The proportion of pregnant women with MIHL was 7.90% (81/1025) in this study, which was higher than that in a previous study conducted in the Beibei district of Chongqing[2]. However, compared with developed areas such as Zhejiang province, MIHL was at low level, and also lower than foreign countries (19.7%-54.4%)[4, 6]. There was no significant difference in the proportion of pregnant women with MIHL in the subscales, but the level of essential knowledge was higher than those with a healthy lifestyle and behavior and basic skills in pregnant women. Instead, a study in Xian City showed that the level of healthy lifestyles and behaviors was lower than other subscales in pregnant women[21], which may be related to the different participants and questionnaires. These findings revealed that mothers have a better grasp of essential knowledge but lack the application of this knowledge[22], healthcare providers should teach women how to translate knowledge into healthy behaviors and skills.
In addition, earlier studies demonstrated that with the progression of gestational weeks, the level of MIHL in pregnant women improved [23]; however, in this study, the level of MIHL was the highest (9.94%) in the first trimester and the lowest (5.19%) in the second trimester. Probably because the second trimester was the longest period in the pregnancy process, and most women (85.91%) had normal prenatal results during pregnancy in this study, they may ignore the acquisition of maternal and infant health knowledge. This result indicates that medical staff could increase the frequency of health education for pregnant women in the second trimester to improve their level of MIHL.
This study found that the level of MIHL was positively associated with higher educational levels of participants, worries about the effect of pregnancy on work, and attendance at pregnancy school. First, the level of MIHL in women with high school education and above was 3.6 times that of those with junior high school and below, previous research also found that with the improvement in educational level, the level of MIHL in pregnant women increased [24–25]. Mothers with higher educational levels can access, understand, and use information to promote maternal and infant health. Therefore, medical staff should consider the low-educated population a critical health education group. Second, women who worries about the effect of pregnancy on work had a higher level of MIHL than women didn’t worry about the effect of pregnancy on work, probably because 69.81% of the women in this study still worked during pregnancy, the worries make them take healthy lifestyles and behaviors. Third, attending pregnancy school was a critical factor in the level of MIHL; the more frequent the attendance at pregnancy school, the higher the level of MIH which was consistent with previous researches[26]. Pregnancy school was the main platform for conducting health education for pregnant women. However, in our study, most women (67.58%) never attended pregnancy school, which was unfavorable for improving MIHL. A survey showed that 43.6% of pregnant women thought the teaching form was single and lacked practice in the pregnancy school[27]; as a result, mothers were not interested in the pregnancy schools’ courses. Future research could explore the combination of mobile Internet and nursing for improving participation rate of pregnancy school[28].
This study also found that participants from town groups, ethnic minorities, and abnormal results of prenatal screening were risk factors for MIHL.
First, women in town groups have lower levels of MIHL, consistent with previous research[29,30]. One may hypothesize that there are differences in education, economy, and medical resources between rural and urban areas. However, Jiguoping et al.[31] found that women living in rural areas had a higher level of MIHL than women living in urban areas in Anhui province, probably because of the prominent work on maternal and infant health. Therefore, future health education and interventions should focus on pregnant women living in rural areas. Second, Chongqing is a multiethnic city, the study included ethnic characteristics and found that mothers of Han ethnicity had a higher level of MIHL, possibly because ethnic minorities are mostly gathered in remote areas and may lack medical resources. However, a study in the Beibei District of Chongqing found no ethnic effects on the MIHL[2]. Ethnic minorities only accounted for 1.88–15.57% in the above studies, and future studies could expand the sample size of ethnic minorities, focus on the research of MIHL in this group of people, and comprehensively improve the level of MIHL in pregnant women. Third, abnormal results of prenatal screening were also a risk factor for MIHL, and abnormal results, such as gestational diabetes and hypertension, were related to unhealthy behaviors in pregnant women[32], which reflects the low level of MIHL to some extent.
Strengths and Limitations
This study is the first to investigate the level of maternal and child health literacy and influencing factors in pregnant women in Chongqing, China, and the results reflect the position in Chongqing. However, this study had several limitations. First, the proportion of pregnant women with MIHL was not only associated with sociodemographic characteristics but also with mental health status, social support, and others, which should be addressed in future studies. Second, owing to its cross-sectional design, it is difficult to find causal relationships.