Outcomes requiring maternal behavioral competencies showed stronger associations than medically-determined conditions
- Inadequate maternal health literacy was associated with over four-fold increased risk of nutritional deficiencies and developmental delays in vulnerable populations
- The certainty of evidence was rated as Low to Very Low due to cross-sectional study designs and imprecision
Limitations
The review could not establish causality because most studies were cross-sectional rather than experimental. The low certainty of evidence means we cannot be confident about the strength of associations between maternal health literacy and child health outcomes.
Abstract
Background Maternal health literacy (MHL) represents a potentially modifiable public health determinant concentrated among socioeconomically disadvantaged populations. While 15-45% of pregnant women demonstrate inadequate health literacy, its impact across the full spectrum of infant and early childhood outcomes remains inadequately characterized, limiting understanding of its broader public health significance. Objective To systematically synthesize evidence on associations between MHL and infant/child health outcomes from birth through age three, and to examine whether MHL functions as a systemic determinant across outcome domains. Methods Following PRISMA guidelines, we searched MEDLINE, Embase, and Web of Science from inception through March 2025. Studies examining associations between validated MHL measures and any child health outcomes up to age three were included. Methodological quality was assessed using JBI checklists, and the certainty of evidence using the GRADE framework. Narrative synthesis was conducted. Results Eight studies (n = 13,407 participants) from seven countries met inclusion criteria. Higher MHL was consistently associated with favorable birth weight. A pattern consistent with a behavioral pathway hypothesis emerged: outcomes requiring maternal behavioral competencies (e.g., symptom recognition, care-seeking) showed stronger and more consistent associations (e.g., reduced neonatal jaundice readmission, diaper dermatitis) than medically-determined conditions. Limited evidence also suggested MHL effects beyond the perinatal period, with inadequate MHL associated with increased risks of nutritional deficiencies and developmental delays (over four-fold increased risk in vulnerable populations). JBI assessment indicated generally adequate quality, while GRADE rated the certainty of evidence as Low to Very Low due to cross-sectional designs and imprecision. Conclusion MHL shows promising systematic associations with infant outcomes across multiple domains spanning the early life course, operating primarily through behavioral pathways requiring maternal agency. This pattern supports conceptualizing MHL as a potential foundational public health determinant and equity-relevant intervention target. However, low certainty of evidence underscores the need for standardized measurement, longitudinal studies, and intervention trials to establish causality.