{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T17:47:31Z","timestamp":1793296051804,"version":"4.5.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n Maternal health literacy (MHL) represents a potentially modifiable public health determinant concentrated among socioeconomically disadvantaged populations. While 15\u201345% 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Eight studies (\n n<\/jats:italic>\n \u202f=\u202f13,407 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.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1743880","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T05:44:40Z","timestamp":1776231880000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Maternal health literacy as a potential determinant of infant and early childhood health: a systematic review"],"prefix":"10.3389","volume":"14","author":[{"given":"Zanmei","family":"Li","sequence":"first","affiliation":[{"name":"Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiao","family":"Li","sequence":"additional","affiliation":[{"name":"Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiwei","family":"Yao","sequence":"additional","affiliation":[{"name":"Beijing MYYA Health Management Co., Ltd.","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liangkun","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Peking Union Medical College Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"ref1","volume-title":"Health Promotion Glossary of Terms 2021","year":"2021"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"S258","DOI":"10.1097\/PHH.0000000000001324","article-title":"Updating health literacy for healthy people 2030: defining its importance for a new decade in public health","volume":"27","author":"Santana","year":"2021","journal-title":"J Public Health Manag Pract"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1186\/1471-2458-12-80","article-title":"Health literacy and public health: a systematic review and integration of definitions and models","volume":"12","author":"S\u00f8rensen","year":"2012","journal-title":"BMC Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1093\/heapro\/15.3.259","article-title":"Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century","volume":"15","author":"Nutbeam","year":"2000","journal-title":"Health Promot Int"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1146\/annurev-publhealth-090419-102529","article-title":"Understanding and responding to health literacy as a social determinant of health","volume":"42","author":"Nutbeam","year":"2021","journal-title":"Annu Rev Public Health"},{"key":"ref6","volume-title":"Health Literacy and patient Safety: help Patients Understand. Manual for Clinicians","author":"Weiss","year":"2007"},{"key":"ref7","first-page":"3","article-title":"Health literacy: the solid facts","volume":"15","author":"Apfel","year":"2013","journal-title":"Copenhagen"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.jclinepi.2018.05.010","article-title":"Health literacy in chronic disease management: a matter of interaction","volume":"102","author":"Van der Heide","year":"2018","journal-title":"J Clin Epidemiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e40778","DOI":"10.2196\/40778","article-title":"The relation between eHealth literacy and health-related behaviors: systematic review and meta-analysis","volume":"25","author":"Kim","year":"2023","journal-title":"J Med Internet Res"},{"key":"ref10","year":""},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1148","DOI":"10.1186\/s12913-022-08527-9","article-title":"Impact of low health literacy on patients' health outcomes: a multicenter cohort study","volume":"22","author":"Shahid","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.1080\/14767058.2019.1634685","article-title":"Health information needs, sources of information, and barriers to accessing health information among pregnant women: a systematic review of research","volume":"34","author":"Ghiasi","year":"2021","journal-title":"J Matern Fetal Neonatal Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"988","DOI":"10.22038\/jmrh.2016.7980","article-title":"Investigating the determinants of maternal empowerment during pregnancy: a strategy for prenatal healthcare promotion","volume":"5","author":"Borghei","year":"2017","journal-title":"J Midwifery Reprod Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.1007\/s10995-024-03945-z","article-title":"Maternal health literacy in pregnant women: a concept analysis","volume":"28","author":"Putri","year":"2024","journal-title":"Matern Child Health J"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"4533","DOI":"10.1111\/jonm.13830","article-title":"An integrative review on the maternal health literacy among maternal and child workers","volume":"30","author":"Chen","year":"2022","journal-title":"J Nurs Manag"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1007\/s00404-021-06038-2","article-title":"Breastfeeding behavior is not associated with health literacy: evidence from the German KUNO-kids birth cohort study","volume":"304","author":"Graus","year":"2021","journal-title":"Arch Gynecol Obstet"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1007\/s11606-020-06407-8","article-title":"What is the prevalence of low health literacy in European Union member states? 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delay in their children","volume":"18","author":"Hernandez-Mekonnen","year":"2016","journal-title":"J Immigr Minor Health"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"2580","DOI":"10.3390\/diagnostics14222580","article-title":"A prospective evaluation of health literacy levels of pregnant women in antenatal classes: impact on delivery outcomes in nulliparous and multiparous women","volume":"14","author":"Rahimli Ocakoglu","year":"2024","journal-title":"Diagnostics (Basel)"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s12884-022-05302-w","article-title":"Using the teach-back method to improve postpartum maternal-infant health among women with limited maternal health literacy: a randomized controlled study","volume":"23","author":"Cheng","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1080\/03630242.2021.1919282","article-title":"Factors affecting 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maternal health literacy scale","volume":"40","author":"Dai","year":"2015","journal-title":"J Cent South Univ (Med Sci)"},{"key":"ref42","first-page":"589","article-title":"Health literacy for Iranian adults (HELIA): Develoment and psychometric properties","volume":"13","author":"Montazeri","year":"2014","journal-title":"Payesh Health Monitor"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e09462","DOI":"10.1016\/j.heliyon.2022.e09462","article-title":"General health literacy scale for Thais and comparison between age groups","volume":"8","author":"Intarakamhang","year":"2022","journal-title":"Heliyon"},{"key":"ref44","author":"Webb","year":"2003"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1111\/j.1740-8709.2005.00016.x","article-title":"Maternal nutritional knowledge and child nutritional status in the Volta region of Ghana","volume":"1","author":"Appoh","year":"2005","journal-title":"Matern Child 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