Health Literacy and Pregnancy Preparedness in Pregestational Diabetes

Abstract

The 19,000 women with pregestational diabetes who deliver infants each year in the United States are at increased risk of adverse outcomes, including spontaneous abortion, stillbirth, and congenital anomalies. The risk could be limited by preconceptional planning that ensures good glycemic control as well as folic acid supplementation. This pilot study was done to examine the association, if any, between low functional health literacy in women with pregestational diabetes and markers of adverse pregnancy outcomes. Seventy-four pregnant women with type 1 or type 2 pregestational diabetes were prospectively entered into the study. They completed the short form of the Test of Functional Health Literacy in Adults (TOFHLA) as well as a demographic and medical questionnaire. Sixteen of the 74 women (22%) had low functional health literacy based on a TOFHLA score of 30 or lower. Women with adequate health literacy came earlier for prenatal care. There was no intergroup difference in gestational age at the time of evaluation. The adequate-literacy women were more often white and had had diabetes for a longer time. Fewer women in the low-literacy group had a high school education, and these women also had lower socioeconomic status. Unplanned pregnancies were more frequent in the low-literacy group, and women were less likely to have discussed becoming pregnant with a physician. In addition, low-literacy women were less likely to have taken folic acid before pregnancy or in the first trimester. Low-literacy women were likelier to be hospitalized during pregnancy, chiefly because of inadequate glycemic control. There was no group difference in gestational age at delivery, but birth weights were significantly greater in the low-literacy group. These women also were likelier to have an infant weighing more than 4000 g. In women with pregestational diabetes, low functional health literacy is associated with several factors that could negatively affect birth outcomes.